Comparative Effectiveness Research: Evaluating Pharmacist Interventions and Strategies to Improve Medication Adherence

Carter, Barry L.; Mil, J. W. Foppe van

doi:10.1038/ajh.2010.136

Cited by 37 publications

(18 citation statements)

References 54 publications

(80 reference statements)

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“…According to some reports, younger patients show better adherence to pharmacological treatment,5,35 while others state that young age is a determinant of poorer adherence to hypotensive medication 36,37. Some researchers have also found better adherence among elderly patients 25,38–40. Nonadherence in younger patients may be due to the lack of persistent symptoms at early stages of the illness or to concerns about medication side effects.…”

Section: Discussionmentioning

confidence: 99%

Selected factors affecting adherence in the pharmacological treatment of arterial hypertension

Jankowska‐Polańska¹,

Chudiak²,

Uchmanowicz³

et al. 2017

PPA

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BackgroundLow adherence to hypertension (HT) management is one of the major contributors to poor blood pressure (BP) control. Approximately 40%–60% of patients with HT do not follow the prescribed treatment. The aim of the study was to analyze the relationship between selected variables and adherence to hypotensive pharmacological treatment. Besides socioclinical variables, the study focused on the role of illness acceptance.Participants and methodsThe study included 602 patients with HT. Adherence and acceptance of illness were assessed using the following validated instruments: the Acceptance of Illness Scale (AIS) and the Morisky Medication Adherence Scale (MMAS).ResultsThe high-adherence group comprised a significantly higher percentage of patients with high illness acceptance scale scores than that of patients with low-to-moderate scores (42.4 vs 31.8%; P=0.008<0.01). The odds ratio (OR) showed that high adherence to pharmacological treatment was >1.5 times as likely to occur in the high acceptance group as in the low-to-moderate acceptance group (OR =1.58, 95% CI 1.14–2.19). Spearman’s rank correlation coefficients showed statistically significant correlations between adherence and sex (men ρ=−0.101; P=0.012), age >45–66 years (ρ=0.098; P=0.015), higher education level (ρ=0.132; P=0.001), grade ESC of HT (ρ=−0.037; P=0.057), receiving one-tablet polytherapy (ρ=0.131; P=0.015), and illness acceptance (ρ=0.090; P=0.024).ConclusionAcceptance of illness is correlated with adherence to pharmacological treatment, and consideration should be given to more widespread assessment of illness acceptance in daily practice. Male sex, age >45–66 years, duration of illness grade ESC of HT, and receiving one-tablet polytherapy are significant determinants of adherence to pharmacological treatment in HT.

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Section: Discussionmentioning

confidence: 99%

Selected factors affecting adherence in the pharmacological treatment of arterial hypertension

Jankowska‐Polańska¹,

Chudiak²,

Uchmanowicz³

et al. 2017

PPA

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“…There is a discussion in the research available on the relation between age and medication adherence. Some studies have shown that younger patients display higher adherence,16,19,20 while others indicate that young age is a determinant of poor adherence to hypotensive medication 21,22. Several authors report higher adherence in elderly patients,17,23–25 which can be explained by the presence of comorbidities, making the patients perceive themselves as very ill and take the prescribed treatment seriously 22…”

Section: Introductionmentioning

confidence: 99%

The influence of frailty syndrome on medication adherence among elderly patients with hypertension

Jankowska‐Polańska¹,

Dudek²,

Szymańska–Chabowska³

et al. 2016

CIA

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BackgroundHypertension affects about 80% of people older than 80 years; however, diagnosis and treatment are difficult because about 55% of them do not adhere to treatment recommendations due to low socioeconomic status, comorbidities, age, physical limitations, and frailty syndrome.AimsThe purposes of this study were to evaluate the influence of frailty on medication adherence among elderly hypertensive patients and to assess whether other factors influence adherence in this group of patients.Methods and resultsThe study included 296 patients (mean age 68.8±8.0) divided into frail (n=198) and non-frail (n=98) groups. The Polish versions of the Tilburg Frailty Indicator (TFI) for frailty assessment and 8-item Morisky Medication Adherence Scale for adherence assessment were used. The frail patients had lower medication adherence in comparison to the non-frail subjects (6.60±1.89 vs 7.11±1.42; P=0.028). Spearman’s rank correlation coefficients showed that significant determinants with negative influence on the level of adherence were physical (rho =−0.117), psychological (rho =−0.183), and social domain (rho =−0.163) of TFI as well as the total score of the questionnaire (rho =−0.183). However, multiple regression analysis revealed that only knowledge about complications of untreated hypertension (β=0.395) and satisfaction with the home environment (β=0.897) were found to be independent stimulants of adherence level.ConclusionFrailty is highly prevalent among elderly hypertensive patients. Higher level of frailty among elderly patients can be considered as a determinant of lower adherence. However, social support and knowledge about complications of untreated hypertension are the most important independent determinants of adherence to pharmacological treatment.

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“…10–19 Despite these successes, many pharmacy studies have been criticized for involving only a few providers, few minority and low-income patients, poor statistical controls, unblinded blood pressure measurements, high patient drop out, and labor-intensive interventions that are complex, lack sustained effects, and are difficult to implement beyond teaching clinics and closed health systems. 20–22 Studies examining sustainability generally show deterioration in medication adherence 12,15,19,21 and blood pressure control 12,13,23 following intervention discontinuation. One clinic-based study 24 found sustained blood pressure control following intervention discontinuation; however, that intervention involved predominately white patients, and 57% of intervention participants (110 of 192) dropped out or declined to participate in the postintervention study.…”

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confidence: 99%

Improving refill adherence and hypertension control in black patients: Wisconsin TEAM trial

Svarstad

Kotchen

Shireman

et al. 2013

Journal of the American Pharmacists Association

110

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Objective To assess the effectiveness and sustainability of a 6-month Team Education and Adherence Monitoring (TEAM) intervention for black patients with hypertension in community chain pharmacies. Design Cluster randomized trial. Setting 28 chain pharmacies (14 TEAM and 14 control) in five Wisconsin cities from December 2006 to February 2009. Participants 576 black patients with hypertension. Intervention Trained pharmacist–technician teams implemented a 6-month intervention using scheduled visits, Brief Medication Questionnaires (BMQs), and novel toolkits for facilitating medication adherence and pharmacist feedback to patients and physicians. Control participants received patient information only. Main outcome measures Refill adherence (≥80% days covered) and changes in systolic blood pressure (SBP), diastolic blood pressure, and blood pressure control using blinded assessments at 6 and 12 months. Results At baseline, all patients had blood pressure of 140/90 mm Hg or more. Of those eligible, 79% activated the intervention (mean 4.25 visits). Compared with control participants at 6 months, TEAM participants achieved greater improvements in refill adherence (60% vs. 34%, P < 0.001), SBP (−12.62 vs. −5.31 mm Hg, P < 0.001), and blood pressure control (50% vs. 36%, P = 0.01). Six months after intervention discontinuation, TEAM participants showed sustained improvements in refill adherence (P < 0.001) and SBP (P = 0.004), though the difference in blood pressure control was not significant (P < 0.05) compared with control participants. Analysis of intervention fidelity showed that patients who received the full intervention during months 1 through 6 achieved significantly greater 6- and 12-month improvements in refill adherence and blood pressure control compared with control participants. Conclusion A team-based intervention involving community chain pharmacists, pharmacy technicians, and novel toolkits led to significant and sustained improvements in refill adherence and SBP in black patients with hypertension.

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Comparative Effectiveness Research: Evaluating Pharmacist Interventions and Strategies to Improve Medication Adherence

Cited by 37 publications

References 54 publications

Selected factors affecting adherence in the pharmacological treatment of arterial hypertension

Selected factors affecting adherence in the pharmacological treatment of arterial hypertension

The influence of frailty syndrome on medication adherence among elderly patients with hypertension

Improving refill adherence and hypertension control in black patients: Wisconsin TEAM trial

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