Medication adherence through community pharmacy intervention

Community pharmacist-led interventions have been shown to improve adherence and health outcomes for patients with chronic diseases but a number of barriers remain.

Researchers from New Zealand conducted a systematic review across medical and pharmaceutical journals to examine the role of community pharmacist-led intervention in achieving adherence and improved health outcomes among patients using chronic disease medication.¹

Medication adherence may be influenced by disease-related factors, medications, the healthcare system, patient understanding of their condition, and socio-economic factors.² It has been estimated that adherence to chronic disease medications is as low as 50% among the general population in developed countries.²

The 22 studies included in the review showed that community pharmacist-led interventions increased patient medication adherence and contributed to better blood pressure control, cholesterol management, chronic obstructive pulmonary disease (COPD) and asthma control.¹

However, with mixed results for statistically significant effects of interventions on glycated haemoglobin (HbA1c) and blood glucose levels, the study was unable to conclude positive results with intervention in people with diabetes. ^8,12,8,13 None of the depressive symptom control studies yielded improved results compared to the control groups. ^7,14,7,15

In assisting patients with making behavioural modifications to improve medication adherence, multifaceted, targeted and personalised interventions proved most effective. Most of the interventions in the studies reviewed involved a component of patient education on their medications, medical conditions and demonstration of effective device technique. Improved inhaler technique and appropriate use of rescue medication was observed in those with COPD and asthma as well as reduced night-time awakenings.³

Pharmacist-led interventions can positively influence patients’ knowledge and satisfaction. Patient knowledge about their medications or illnesses was significantly increased in three of the six studies explored. Six of the studies reported on patient satisfaction of either pharmacist intervention or pharmacy services. Superior patient satisfaction was reported in the intervention groups in four studies, when compared to control group.^4-9

Pharmacists’ accessibility, regular contact with the patients and the timing of the intervention have a role in the impact of pharmacist-led interventions on adherence. In particular, patients starting a new medication, such as statins¹⁰ or hypertensive therapy,¹¹ may be most likely to benefit from the pharmaceutical care interventions during the initial months, as adherence levels usually decline several months after beginning treatment.

One of the studies in the review saw the potential for economic benefits in the intervention group with diabetes, with a positive return on investment of $US5.74 for every dollar spent on the intervention.¹² This group also saw a significant reduction in emergency hospital visits,¹² annual hospitalisation rates and number of hospitalisation days.¹³

The authors said that while interventions with face-to-face and educational components are effective, easy to implement and relatively low-cost, there can be barriers to implementation, notably the time-intensive nature of the intervention.

Pharmacists ‘performing high-intensity interventions spent approximately 100 minutes per patient compared to less than 15 minutes per patient for low-intensity patients.¹⁶

Educational interventions require pharmacists to be adequately trained, motivated and remunerated in order to provide the best care within the community setting.¹

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References
1. Milosavljevic A, Aspden T, Harrison J. Community pharmacist‐led interventions and their impact on patients’ medication adherence and other health outcomes: a systematic review. Int J Pharm Pract.

2. Sabate E. Adherence to Long-term Therapies: Evidence for Action. Geneva: World Health Organization, 2003.

3. Ottenbros S, et al. Pharmacist-led intervention study to improve drug therapy in asthma and COPD patients. Int J Clin Pharm 2014;36:336–344.

4. Blenkinsopp A, et al. Extended adherence support by community pharmacists for patients with hypertension: a randomised controlled trial. Int JPharm Pract 2000;8:165–175.

5. Brook O, et al. Impact of coaching by community pharmacists on drug attitude of depressive primary care patients and acceptability to patients: a randomized controlled trial. D Eur Neuropsychopharmacol 2003;13:1–9.

6. Svarstad BL, et al. Improving refilladherence and hypertension control in black patients: Wisconsin TEAM trial. J Am Pharm Assoc 2013;53:520–529.

7. Rubio-Valera M, et al. Evaluation of a pharmacist intervention on patients initiating pharmacological treatment for depression: a randomized controlled superiority trial. Eur Neuropsychopharmacol 2013;23:1057–1066.

8. Jahangard-Rafsanjani Z, et al. Effect of a community pharmacist-delivered diabetes support program for patients receiving specialty medical care: a randomized controlled trial. Diabetes Educ 2015;41:127–135.

9. Sturgess IK, et al. Community pharmacy based provision of pharmaceutical care to older patients. PharmWorld Sci 2003;25:218-26.

10. Eussen SR, et al. A pharmaceutical care program to improve adherence to statin therapy: a randomized controlled trial. Ann Pharmacother 2010;44:1905–13.

11. Vrijens B, et al. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ 2008;336:1114–7.

12. Spence MM, et al. Evaluation of an outpatient pharmacy clinical services program on adherence and clinical outcomes among patients with diabetes and/or coronary artery disease. J Manag Care Spec Pharm 2014;20:1036–45.

13. Mehuys E, et al. Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial. J Clin Pharm Ther 2011;36:602–13.

14. Rickles NM, et al. Pharmacist tele-monitoring of antidepressant use:effects on pharmacist-patient collaboration. J Am Pharm Assoc (2003)2005;45:344–53.

15. Bosmans JE, et al. Cost effectiveness of a pharmacy-based coaching programme to improve adherence to antidepressants. Pharmacoeconomics 2007;25:25–37.

16. Chabot I, et al. Pharmacist intervention program for control of hypertension. Ann Pharmacother 2003;37:1186–93.