Tailored interventions by community pharmacists and general practitioners improve adherence to statins in a Spanish randomized controlled trial

Abstract

Objective To evaluate the impact of health professionals’ intervention on adherence to statins, the influence on total cholesterol levels, and lifestyle patterns in patients with hypercholesterolemia and analyze the differences according to the center of recruitment. Study Setting Forty‐six community pharmacies and 50 primary care centers of Spain. Study Design Randomized controlled trial design (n = 746). Patients were assigned into adherent (ADH) or nonadherent group depending on their initial adherence to statins. Nonadherent patients were randomly assigned to intervention (INT) or nonintervention (NOINT) group. Patients enrolled in the INT group received an intervention depending on the cause of nonadherence. Patients in the ADH and NOINT groups received usual care. Intention‐to‐treat (ITT) analysis was performed with multiple imputation to replace the missing data. Data Collection Adherence, total cholesterol levels, and lifestyle behaviors. Findings The odds of becoming adherent during the 6 months was higher in the INT group compared to the NOINT group (OR = 1,49; 95% CI: 1.30‐1.76; P < 0.001), especially in the community pharmacy group (OR = 2.34; 95% CI: 1.81‐3.03; P < 0.001). Adherent patients showed lower values of total cholesterol compared with nonadherent patients at baseline (ADH: 200.3 mg/dL vs NOADH: 216.7 mg/dL; P < 0.001) and at the endpoint (ADH: 197.3 mg/dL vs NOADH: 212.2 mg/dL; P < 0.001). More patients enrolled in the INT group practices exercise at the end of the study (INT: +26.6 percent; P = 0.002), and a greater number of patients followed a diet to treat hypercholesterolemia (+30.2 percent; P < 0.001). Conclusions The intervention performed by health professionals, especially by community pharmacists, improved adherence to statins by hypercholesterolemic patients, and this improvement in adherence was accompanied by a reduction in total cholesterol levels and a healthier lifestyle.

Community pharmacist interventions to improve adherence to lipid lowering medication and their influence on clinical outcomes: A systematic review and meta‐analysis

“…Publication years of selected studies ranged from 2010 to 2019. With respect to location, three studies were performed in Europe, 40‐42 one in Australia, 39 and one in North America 43 . Regarding study type, three studies were traditional RCTs 40‐42 and two studies were cluster‐randomized controlled trials (c‐RCTs) 39,43 …”

“…All five studies described their target interventions in detail: four interventions were face to face 39,40,42,43 and one was telephone based 41 . The follow‐up period was more than 6 months in three studies 39,40,43 and 6 months in two studies 41,42 .…”

“…All five studies described their target interventions in detail: four interventions were face to face 39,40,42,43 and one was telephone based 41 . The follow‐up period was more than 6 months in three studies 39,40,43 and 6 months in two studies 41,42 . The frequency of visits was every 2 months for two studies, 42,43 every 3 months for one study, 39 and variable for two studies 40,41 .…”

Real‐world evaluation of the impact of statin intensity on adherence and persistence to therapy: A Scottish population‐based study

“…With pharmacists increasingly being introduced into GP practices in Scotland, 52 there is scope to explore options for improving the dialogue between patients and healthcare professionals, and to potentially implement other interventions tailored to patients that could improve adherence to statinssuch as providing verbal and written information about the disease and/or the treatment, adapting treatment regimens or using dispensing support tools such as dosette boxes, depending on context and reasons for nonadherence to therapy. 53 Most importantly, shared decisions about the initiation of treatment, discussing the potential risks and benefits of statin therapy, and shared management plans are essential to improve adherence rates and quality of medicines use. 20,26 We will be discussing the implications of our findings with key stakeholders in Scotland as a basis for debating possible future interventions that could be instigated to improve prescribing and adherence rates.…”

Farmacia comunitaria, adherencia al tratamiento y COVID-19

“…En base a lo anterior, se ha publicado una nueva clasificación de pacientes no adherentes (5), fundamentada en los perfiles obtenidos en la encuesta telefónica y matizados según las actitudes que presenta el paciente hacia su medicación y enfermedad, obteniendo tres perfiles de pacientes NA. Dichos perfiles, publicados en la guía ADHe+ (5) Colaboración Identificar las barreras que impiden a cada paciente ser adherente es fundamental para luego poder elegir las estrategias más adecuadas para ayudarlo a ser más adherente (7). Al clasificar al paciente, protocolizamos dicha identificación facilitando la tarea de evaluación de sus creencias hacia un medicamento en concreto y en un momento determinado.…”