Patient-centred advice is effective in improving adherence to medicines
To assess the effects of pharmacists giving advice to meet patients’ needs after starting a new medicine for a chronic condition.
A prospective health technology assessment including a randomised controlled trial of a pharmacist-delivered intervention to improve adherence using a centralised telephone service to patients at home in England. Patients were eligible for recruitment if they were receiving the first prescription for a newly prescribed medication for a chronic condition and were 75 or older or suffering from stroke, cardiovascular disease, asthma, diabetes or rheumatoid arthritis.
Main outcome measures
Incidence of non-adherence, problems with the new medicine, beliefs about the new medicine, safety and usefulness of the interventions.
Five hundred patients consented and were randomised. At 4-week follow-up, non-adherence was significantly lower in the intervention group compared to control (9% vs. 16%, P = 0.032). The number of patients reporting medicine-related problems was significantly lower in the intervention group compared to the control (23% vs. 34%, P = 0.021). Intervention group patients also had more positive beliefs about their new medicine, as shown by their higher score on the “necessity-concerns differential” (5.0 vs. 3.5, P = 0.007). The phone calls took a median of 12 min each. Most advice was judged by experts to be safe and helpful, and patients found it useful.
Overall, these findings show benefits from pharmacists meeting patients’ needs for information and advice on medicines, soon after starting treatment. While a substantially larger trial would be needed to confirm that the effect is real and sustained, these initial findings suggest the service may be safe and useful to patients.
KeywordsChronic disease England Patient adherence Patient needs Pharmacist Randomized controlled trial Telephone service
- 1.Smith M. The cost of non-compliance and the capacity of improved compliance to reduce health care expenditures. In: Improving medication compliance. Proceedings of a Symposium held in Washington DC, November 1984. Reston, Virginia: National Pharmaceutical Council, 1985;35-4.Google Scholar
- 2.Horne R. Adherence to medication: a review of the existing literature. In: Myers L, Midence K, editors. Adherence to treatment in medical conditions. Amsterdam: Harwood Academic Press; 1998. p 285–310. ISBN: 9057022656.Google Scholar
- 3.Lewis A. Noncompliance: A $100 billion problem. Remington Report. 1997;5(4):14-.Google Scholar
- 7.Horne R. Treatment perceptions and self-regulation. In: Cameron LD, Leventhal H, editors. The self-regulation of health and illness behaviour. London: Routledge Taylor & Francis Group, 2003. p 138–53. ISBN: 0415297001.Google Scholar
- 16.Department of Health. Pharmacy in the future. 2000. Available at: http://www.dh.gov.uk/assetRoot/04/06/82/04/04068204.pdf. (Accessed March 13th 2005).
- 17.Department of Health. A Vision for Pharmacy in the New NHS. 2003. [26 pages]. Available at: http://www.dh.gov.uk/assetRoot/04/06/83/56/04068356.pdf. (Accessed March 13th 2005).
- 18.Blenkinsopp A, Phelan M, Bourne J, Dakhil N. Extended adherence support by community pharmacists for patients with hypertension: a randomised controlled trial. Int J Pharm Pract 2000;8:165-5.Google Scholar
- 19.Goodyer LI, Miskelly F, Milligan P. Does encouraging good compliance improve patients’ clinical condition in heart failure? Br J Clin Pharmacol 1995;49(4):173–6.Google Scholar