Medication adherence beliefs of U.S community pharmacists

Evaluating Greek pharmacists' attitudes and barriers regarding medicines adherence

Adherence constitutes an integral aspect of achieving consistently good clinical results. Understanding pharmacists' perceptions and attitudes, along with existing barriers is essential on the roadmap of enhancing patient adherence. This constitutes the goal of this study.

Methodology

A validated questionnaire was sent to a sample of 280 community pharmacists. Pharmacists were notified both by email and telephone. A response rate of 55% was achieved.

Results

Most pharmacists agree that the identification of patients' suboptimal adherence falls under their professional responsibility and they engage in activities to promote it. There is evidence to support that the most popular interventions were self-management and indirect methods. Specific tools were used to a lesser degree. Finally, the current study illustrated that the most commonly identified barriers were the preference of patients for physicians regarding adherence, lack of information from patients and lack of time.

Conclusion

Although the important role of pharmacists in adherence is ascertained, significant discrepancies in the tools used to control and promote adherence among pharmacists were identified, and also in obstacles faced by themselves and their patients. The interventions should be more consistent and the notion of cooperation among health care professionals should be nurtured.

Disparities in the Timeliness of Addressing Patient-Initiated Telephone Calls in a Primary Care Clinic: The Impact of Quality Improvement Interventions

A timely response to patient-initiated telephone calls can affect many aspects of patient health, including quality of care and health equity. Historically, at a family medicine residency clinic, at least 1 out of 4 patient calls remained unresolved three days after the call was placed. We sought to explore whether there were differential delays in resolution of patient concerns for certain groups and how these were affected by quality improvement interventions to increase responsiveness to patient calls. A multidisciplinary team at a primary care residency clinic applied Lean education and tools to improve the timeliness of addressing telephone encounters. Telephone encounter data were obtained for one year before and nine months after the intervention. Data were stratified by race, ethnicity, preferred language, sex, online portal activation status, age category, zip code, patient risk category, and reason for call. Stratified data revealed consistently worse performance on telephone encounter closure by 72 hours for Black/African American patients compared to Hispanic and non-Hispanic White patients pre-intervention. Interventions resulted in statistically significant overall improvement, with an OR of 2.9 (95% CI: 2.62 to 3.21). Though interventions did not target a specific population, pre-intervention differences based on race and ethnicity resolved post-intervention. Telephone calls serve as an important means of patient communication with care teams. General interventions to improve the timeliness of addressing telephone encounters can lead to sustainable improvement in a primary care academic clinic and may also alleviate disparities.

Development and testing of a framework for defining a strategy to address medication adherence during patient encounters in community pharmacies

Background

Counseling patients on medication adherence could be ameliorated in pharmacy practice. There is a lack of simple and practical strategies to address medication adherence with patients in daily practice. The goal was to develop and test a framework that allows pharmacy teams to define and apply a strategy to address medication adherence in community pharmacies.

Methods

A framework based on the principles of social marketing was developed. It consisted of 3 items: the target patient (“Who”), the target plan (“How”), and the target goal (“How many”). To test the framework, each participating pharmacy team developed their strategy by defining the 3 items and applied them during one pilot day. A master student observed the encounters between patients and pharmacy team members and used a structured checklist to document the patient's characteristics, counseling content, and strategy use. Pharmacy teams answered a feedback questionnaire at the end of the pilot day.

Results

Ten pharmacy teams were included. During a brainstorming session that lasted on average 31 ± 8 min, unique strategies comprised 18 different target patients and 20 different target plans. The planned target goal was a mean of 31 patients (range: 1 to “all”). A total of 325 encounters were observed, of which 208 patients (64%) corresponded to the predefined target patients. Medication adherence was addressed with 73 patients (22.5%), and adherence counseling was performed with 50 patients (15%). The pharmacy teams accepted the framework and judged it feasible and adaptable to their needs.

Conclusion

The proposed framework represents a simple tool that enables pharmacy teams to develop a strategy for addressing medication adherence in community pharmacies. Its adoption by pharmacy teams occurred without additional training and its integration into daily practice without difficulties. A further study is now needed to investigate if pharmacy teams can successfully engage patients in discussion on medication adherence and ultimately propose targeted adherence interventions.

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A 3-item framework to address medication adherence in pharmacies was introduced.

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The three framework was well received by the pharmacy teams.

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The adoption of the 3-item framework by the pharmacy teams was simple and quick.

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The teams chose target patient not according to known factors for poor adherence

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Patients reacted mainly positively when asked about medication adherence

Towards a reconsideration of the use of agree-disagree questions in measuring subjective evaluations

Agree-disagree (AD) or Likert questions (e.g., "I am extremely satisfied: strongly agree … strongly disagree") are among the most frequently used response formats to measure attitudes and opinions in the social and medical sciences. This review and research synthesis focuses on the measurement properties and potential limitations of AD questions. The research leads us to advocate for an alternative questioning strategy in which items are written to directly ask about their underlying response dimensions using response categories tailored to match the response dimension, which we refer to as item-specific (IS) (e.g., "How satisfied are you: not at all … extremely"). In this review we: 1) synthesize past research comparing data quality for AD and IS questions; 2) present conceptual models of and review research supporting respondents' cognitive processing of AD and IS questions; and 3) provide an overview of question characteristics that frequently differ between AD and IS questions and may affect respondents' cognitive processing and data quality. Although experimental studies directly comparing AD and IS questions yield some mixed results, more studies find IS questions are associated with desirable data quality outcomes (e.g., validity and reliability) and AD questions are associated with undesirable outcomes (e.g., acquiescence, response effects, etc.). Based on available research, models of cognitive processing, and a review of question characteristics, we recommended IS questions over AD questions for most purposes. For researchers considering the use of previously administered AD questions and instruments, issues surrounding the challenges of translating questions from AD to IS response formats are discussed.

Low perceived service quality in community pharmacy is associated with poor medication adherence

OBJECTIVE

Community pharmacists are highly accessible healthcare professionals, whose regular contact with patients provides ongoing opportunities to improve medication safety and promote medication adherence. This study investigates whether patients who experience low service quality in community pharmacies are less adherent to their regular medications.

METHODS

Eight Australian pharmacies were recruited, 5 self-identified as having a price promotion business strategy and 3 with a service-focused business strategy. Patients taking regular prescribed medicines who had previously attended the pharmacy completed e-surveys in-store with measures of perceived service quality (pSQ) and self-reported adherence. Multivariate regression using multilevel modelling with bootstrapping was used to explore the relationships between variables.

RESULTS

Surveys were completed by 319 respondents. Attending pharmacies with a price promotion business strategy was predictive of lower pSQ and poor medication adherence. The between-pharmacy slope of the relationship between pSQ and adherence was 2.25 (with 95 % confidence intervals = 1.50, 2.86) and was highest in pharmacies with lowest pSQ.

CONCLUSION

This study highlights that when patients experience low service quality, in community pharmacies they are more likely to report poor adherence to their regular prescribed medicines.

PRACTICE IMPLICATIONS

Community pharmacies need to be designed and managed to allow pharmacists to provide high levels of patient-centred care.