What are the impacts of alcohol supply reduction measures on police-recorded adult domestic and family violence in the Northern Territory of Australia?

BACKGROUND: During 2017-18, the Northern Territory (NT) introduced a Banned Drinker Register (BDR) and Minimum Unit Price (MUP) NT-wide; Police Auxiliary Liquor Inspectors (PALIs) in three regional towns; and restrictions on daily purchases/opening hours (DPOH) in one regional town. The BDR is an individual-level alcohol ban; MUP is a pricing policy; and PALIs enforce bans on restricted areas at takeaway outlets. This study examines the impact of these policies on adult domestic and family violence (DFV). METHODS: We examined DFV assaults and breaches of violence orders from January 2014 - February 2020 using interrupted time series models for NT, Greater Darwin, Katherine, Tennant Creek, and Alice Springs. To account for increasing numbers of individuals on the BDR we tested two timepoints (Sept 2017, March 2018). FINDINGS: Following DPOH, assaults (78 %) and alcohol-involved assaults (92 %) decreased in Tennant Creek. After PALIs, assaults (79 %) in Tennant Creek, and breaches (39 %) and alcohol-involved breaches (58 %) in Katherine decreased. After MUP, assaults (11 %), alcohol-involved assaults (21 %) and alcohol-involved breaches (21%) decreased NT wide. After MUP/PALIs in Alice Springs, alcohol-involved assaults (33 %), breaches (42 %), and alcohol-involved breaches (57 %) decreased. BDR (Sept 2017) found increases in assaults (44 %) and alcohol-involved assaults (39 %) in Katherine and assaults (10%) and alcohol-involved assaults NT-wide (17 %). There were increases of 21 %-45 % in breaches NT-wide, in Darwin, Katherine, and Alice Springs. Following March 2018 found increases in assaults (33 %) and alcohol-involved assaults (48 %) in Katherine. There were increases - from 20 % to 56 % - in breaches in NT-wide, Katherine, and Alice Springs. CONCLUSION: PALIs and DPOH were associated with some reductions in DFV; the BDR was associated with some increases. The upward trend commences prior to the BDR, so it is also plausible that the BDR had no effect on DFV outcomes. Although MUP was associated with reductions in the NT-wide model, there were no changes in sites without cooccurring PALIs.

The Impact of Minimum Unit Price on Police-Recorded Alcohol-Related Assault Rates in the Northern Territory, Australia.

OBJECTIVE: From October 1, 2018, the Northern Territory (NT) of Australia introduced a minimum unit price (MUP) for alcohol of AU$1.30 per standard drink. The MUP was introduced to address the high alcohol consumption rates and harms within the NT. This study aimed to investigate the unique short-term impact of the MUP on alcohol-related assaults across the NT, for the NT overall and separately for four key regions (Darwin and Palmerston, Alice Springs, Katherine, and Tennant Creek); which allowed for the consideration of differences in concurrent alcohol interventions and population (e.g., Alice Springs had Police Auxiliary Liquor Inspectors (PALIs) introduced on October 1, 2018, whereas Darwin and Palmerston only had the MUP introduced in this period). PALIs effectively equate to a police officer being stationed in every off-premise liquor vendor. METHOD: Using data from January 2013 to September 2019, interrupted time series (ITS) analyses assessed the short-term impact of the MUP on the monthly rate of police-recorded alcohol-related assaults. RESULTS: A 14% reduction (B = -3.07 [-5.40, -0.74], p < .010) was found for alcohol-related assault offenses per 10,000 in Darwin/Palmerston. Significant reductions were also noted in Alice Springs and the NT overall, although PALIs are likely to have contributed to these reductions in addition to the MUP. CONCLUSIONS: This short-term impact warrants longer-term follow-up to determine whether the reductions in alcohol-related assaults following the introduction of MUP are maintained, and the extent to which assault rates are influenced by other alcohol-policy interventions in the NT.

YArnhem: Co-designing a model of social and emotional wellbeing stepped care for young people of the north east Arnhem region: A development study protocol.

INTRODUCTION: More Aboriginal and Torres Strait Islander young people experience high or very high levels of psychological distress compared to their non-Indigenous counterparts. This may be partly attributed to systemic barriers resulting in lower rates of help-seeking, sub-optimal identification of psychological challenges, and undertreatment. Reducing these barriers within health systems is an important factor in reducing the Social and Emotional Wellbeing (SEWB) health burden on young Aboriginal and Torres Strait Islander people. OBJECTIVES: In partnership with Miwatj Health Aboriginal Corporation (Miwatj), this project will co-design an integrated youth Social and Emotional Wellbeing (SEWB) and mental health stepped care model for remote Aboriginal communities in the north east Arnhem region of the Northern Territory. DESIGN: A collaborative research approach using co-design methods will underpin a community-centric stepped care allocation method, to which culturally appropriate SEWB and mental health interventions and treatments are assigned. These components of the project will inform a digital platform which will facilitate access to SEWB care for young people in north east Arnhem land. This concept was co-developed in a partnership between researchers and Miwatj and builds on Miwatj's previous work to map the stepped needs of young people. The co-design of the content and features of these outputs will be facilitated through community participation and overseen by community, health, and cultural governance structures. This will ensure the solutions developed by the project are culturally responsive, fit for purpose, and will enhance self-determination while reducing systemic barriers to care.

Drink and drug driving education in the Northern Territory: a qualitative study illustrating issues of access and inequity.

OBJECTIVE: In the Northern Territory, people who commit drink driving offences are required to undertake an approved course or treatment to be eligible for a driver's licence, however, course uptake is low. We investigated barriers to program uptake. METHODS: We conducted semi-structured interviews with 24 program attendees, course providers and government stakeholders. We used a framework analysis. RESULTS: Program coverage in remote areas was limited, leading to inequitable access. The course cost affected uptake and exacerbated existing financial hardship. There were mixed views among government stakeholders on the program. While some held a view that offenders should 'pay the price', some also saw the user-pays model and high program cost as a clear barrier to accessibility. CONCLUSIONS: The data from this study demonstrate how the current delivery model for drink and drug driving education increases inequities for those in regional and remote areas, and Aboriginal and Torres Strait Islander people. IMPLICATIONS FOR PUBLIC HEALTH: Moving away from the current user-pays model to a subsidised or free model may facilitate greater access. Online delivery may increase accessibility; however, consultation is required to ensure the program is delivered equitably with consideration of language, literacy, cultural factors and access to technology.

Learning from alcohol (policy) reforms in the Northern Territory (LEARNT): protocol for a mixed-methods study examining the impacts of the banned drinker register.

INTRODUCTION: The Banned Drinker Register (BDR) was reintroduced in the Northern Territory (NT) in September 2017. The BDR is a supply reduction measure and involves placing people who consume alcohol at harmful levels on a register prohibiting the purchase, possession and consumption of alcohol. The current study aims to evaluate the impacts of the reintroduction of the BDR, in the context of other major alcohol policy initiatives introduced across the NT such as Police Auxiliary Liquor Inspectors and a minimum unit price for alcohol of US$1.30 per standard drink. METHODS AND ANALYSES: The Learning from Alcohol (policy) Reforms in the Northern Territory project will use a mixed-methods approach and contain four major components: epidemiological analysis of trends over time (outcomes include health, justice and social welfare data); individual-level data linkage including those on the BDR (outcomes include health and justice data); qualitative interviews with key stakeholders in the NT (n≥50); and qualitative interviews among people who are, or were previously, on the BDR, as well as the families and communities connected to those on the BDR (n=150). The impacts of the BDR on epidemiological data will be examined using time series analysis. Linked data will use generalised mixed models to analyse the relationship between outcomes and exposures, utilising appropriate distributions. Qualitative data will be analysed using thematic analysis. ETHICS AND DISSEMINATION: Ethics approvals have been obtained from NT Department of Health and Menzies School of Health Research Human Research Ethics Committee (HREC), Central Australia HREC and Deakin University HREC. In addition to peer-reviewed publications, we will report our findings to key organisational, policy, government and community stakeholders via conferences, briefings and lay summaries.

A historical overview of legislated alcohol policy in the Northern Territory of Australia: 1979-2021.

BACKGROUND: The Northern Territory (NT) has the highest levels of alcohol consumption and harms in Australia. Since the creation of the NT Liquor Act 1978, which came into effect in 1979, numerous legislated alcohol policies have been introduced to attempt to address these harms. We present a narrative historical overview of alcohol policies implemented in the NT from 1979 to 2021. METHODS: Using scoping review methodology, databases were searched from 1979 to 2021. Of 506 articles screened, 34 met inclusion criteria. Reference lists of all included articles were searched, resulting in the inclusion of another 41 articles and reports, totalling 75 final documents. Policies were organised using Babor and colleagues (2010) established framework: 1. pricing/ taxation; 2. regulating physical availability; 3. modifying drinking environments; 4. drink-driving countermeasures; 5. restrictions on marketing; 6. education/persuasion; 7. treatment/early intervention. RESULTS: Two pricing/taxation policies have been implemented, Living With Alcohol (LWA) and Minimum Unit Price, both demonstrating evidence of positive effects on health and consumption outcomes. Eight policies approaches have focused on regulating physical availability, implemented at both individual and local area levels. Several of these policies have varied by location and been amended over time. There is some evidence demonstrating reduction in harms attributable to Liquor Supply Plans, localised restrictions, and General Restricted Areas, although these have been site specific. Of the three policies which targeted modifying the drinking environment; one was evaluated, finding a relocation of social harms, rather than a reduction. The literature outlines a range of controversies, particularly regarding policies in domain 2-3, including racial discrimination and a lack of policy stability. No policies relating to restricting marketing or education/persuasion programs were found. The only drink-driving legislated policy was considered to have contributed to the success of the LWA program. Three policies relating to treatment were described; two were not evaluated and evidence showed no ongoing benefits of Alcohol Mandatory Treatment. DISCUSSION: The NT has implemented a large number of alcohol policies, several of which have evidence of positive effects. However, these policies have often existed in a context of clear politicisation of alcohol policy, frequently with an implicit focus on Aboriginal people's consumption.

Industry views about the Banned Drinker Register in the Northern Territory: Early lessons from a qualitative evaluation.

INTRODUCTION AND AIMS: The Northern Territory Government has recently planned and implemented an extensive suite of alcohol harm minimisation policies, including the reintroduction of the Banned Drinker Register (BDR). It is an explicit alcohol supply reduction measure that places persons who consume alcohol at harmful levels onto a register, prohibiting the purchase of alcohol from take-away liquor outlets. This paper explores industry stakeholders' perspectives regarding the extent to which the BDR is meeting its objectives to improve community health and safety by reducing alcohol-related harms. DESIGN AND METHODS: Interviews and one focus group were conducted with 66 alcohol industry stakeholders from urban and remote locations. Focusing on outcomes both central (crime and safety) and peripheral (health and therapeutic support) to the stakeholders' interest, the authors used inductive thematic analysis to examine participants' perceptions about the effectiveness of the BDR. RESULTS: Analysis revealed mixed views about the effectiveness of the BDR. There is a tension between the objective to address public amenity and decrease crime, as expressed by the participants, compared to the health-focused approach to therapeutic services and referrals identified in other sources. DISCUSSION AND CONCLUSIONS: Drawing on these findings, alongside other relevant sources, the authors argue there is a need for a more effective communication strategy to the public and professional community to enhance the capacity of the BDR to meet its goals. The authors recognise the limitations of alcohol industry stakeholder views and identify the need for a comprehensive evaluation approach that includes multiple stakeholder perspectives.

How the EMERGE guideline on medication adherence can improve the quality of clinical trials.

Medication adherence in drug trials is suboptimal, affecting the quality of these studies and adding significant costs. Nonadherence in this setting can lead to null findings, unduly large sample sizes and the need for dose modification after a drug has been approved. Despite these drawbacks, adherence behaviours are not consistently measured, analysed or reported appropriately in trial settings. The ESPACOMP Medication Adherence Reporting Guideline (EMERGE) offers a solution by facilitating a sound protocol design that takes this crucial factor into account. This article summarises key evidence on traditional and newer measurements of adherence, discusses implementation in clinical trial settings and makes recommendations about the analysis and interpretation of adherence data. Given the potential benefits of this approach, the authors call on regulators and the pharmaceutical industry to endorse the EMERGE guideline.

Concepts and Instruments for Patient-Reported Outcome Assessment in Celiac Disease: Literature Review and Experts' Perspectives.

BACKGROUND: In diseases where there is a large subjective component, such as celiac disease (CD), patient reported-outcomes (PRO) endpoints are highly relevant. However, there is a gap in knowledge about which PRO endpoints and instruments should be used for clinical trials for treatment of celiac disease. OBJECTIVES: To identify patient-centered symptom, impact, and health-related quality of life (HRQoL) concepts in CD and relevant PRO instruments, and to gather expert input on concepts and instruments to inform selection of PRO endpoints for use in clinical trials of new CD treatments. METHODS: A targeted literature review was conducted to identify symptom, impact, and HRQoL concepts, including those captured in PROs further reviewed against U.S. Food and Drug Administration standards for development and validation as endpoints. US and European clinicians, payers, and a patient advocate (n = 21) were interviewed to assess the identified concepts' relative importance in measuring treatment benefit and to gauge the value of potential PROs as endpoints for market access/reimbursement. RESULTS: Thirty-four published studies were identified: 27 elucidated patient-centered concepts and 7 detailed the development or validation of PRO instruments. The Celiac Disease Symptom Diary and Celiac Disease Patient Reported Outcome instrument were deemed most appropriate for use as endpoints; however, each had limitations related to conceptual coverage, evidence for measurement properties, and feasibility for use in clinical trials. Experts reported gastrointestinal symptoms as most important to treat, with extra-intestinal symptoms burdensome from the patient perspective as well. Payers emphasized measuring both frequency and severity of symptoms and targeting patients nonresponsive to the gluten-free diet for treatment. CONCLUSIONS: With emerging treatment options for CD, further work is needed to operationalize PRO symptom endpoints that are meaningful to patients, valued by payers, and acceptable to regulators in demonstrating efficacy.

Governing for Health: Advancing Health and Equity through Policy and Advocacy.

In an age of wellness peddled to the predominantly white middle-class by the overwhelmingly white upper-class, Baum's book is a firm reminder of the systemic and structural issues which detrimentally impact an individual's health. As Gwyneth Paltrow charges approximately $8000 a ticket for entry to her 'In Goop Health summit' (Bryant, 2019), and lifestyle influencers brand their perfectly styled, plastic free, free range, organic, sustainable lifestyles as authentic and achievable (Chocano, 2019), Baum's distaste for the neoliberal naval gazing (and subsequent individual blaming) is a refreshing addition to the conversation.

Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV: Systematic Review and Meta-Analysis.

BACKGROUND: With advances in antiretroviral therapy, most deaths in people with HIV are now attributable to noncommunicable illnesses, especially cardiovascular disease. We determine the association between HIV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HIV. METHODS: We conducted a systematic review across 5 databases from inception to August 2016 for longitudinal studies of cardiovascular disease in HIV infection. A random-effects meta-analysis across 80 studies was used to derive the pooled rate and risk of cardiovascular disease in people living with HIV. We then estimated the temporal changes in the population-attributable fraction and disability-adjusted life-years (DALYs) from HIV-associated cardiovascular disease from 1990 to 2015 at a regional and global level. National cardiovascular DALYs associated with HIV for 2015 were derived for 154 of the 193 United Nations member states. The main outcome measure was the pooled estimate of the rate and risk of cardiovascular disease in people living with HIV and the national, regional, and global estimates of DALYs from cardiovascular disease associated with HIV. RESULTS: In 793 635 people living with HIV and a total follow-up of 3.5 million person-years, the crude rate of cardiovascular disease was 61.8 (95% CI, 45.8-83.4) per 10 000 person-years. In comparison with individuals without HIV, the risk ratio for cardiovascular disease was 2.16 (95% CI, 1.68-2.77). Over the past 26 years, the global population-attributable fraction from cardiovascular disease attributable to HIV increased from 0.36% (95% CI, 0.21%-0.56%) to 0.92% (95% CI, 0.55%-1.41%), and DALYs increased from 0.74 (95% CI, 0.44-1.16) to 2.57 (95% CI, 1.53-3.92) million. There was marked regional variation with most DALYs lost in sub-Saharan Africa (0.87 million, 95% CI, 0.43-1.70) and the Asia Pacific (0.39 million, 95% CI, 0.23-0.62) regions. The highest population-attributable fraction and burden were observed in Swaziland, Botswana, and Lesotho. CONCLUSIONS: People living with HIV are twice as likely to develop cardiovascular disease. The global burden of HIV-associated cardiovascular disease has tripled over the past 2 decades and is now responsible for 2.6 million DALYs per annum with the greatest impact in sub-Saharan Africa and the Asia Pacific regions. CLINICAL TRIAL REGISTRATION: URL: https://www.crd.york.ac.uk/prospero . Unique identifier: CRD42016048257.

Adult ADHD patient experiences of impairment, service provision and clinical management in England: a qualitative study.

BACKGROUND: There is limited evidence of the unmet needs and experiences of adults with Attention Deficit Hyperactivity Disorder (ADHD) in the published scientific literature. This study aimed to explore the experiences of adults in England with ADHD regarding access to diagnostic and treatment services, ADHD-related impairment and to compare experiences between patients diagnosed during adulthood and childhood. METHODS: In this qualitative study, 30 adults with ADHD were recruited through an ADHD charity (n = 17) and two hospital outpatient clinics for adults with ADHD in England (n = 13). Half of the participants were diagnosed with ADHD during childhood or adolescence and the remainder during adulthood. Semi-structured interviews were conducted and data was analysed using a thematic approach based on Grounded Theory principles. RESULTS: Analysis revealed five core themes: 'An uphill struggle': the challenge of accessing services, 'Accumulated Psychosocial Burden and the Impact of ADHD', 'Weighing up Costs vs. Benefits of ADHD Pharmacological Treatment', 'Value of Non-pharmacological Treatment' and 'Barriers to Treatment Adherence'. Accessing services and the challenges associated with securing a definitive diagnosis of ADHD in adulthood was an 'uphill struggle', often due to sceptical and negative attitudes towards ADHD by healthcare professionals. ADHD-related impairment had an overwhelmingly chaotic impact on every aspect of patients' lives and many felt ill equipped to cope. A persistent sense of failure and missed potential from living with the impact of ADHD impairment had led to an accumulated psychosocial burden, especially among those diagnosed from late adolescence onwards. In contrast, positive adjustment was facilitated by a younger age at diagnosis. Although medication was perceived as necessary in alleviating impairment, many felt strongly that by itself, it was inadequate. Additional support in the form of psychological therapies or psycho-education was strongly desired. However, few patients had access to non-pharmacological treatment. In some, medication use was often inadequately monitored with little or no follow-up by healthcare professionals, leading to poor adherence and a sense of abandonment from the healthcare system. CONCLUSION: The findings suggest that the unmet needs of adults with ADHD are substantial and that there is a wide gap between policy and current practice in England.

Suitability of measures of self-reported medication adherence for routine clinical use: a systematic review.

BACKGROUND: There is a recognised need to build primary care medication adherence services which are tailored to patients' needs. Continuous quality improvement of such services requires a regular working method of measuring adherence in order to monitor effectiveness. Self report has been considered the method of choice for clinical use; it is cheap, relatively unobtrusive and able to distinguish between intentional and unintentional non-adherence, which have different underlying causes and therefore require different interventions. A self report adherence measure used in routine clinical practice would ideally be brief, acceptable to patients, valid, reliable, have the ability to distinguish between different types of non-adherence and be able to be completed by or in conjunction with carers where necessary. METHODS: We systematically reviewed the literature in order to identify self report adherence measures currently available which are suitable for primary care and evaluate the extent to which they met the criteria described above. We searched the databases Medline, Embase, International Pharmaceutical Abstracts, Pharmline, CINAHL, PsycINFO and HaPI to identify studies reporting the development, validation or reliability of generic adherence measures. One reviewer screened all abstracts and assessed all relevant full text articles obtained and a second reviewer screened/assessed 10% to check reliability. RESULTS: Fifty eight measures were identified. While validation data were presented in support of the vast majority of self reported measures (54/58), data for a relatively small number of measures was presented for reliability (16/58) and time to complete (3/58). Few were designed to have the ability to be completed by or in conjunction with carers and few were able to distinguish between different types of non-adherence, which limited their ability be used effectively in the continuous improvement of targeted adherence enhancing interventions. The data available suggested that patients find it easier to estimate general adherence than to report a specific number of doses missed. Visual analogue scales can be easier for patients than other types of scale but are not suitable for telephone administration. CONCLUSIONS: There is a need for a measure which can be used in the routine continual quality monitoring of adherence services.

Exploring chronic myeloid leukemia patients' reasons for not adhering to the oral anticancer drug imatinib as prescribed.

Nonadherence has been shown to be frequent amongst chronic myeloid leukemia (CML) patients prescribed imatinib, which results in reduced clinical response and increased healthcare costs. However, little is known about the reasons why CML patients frequently do not take their imatinib as prescribed. The current study explored CML patients' experience of taking, or not taking, imatinib therapy through in-depth interviews with twenty-one patients. Their adherence had been previously measured using a medication events monitoring device. The interviews were recorded, transcribed and analysed in accordance with established techniques. Patients revealed a variety of reasons for their nonadherence. Major themes that emerged from the data were the intentional and unintentional reasons for nonadherence. Furthermore, as a result of information received from health care professionals, several patients felt inappropriately reassured that their nonadherence would not have a detrimental effect on their clinical response. Factors that seemed to favour adherence were finding ways to deal with side effects and using prompts as reminders to take the medicine. This study forms a basis on which to build future adherence research and may help to develop interventions designed to ensure that patients with CML and other cancers adhere optimally to their oral drugs treatment.

The cost effectiveness of a telephone-based pharmacy advisory service to improve adherence to newly prescribed medicines.

OBJECTIVE: This "proof of concept" study aimed to assess the cost effectiveness of pharmacists giving advice via telephone, to patients receiving a new medicine for a chronic condition, in England. METHODS: The self-regulatory model (SRM) theory was used to guide development of our intervention and used in training pharmacists to adopt a patient-centred approach. Non-adherence to new medicines for chronic conditions develops rapidly so we developed a study intervention in which a pharmacist telephoned patients two weeks after they had started a new medicine for a chronic condition. Patients were included if they were 75 or older, or were suffering from stroke, cardiovascular disease, asthma, diabetes or rheumatoid arthritis, and were randomized into treatment or control arms. Main outcome measures were non-adherence and cost to the UK NHS, obtained via a questionnaire sent two months after starting therapy. Cost of the intervention was also included. Incremental cost effectiveness ratios (ICERs) were generated. RESULTS: Five hundred patients were recruited. At 4-week follow-up, non-adherence was significantly lower in the intervention group (9% vs 16%, p=0.032). The number of patients reporting medicine-related problems was significantly lower in the intervention group compared to the control, (23% vs 34% p=0.021). Mean total patient costs at 2-month follow-up (median, range) were intervention: pound sterling 187.7 (40.6, 4.2-2484.3); control: pound sterling 282.8 (42, 0-3804) (p<0.0001). The intervention was dominant (less costly and more effective). If the decision maker is not willing to pay anything for one extra adherent patient, there is still a 90% probability that the intervention is cost effective. CONCLUSIONS: These findings suggest that pharmacists can meet patients' needs for information and advice on medicines, soon after starting treatment. While a larger trial is needed to confirm that the effect is real and sustained, these initial findings suggest the study intervention may be effective, at least in the short term, with a reduced overall cost to the health provider.

Patient-centred advice is effective in improving adherence to medicines.

OBJECTIVE: To assess the effects of pharmacists giving advice to meet patients' needs after starting a new medicine for a chronic condition. METHOD: A prospective health technology assessment including a randomised controlled trial of a pharmacist-delivered intervention to improve adherence using a centralised telephone service to patients at home in England. Patients were eligible for recruitment if they were receiving the first prescription for a newly prescribed medication for a chronic condition and were 75 or older or suffering from stroke, cardiovascular disease, asthma, diabetes or rheumatoid arthritis. MAIN OUTCOME MEASURES: Incidence of non-adherence, problems with the new medicine, beliefs about the new medicine, safety and usefulness of the interventions. RESULTS: Five hundred patients consented and were randomised. At 4-week follow-up, non-adherence was significantly lower in the intervention group compared to control (9% vs. 16%, P = 0.032). The number of patients reporting medicine-related problems was significantly lower in the intervention group compared to the control (23% vs. 34%, P = 0.021). Intervention group patients also had more positive beliefs about their new medicine, as shown by their higher score on the "necessity-concerns differential" (5.0 vs. 3.5, P = 0.007). The phone calls took a median of 12 min each. Most advice was judged by experts to be safe and helpful, and patients found it useful. CONCLUSION: Overall, these findings show benefits from pharmacists meeting patients' needs for information and advice on medicines, soon after starting treatment. While a substantially larger trial would be needed to confirm that the effect is real and sustained, these initial findings suggest the service may be safe and useful to patients.