It is important for pharmacists to understand the relationship between medication adherence and patient outcomes.
This is neither the first nor the last thing you will read about patient adherence to drug therapy. Ensuring, or at least promoting or facilitating, drug adherence is one of the most salient unmet health care needs and is a real call to the pharmacy profession. Therefore, it is useful to examine attempts to promote patient compliance in daily practice and also in the context of specific value-added services led by pharmacists. Understanding the relationship between medication adherence and patient outcomes is all the more important for us.
A systematic review of pharmacist-led interventions and their impact on adherence and other outcomes has been published in the International Journal of Pharmacy Practice.1 The investigators’ literature search revealed 22 studies reported in 26 different peer-reviewed articles. In some cases, adherence has been measured using objective methods such as pill count and Drug Event Monitoring System (MEMS) caps on drug vials, while other studies have used patient self-assessment measures.
The review looked at clinical outcomes including blood pressure, HbA1c for blood sugar, blood lipids, respiratory disease control, such as decreased use of rescue medications and patient forced expiratory volume; symptoms of depression, patient knowledge, patient satisfaction, patient quality of life and economic outcomes. Community pharmacist-led interventions have been shown to improve patient compliance and contribute to better blood pressure control, cholesterol management, chronic obstructive pulmonary disease and asthma control, and to a mix of outcomes such as quality of life and economic indicators. However, the studies in this review did not report statistically significant effects of interventions for diabetes or the control of depression. The authors caution that many studies could have been biased because it was the pharmacists themselves who reported the patient outcomes.
Pharmacists can provide a tremendous amount of the public good in the services they provide. There are models that allow pharmacists to have positive effects on patient outcomes in a number of conditions, and we can learn from past efforts to improve our attempts in other disease states. Promoting adherence will continue to be one of our main goals, even as we further expand our activities in the areas of public health.
Pharmacy managers can use the literature as a model for success and need to document improved outcomes to better justify paying for these value-added services. While pharmacy staff generally understand the importance of medication adherence, managers can emphasize this as the core value of pharmacy and stay abreast of technologies, interventions, and educational approaches that maximize adherence. medication.
Additional information on value-added services as a component of improving the roles of pharmacists in public health can be found in Pharmacy management: essential elements for all practice settings, 5e.
Shane P. Desselle, RPh, PhD, FAPhA, Professor of Social / Behavioral Pharmacy at Touro University of California in Vallejo.
Minosavljevic A, Aspden T, Harrison J. Int J Pharm Pract. 2018; 26: 387-397.