1
|
Fénélon-Dimanche R, Guénette L, Trudel-Bourgault F, Yousif A, Lalonde G, Beauchesne MF, Collin J, Blais L. Development of an electronic tool (e-AdPharm) to address unmet needs and barriers of community pharmacists to provide medication adherence support to patients. Res Social Adm Pharm 2020; 17:506-513. [PMID: 32402728 DOI: 10.1016/j.sapharm.2020.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/20/2020] [Accepted: 04/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Community pharmacists are best placed to improve medication adherence because they frequently interact with patients and have been trained to manage medication-related problems. Therefore, it is essential to equip pharmacists adequately to detect non-adherent patients quickly and intervene to improve medication adherence. OBJECTIVE To design e-AdPharm, a tool that addresses unmet needs and barriers of community pharmacists to provide medication adherence support to patients with chronic diseases. METHODS A qualitative study using 4 focus group discussions with community pharmacists was conducted with a semi-structured interview guide and discussions lasting for 1-2 h. The discussions covered the barriers and needs of pharmacists related to medication adherence support provided to patients, their expectations of an electronic tool based on prescription refills to help them provide this support, and the design of the tool. Focus group data were coded and analyzed using an iterative process, with thematic and descriptive analyses. RESULTS Twenty-six community pharmacists participated. Lack of time and motivation from pharmacists and patients were common barriers to the provision of medication adherence support. Accordingly, community pharmacists wished to measure medication adherence quickly, provide easily interpretable data to patients on their medication use, and raise the patient's awareness of non-adherence. The pharmacists expressed their need to have an electronic tool to share medication adherence information with the treating physician. Regarding the design of e-AdPharm, the pharmacists wanted a table displaying medication adherence with a color code representing adherence level. They also stressed the importance of a structured section enabling them to continuously document the interventions made and the need for patient follow-ups. CONCLUSIONS e-AdPharm meet the needs and overcome the barriers of community pharmacists to provide medication adherence support to their patients. Future studies should examine the feasibility of implementing e-AdPharm in community pharmacies and test its efficacy for improving medication adherence.
Collapse
Affiliation(s)
- Rébecca Fénélon-Dimanche
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Centre, CIUSSS du Nord-de-l'île de Montréal, Montréal, Québec, Canada.
| | - Line Guénette
- Faculty of Pharmacy, Université Laval, Québec, Québec, Canada; CHU de Québec Research Centre, Population Health and Optimal Health Practices Research Unit, Québec, Québec, Canada.
| | | | - Alia Yousif
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Centre, CIUSSS du Nord-de-l'île de Montréal, Montréal, Québec, Canada.
| | - Geneviève Lalonde
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Centre, CIUSSS du Nord-de-l'île de Montréal, Montréal, Québec, Canada.
| | - Marie-France Beauchesne
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Centre, CIUSSS du Nord-de-l'île de Montréal, Montréal, Québec, Canada; Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
| | - Johanne Collin
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada.
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Centre, CIUSSS du Nord-de-l'île de Montréal, Montréal, Québec, Canada; Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health, Montréal, Québec, Canada.
| |
Collapse
|
2
|
Fénélon-Dimanche R, Guénette L, Yousif A, Lalonde G, Beauchesne MF, Collin J, Blais L. Monitoring and managing medication adherence in community pharmacies in Quebec, Canada. Can Pharm J (Ott) 2020; 153:108-121. [PMID: 32206156 DOI: 10.1177/1715163520902494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Community pharmacists have direct access to prescription refill information and regularly interact with their patients. Therefore, they are in a unique position to promote optimal medication use. Objectives To describe how community pharmacists in Quebec, Canada, identify nonadherent patients, monitor medication use and promote optimal medication adherence. Methods An invitation to complete a web-based survey was published online through different platforms, including a Facebook pharmacists' group, an electronic newsletter, a pharmacy network forum and e-mail. The survey included questions on participant characteristics, methods used by pharmacists to identify nonadherent patients and monitor medication use and interventions they used to promote medication adherence. Results In total, 342 community pharmacists completed the survey. The participants were mainly women (71.6%), staff pharmacists (56.7%) and aged 30 to 39 years (34.2%). The most common method to identify nonadherent patients was to check gaps between prescription refills (98.8%). The most common intervention to promote adherence was patient counselling (82.5%). The most common barriers to identifying nonadherent patients were lack of time (73.1%) and lack of prescription information (65.8%), whereas the most common barriers to intervening were anticipation of a negative reaction from their patients (91.2%) and lack of time (64%). Conclusion Lack of time and lack of prescription information are frequent challenges encountered by community pharmacists regarding effective monitoring and management of patients with poor medication adherence. Pharmacists could benefit from electronic tools based on prescription refills that would provide quick and easily interpretable information on their patients' medication adherence. Can Pharm J (Ott) 2020;153:xx-xx.
Collapse
Affiliation(s)
- Rébecca Fénélon-Dimanche
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Line Guénette
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Alia Yousif
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Geneviève Lalonde
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Marie-France Beauchesne
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Johanne Collin
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Lucie Blais
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| |
Collapse
|
3
|
Ghimire S, Lee K, Jose MD, Castelino RL, Zaidi STR. Adherence assessment practices in haemodialysis settings: A qualitative exploration of nurses and pharmacists' perspectives. J Clin Nurs 2019; 28:2197-2205. [PMID: 30786082 DOI: 10.1111/jocn.14821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 01/14/2019] [Accepted: 02/09/2019] [Indexed: 12/26/2022]
Abstract
AIMS AND OBJECTIVES To explore clinician assessment of patient adherence and identify strategies to improve adherence assessment practices in haemodialysis settings. BACKGROUND Patients with chronic kidney disease undergoing haemodialysis are typically prescribed complex regimens; as such, they are at high risk of medication nonadherence. Current clinical practices focus on prescribing medications; however, little attention is paid to measuring and ensuring patient adherence to their prescribed treatments. DESIGN A qualitative study. METHODS Semi-structured individual interviews were conducted in November and December 2016, with 12 nurses and 6 pharmacists, working in Australian haemodialysis settings. The study was conducted and reported in accordance with COREQ guidelines. RESULTS Participants were 25-60 years old and had 1-27 years of experience in dialysis. Seven themes related to assessing adherence were identified: prioritisation of resources, interplay between workload and available time, awareness of formalised adherence measures and training deficits, concerns about practicality/suitability of adherence measures, communication of assessment services, patient participation and trust. Three themes related to strategies for improving adherence assessment practices were identified: formalisation of adherence assessment process, integration of assessment processes and tools into routine, and use of multidisciplinary support to assess and promote adherence. CONCLUSIONS Current adherence assessment practices could be improved through formalisation and integration of the assessment process into dialysis unit policy/procedures. Additionally, as barriers to assessing adherence were identified at organisational, professional and patient levels, there is a need to address barriers from each level in order to improve adherence assessment practices in haemodialysis settings. RELEVANCE TO CLINICAL PRACTICE This qualitative study highlights the challenges and practical ways by which adherence assessment practices could be improved in haemodialysis settings. This would encourage renal clinicians to actively participate in adherence assessment and promotion activities to ensure patients benefit from their therapies.
Collapse
Affiliation(s)
- Saurav Ghimire
- Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Kenneth Lee
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew D Jose
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Ronald L Castelino
- Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | | |
Collapse
|
4
|
Ghimire S, Banks C, Jose MD, Castelino RL, Zaidi STR. Medication adherence assessment practices in dialysis settings: A survey of renal nurses’ perceptions. J Clin Nurs 2018; 28:528-537. [DOI: 10.1111/jocn.14642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/05/2018] [Accepted: 08/02/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Saurav Ghimire
- Unit for Medication Outcomes Research and Education (UMORE) Pharmacy School of Medicine Faculty of Health University of Tasmania Hobart Tas. Australia
| | - Colin Banks
- Department of Nephrology Royal Hobart Hospital Hobart Tas. Australia
| | - Matthew D. Jose
- Department of Nephrology Royal Hobart Hospital Hobart Tas. Australia
- School of Medicine Faculty of Health University of Tasmania Hobart Tas. Australia
| | | | - Syed Tabish R. Zaidi
- Unit for Medication Outcomes Research and Education (UMORE) Pharmacy School of Medicine Faculty of Health University of Tasmania Hobart Tas. Australia
- School of Healthcare University of Leeds Leeds UK
| |
Collapse
|
5
|
Ghimire S, Banks C, Jose MD, Castelino RL, Zaidi STR. Renal pharmacists’ perceptions and current practices of assessing medication adherence in dialysis patients. Int J Clin Pharm 2017; 40:26-35. [DOI: 10.1007/s11096-017-0574-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
|
6
|
Houle SK, Charrois TL, Faruquee CF, Tsuyuki RT, Rosenthal MM. A randomized controlled study of practice facilitation to improve the provision of medication management services in Alberta community pharmacies. Res Social Adm Pharm 2017; 13:339-348. [DOI: 10.1016/j.sapharm.2016.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/28/2022]
|
7
|
Dikun JA, Crumby AS, Shahpurwala Z, Hall J, Charrois TL, Rosenthal MM. Understanding pharmacist success in practice: A scoping review. J Am Pharm Assoc (2003) 2016; 56:649-655. [DOI: 10.1016/j.japh.2016.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 11/27/2022]
|
8
|
Kadia NK, Schroeder MN. Community Pharmacy–Based Adherence Programs and the Role of Pharmacy Technicians. J Pharm Technol 2015; 31:51-57. [DOI: 10.1177/8755122515572809] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To increase pharmacy technician awareness of medication nonadherence enabling them to identify opportunities to participate in the provision of community pharmacy–based adherence programs. Data Sources: Articles were identified through searches of MEDLINE/PubMed (1950 through December 2014) using the following search terms: “adherence,” “role of technicians,” “community adherence programs,” “adherence and technician’s role,” “medication synchronization,” “retail pharmacy adherence programs,” and “CMS Star Ratings.” Additionally, resources on adherence programs were used from the American Society of Health-System Pharmacists, the American Pharmacists Association, and the Food and Drug Administration. Study Selection and Data Extraction: Articles describing community pharmacy adherence programs, the role of pharmacy technicians in providing these services, and medication synchronization were included. Data Synthesis: Nonadherence to medications creates a burden in terms of patient health and leads to high health care costs to the patients, providers, and insurers. Initiatives on pharmacist-led adherence programs have proven to reduce these overall health care–related costs. Pharmacy technicians can have an active role in the management of these adherence programs to reduce the burden on community pharmacists who are running adherence programs. Pharmacy technicians can be responsible for gathering medication histories, organizing patient medication lists, making appointment calls to schedule patients, collecting patient demographic history, conducting follow-up calls, and in promoting the program overall. Conclusions: Pharmacy technicians are a valuable asset to the community pharmacists in the process of running adherence programs, and they can work with the pharmacists to coordinate and promote community pharmacy–based medication adherence programs.
Collapse
|
9
|
Boeni F, Arnet I, Hersberger KE. Adherence counseling during patient contacts in swiss community pharmacies. Patient Prefer Adherence 2015; 9:597-605. [PMID: 25960642 PMCID: PMC4423509 DOI: 10.2147/ppa.s76027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Numerous studies showed the effectiveness of pharmaceutical care in improving medication adherence in primary care patients. However, in daily pharmacy practice, the provision of pharmaceutical care appears to be limited. We aimed at quantifying the content of counseling by community pharmacy staff during patient contacts, especially adherence counseling, and at investigating pharmacist views about their practice of adherence counseling. PATIENTS AND METHODS A Master's student in Pharmacy observed patient contacts at selected community pharmacies in the region of Basel, Switzerland. Content of counseling was manually ticked on a checklist with predefined themes (administration, dose, effect, and adherence). Pharmacists working in the pharmacy were interviewed on triggers, topics, and barriers in adherence counseling. RESULTS In 20 community pharmacies and during a total of 148.1 hours, 1,866 patient contacts were observed. During the 1,476 patient contacts including the dispensing of one or more medications, counseling was provided to 799 (54.1%) patients; with 735 (49.8%) patients counseled about administration, 362 (24.5%) about dose, 267 (18.1%) about effect, and 99 (6.7%) about adherence. Significantly more patients received counseling when they obtained prescribed versus over-the-counter medication (P=0.002), a new prescription versus a repeat prescription (P<0.001), or when they were served by a pharmacist versus by another staff member (P<0.001). Of the 33 interviewed pharmacists, all except one reported actively approaching patients for adherence counseling. Triggers included medication-related and patient-related factors. The pharmacists named predominantly product-centered topics of adherence counseling. The most cited barriers were rejection of counseling by the patient and lack of time. CONCLUSION Half of the patients receiving one or more medications were counseled, and only 6.7% of all contacts included adherence counseling. Future studies should clarify how barriers to adherence counseling at the community pharmacy can be overcome.
Collapse
Affiliation(s)
- Fabienne Boeni
- Pharmaceutical care research group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Correspondence: Fabienne Boeni, Pharmaceutical care research group, Department of Pharmaceutical sciences, University of Basel, Klingelbergstrasse 50, CH-4056 Basel, Switzerland, Tel +41 61 267 15 29, Fax +41 61 267 14 26, Email
| | - Isabelle Arnet
- Pharmaceutical care research group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Kurt E Hersberger
- Pharmaceutical care research group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| |
Collapse
|
10
|
Mehralian G, Rangchian M, Javadi A, Peiravian F. Investigation on barriers to pharmaceutical care in community pharmacies: a structural equation model. Int J Clin Pharm 2014; 36:1087-94. [PMID: 25168648 DOI: 10.1007/s11096-014-9998-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/30/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The concept of pharmaceutical care (PhC) has been popular in pharmacy during past decades. However, in some countries, including Iran, it does not seem to mature. AIM OF THE STUDY To identify and prioritize barriers to the provision of PhC in Iranian community pharmacies, based on the perceptions of community pharmacists in Tehran. METHOD Between August and November 2013, a cross-sectional descriptive study was performed using an anonymous questionnaire asking the pharmacists' perceptions on the implementation of PhC. Of the 2000 invited community pharmacists, 505 pharmacists responded. A descriptive analysis, was conducted, and the data were also analyzed through structural equation modeling. MAIN OUTCOME MEASURE Priorities of barriers to the implementation of PhC in Iran. RESULTS Five major dimensions included in the survey instrument were confirmed by confirmatory factor analysis. According to the model developed based on pharmacists' opinions, lack of pharmacists' skills and lack of appropriate regulation and environment are the two most important barriers of the provision of PhC, and the least important is lack of resources. CONCLUSION The results show that the main barriers to PhC in Iran are the lack of skills and of appropriate regulation and environment. These main barriers are different from those mentioned in studies conducted in other countries.
Collapse
Affiliation(s)
- Gholamhossein Mehralian
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Vali-e Asr Ave., Niayesh Junction, Tehran, Iran,
| | | | | | | |
Collapse
|
11
|
Beloin-Jubinville B, Joly-Mischlich T, Rouleau ED, Noiseux P, Blais L, Forget A, Beauchesne MF. Does hospitalization influence patients' medication adherence and community pharmacists' interventions? Ann Pharmacother 2014; 47:1143-52. [PMID: 24259729 DOI: 10.1177/1060028013503123] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Medication adherence reduces disease morbidity. Data regarding changes in a patient's adherence before and after hospitalization and how this hospitalization influences a pharmacist's interventions are scarce. OBJECTIVE To assess changes in adherence to cardiovascular and respiratory medications in the year preceding and following a hospitalization; explore patients' perceptions about medication adherence and the pharmacist's role; and describe pharmacists' interventions regarding medication adherence. METHODS This cohort study included patients hospitalized for acute coronary syndrome, acute worsening of heart failure, or acute COPD exacerbations. Adherence to cardiovascular and respiratory medications was measured by calculating the proportion of days covered (PDC) from prescription refills. Patient interviews were completed to explore their perceptions about medication adherence and the role of the pharmacist. Community pharmacists were invited to complete an online survey and to participate in focus groups to discuss interventions to improve medication adherence. RESULTS Medication adherence was assessed for 61 patients; the mean PDC was 69.8% 12 months before hospitalization and 72.4% 12 months following hospitalization. Patients reported that they felt the need to take their medications to prevent worsening of their disease. They were satisfied with current pharmaceutical services. A total of 136 questionnaires completed by pharmacists were analyzed and 9 participants attended the focus groups. Most pharmacists reported monitoring prescription renewals to assess adherence, with no significant influence from the hospitalization itself. The patient's interest was reported to be an important facilitator, whereas a lack of time and face-to-face interaction with patients who had their medication delivered to their home was reported a main barrier to interventions. This study was limited by a small sample size. CONCLUSIONS Patient medication adherence did not significantly change following hospitalization. Hospitalization does not appear to significantly influence patient and pharmacist behavior towards medication adherence.
Collapse
|
12
|
Cunico C, Picheth G, Correr CJ, Scartezini M. Assessing the adherence to and the therapeutic effectiveness of hypolipidemic agents in a population of patients in Brazil: a retrospective cohort study. Pharm Pract (Granada) 2014; 12:378. [PMID: 25035713 PMCID: PMC4100947 DOI: 10.4321/s1886-36552014000200002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 05/27/2014] [Indexed: 12/11/2022] Open
Abstract
Objective to evaluate the relation between patient adherence and therapeutic effectiveness of hypolipidemic
agents in clinical practice. Methods A retrospective cohort study of 417 patients using hypolipidemic drugs (simvastatin,
atorvastatin) between 2003 and 2010 was performed. The population studied consists of patients
assisted by the Public Health Service in the far-west region of the State of Santa Catarina, Brazil.
The Medication Possession Ratio obtained from pharmacy refill data was used to measure patient
adherence. Therapeutic effectiveness was evaluated based on the difference obtained in the serum
levels of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides, before and after
taking the drug, in an average time of 8.3 months. Results Following the treatment with hypolipidemic agents, it has been observed a reduction of
14.3% for total cholesterol, 19.6% for LDL-cholesterol, and 14.4% for
triglycerides. HDL-cholesterol increased by an 8.0% average. The major changes in lipid
profile were promoted by atorvastatin 20 mg daily. The medication adherence rate decreased over the
monitoring period. Adherence rates below 60% were associated with therapeutic failure, while
rates equal to 80% or higher were associated with the best response to the lipid-lowering
drugs. Conclusion Adherence to hypolipidemic agents is higher at the beginning of the treatment, but it decreases
over time, affecting the achievement of therapeutic goals.
Collapse
Affiliation(s)
- Cássia Cunico
- Municipal Health of the São Miguel do Oeste and State Health Administration of the State of Santa Catarina. Florianópolis ( Brazil )
| | - Geraldo Picheth
- Department of Medical Pathology, Federal University of Parana (UFPR) , Curitiba, PR ( Brazil )
| | - Cassyano J Correr
- Department of Pharmacy, Federal University of Parana (UFPR) Curitiba, PR ( Brazil )
| | - Marileia Scartezini
- Department of Medical Pathology, Federal University of Parana (UFPR) , Curitiba, PR ( Brazil )
| |
Collapse
|