Delivery of patient adherence support: a systematic review of the role of pharmacists and doctors

Abstract

We conducted a systematic review of adherence support programs involving doctors and pharmacists. We searched MEDLINE ® , Embase, International Pharmaceutical Abstracts, PsycINFO ® , and CINAHL using the keywords "pharmacist" or "doctor" and "adhere*" or " compli*" and "randomized controlled trials". We found 89 studies involving pharmacists; in contrast, only 14 studies involved doctors. The roles of pharmacists and doctors ranged from providing education and counseling to adjusting treatment. Most interventions that specified a patient group were carried out with patients with chronic conditions (n=79) and only six included short-term treatments. The majority of interventions improved adherence and clinical outcomes to some extent, although the size of effect size was sometimes small. Resource utilization (eg, hospitalization rates, visits to doctors) did not change in the majority of studies that reported it. Few studies included cost analyses. All but one study had high risk of performance bias due to the nature of the interventions, which made it impossible to blind the participants. The majority of studies did not report tailoring the interventions to patient needs and the vast majority of papers did not report taking a concordant patient-centered approach or considering patients' own views and experiences when providing adherence support. In addition, the majority of studies did not describe training for the health care professionals involved in providing adherence support. Providing training for doctors and pharmacists to take a more patient-centered concordant approach would be expected to increase the effectiveness of adherence support further.

Effects of Telephone Counseling Intervention by Pharmacists (TelCIP) on Medication Adherence; Results of a Cluster Randomized Trial

“…The intervention was based on theoretical models and guidelines and the interview protocol contained pre-defined questions and relevant knowledge items. Moreover the protocol stimulated pharmacists to ask about patient opinions, for example by asking “What do you think of getting this medicine?” and to tailor counseling to patients' needs which is important to improve adherence (Andersson et al, 2014). Our study also has its limitations.…”

Barriers and enablers to medication adherence in glaucoma: A systematic review of modifiable factors using the Theoretical Domains Framework

“…Educational meetings can change professional practice, 141 and while they have been effective in supporting practitioners manage nonadherence issues in asthma, training for HCPs involved in medication adherence is generally lacking. 142 Arranging educational events at national/international conferences or local study days focussing on best adherence practice, practitioner communication skills and updating and refreshing glaucoma knowledge will provide HCPs with the tools to address adherence better in practice. Practitioners are also encouraged to follow professional body guidelines and recommendations to aid in prescribing and management decisions.…”

Factors influencing effective communication when prescribing

“…37 This has substantive implications for the patient's health outcomes. Thorough reviews from Haynes et al 38 and from Andersson et al 39 have identified improved doctorpatient communication as critical to improved adherence to drug regimes, with consequent benefits in health outcomes.…”

“…A number of interventions shaped by behavioural insights have been shown to be effective. These include shorterterm regimens; fewer doses per day; easy-to-use packaging; reminders; tailoring; patient education; and patient satisfaction measurement (see reviews from Haynes et al 38 and Andersson et al 39 ). One idea to ensure individuals finish their regime is to make the final few pills in different colours to the rest and to state that these needed to be taken last (Kesselheim et al 124 ).…”