Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications

A non-randomised pilot study of the Solutions for Medication Adherence Problems (S-MAP) intervention in community pharmacies to support older adults adhere to multiple medications

“…The feasibility of collecting data for a range of outcome measures including medication adherence, HRQOL and unplanned hospital admissions was also explored. This research will advance the existing literature by helping to address evidence gaps identified in the recent Cochrane review of adherence interventions delivered to older people prescribed multiple medicines that noted a lack of tailored interventions in this area [1].…”

“…4 Participant flow diagram for the S-MAP study. 1 One patient was ineligible for two reasons: prescribed medications for dementia and adherent based on PMR data/discussions; 2 Reasons included non-completion of the baseline questionnaire, non-completion of 6-month followup questionnaire, unable to collect dispensing data due to COVID-19 pandemic and/or dispensing data not suitable for analysis due to instalment (weekly) dispensing identified during this session for all but one patient (who chose to withdraw from the study following the first session). A median of two adherence barriers was identified per patient (IQR, 2-4).…”

“…Medication adherence, defined as taking medications in accordance with the prescribers' directions, can be problematic, particularly in older patients (≥ 65 years) prescribed multiple medicines to treat a range of long-term conditions [1]. A recent study in Ireland found that 31% of older people living with multimorbidity (≥ 2 chronic conditions) were non-adherent, with non-adherence rates varying across conditions and treatments [2].…”

“…Polypharmacy, commonly defined as the prescribing of four or more medications, is associated with low adherence [3]. Medication non-adherence has a negative impact on both individual patients and the wider healthcare system as it can result in inadequate disease control, decreased quality of life, increased morbidity, hospitalisations and increased healthcare costs [1,4]. For example, a 2012 report from the Institute for Healthcare Informatics estimated that total costs from non-adherence amounted to approximately US$270 billion per year globally [5].…”

“…To date, a plethora of interventions have been developed to address the challenge of medication non-adherence in adults, but these have shown only limited effectiveness in improving adherence and clinical outcomes [6]. A recent Cochrane review of adherence interventions, designed to target older patients prescribed multiple medications, found a lack of high-quality evidence on intervention effectiveness and interventions were not commonly tailored to individual patient-reported barriers to adherence [1]. It has been proposed that psychological theories may guide the development of more effective complex adherence interventions by targeting causal determinants of behaviour [7].…”