Patient-centred advice is effective in improving adherence to medicines

  • Sarah Clifford
  • Nick BarberEmail author
  • Rachel Elliott
  • Elaine Hartley
  • Rob Horne
Original Paper



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.


Chronic disease England Patient adherence Patient needs Pharmacist Randomized controlled trial Telephone service 



We would like to thank the many who helped us: Intervention pharmacists: Helen Smurthwaite, Glen Savage. Expert panel: Imogen Savage, Mike Schachter, Colin Bradley, John Benson, Marie Miller. Statistical advice: Colin Chalmers. This work was undertaken by Professor N Barber and colleagues who received funding from the DHSC London, Research & Development, Responsive Funding Programme. The views expressed in the publication are those of the authors and not necessarily those of the National Health Service or the Department of Health.


  1. 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. 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. 3.
    Lewis A. Noncompliance: A $100 billion problem. Remington Report. 1997;5(4):14-.Google Scholar
  4. 4.
    McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA 2002;288:2868-9.CrossRefPubMedGoogle Scholar
  5. 5.
    Leventhal H, Cameron LD. Behavioral theories and the problem of compliance. Patient Educ Couns 1987;10:117-8.CrossRefGoogle Scholar
  6. 6.
    Horne R, Weinman J. Patients’ beliefs about medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999;47(6):555-7.CrossRefPubMedGoogle Scholar
  7. 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
  8. 8.
    Barber N, Parsons J, Clifford S, Darracott R, Horne R. Patients’ problems with new medication for chronic conditions. Qual Saf Health Care 2004;13(3):172–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Ware JE, Sherbourne CD. The MOS 36 item short form health survey (SF-36): Conceptual framework and item selection. Med Care 1992;30:473.CrossRefPubMedGoogle Scholar
  10. 10.
    Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: the development of a new method for assessing the cognitive representation of medication. Psychol Health 1999;14:1–24.CrossRefGoogle Scholar
  11. 11.
    Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications. JAMA 2002;288:2880-.CrossRefPubMedGoogle Scholar
  12. 12.
    Haynes RB, Taylor DW, Sackett DL, Gibson ES, Bernholtz CD, Mukherjee J. Can simple clinical measures detect patient non-compliance? Hypertension 1980;2:757-4.PubMedGoogle Scholar
  13. 13.
    Barber N. Should we consider non-compliance a medical error? Qual Saf Health Care 2002;11:81-.CrossRefPubMedGoogle Scholar
  14. 14.
    Dean B, Barber N. Validity and reliability of observational methods for studying medication administration errors. Am J Health-Syst Pharm 2001;58:54-.PubMedGoogle Scholar
  15. 15.
    Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999;47:555-7.CrossRefPubMedGoogle Scholar
  16. 16.
    Department of Health. Pharmacy in the future. 2000. Available at: (Accessed March 13th 2005).
  17. 17.
    Department of Health. A Vision for Pharmacy in the New NHS. 2003. [26 pages]. Available at: (Accessed March 13th 2005).
  18. 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. 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
  20. 20.
    Kaplan RM, Simon HJ. Compliance in medical care: reconsideration of self-predictions. Ann Behav Med 1990;12:66–71.CrossRefGoogle Scholar
  21. 21.
    Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA 1992;267:2221-6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Sarah Clifford
    • 1
  • Nick Barber
    • 2
    Email author
  • Rachel Elliott
    • 3
  • Elaine Hartley
    • 4
  • Rob Horne
    • 5
  1. 1.The School of PharmacyLondonUK
  2. 2.Department of Practice and PolicyThe School of PharmacyLondonUK
  3. 3.School of Pharmacy and Pharmaceutical SciencesUniversity of ManchesterManchesterUK
  4. 4.Alliance PharmacyFalthamUK
  5. 5.School of Pharmacy and Biomolecular SciencesUniversity of BrightonBrightonUK

Personalised recommendations