Effect of a 36-month pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients
- 854 Downloads
Objective: The primary objective of this study was to evaluate the effect of a pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients. The clinical outcomes of this pharmacotherapy adherence approach were the secondary objective of the study. Setting: Public Primary Health Care Unit in a municipality in the Brazilian State of Sao Paulo. Method: A 36-month randomized, controlled, prospective clinical trial was carried out with 200 patients divided into two groups: control (n = 100) and intervention (n = 100). The control group received the usual care offered by the Primary Health Care Unit (medical and nurse consultancies). The patients randomized into the intervention group received pharmaceutical care intervention besides the usual care offered. Main outcome measure: Pharmacotherapy adherence (Morisky-Green test translated into Portuguese and computerized dispensed medication history) and clinical measurements (blood pressure, fasting glucose, A1C hemoglobin, triglycerides and total cholesterol) were evaluated at the baseline and up to 36 months. A P value <0.05 was considered statistically significant. Results: A total of 97 patients from the intervention group and 97 patients from the control group completed the study (n = 194). Significant improvements in the pharmacotherapy adherence were verified for the intervention group according to the Morisky-Green test (50.5% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001) and the computerized dispensed medication history (52.6% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001); no significant changes were verified in the control group. Significant improvements in the number of patients reaching adequate values for their blood pressure (26.8% at baseline vs. 86.6% after 36-months; P < 0.001), fasting glucose (29.9% at baseline vs. 70.1% after 36 months; P < 0.001), A1C hemoglobin (3.3% at baseline vs. 63.3% after 36 months; P < 0.001), triglycerides (47.4% at baseline vs. 74.2% after 36 months; P < 0.001) and total cholesterol (59.8% at baseline vs. 80.4% after 36 months; P = 0.002) were verified in the intervention group, but remained unchanged in the control group. Conclusion: These results indicated the effectiveness of pharmaceutical care in improving pharmacotherapy adherence, with positive effects in the clinical outcomes of the patients studied.
KeywordsBrazil Clinical trial Diabetes Elderly Hypertension Medication adherence Pharmaceutical care Public health
The authors would like to thank the pharmacists and researchers for their assistance during the research.
Conflicts of interest
The authors have no conflicts of interest to declare.
- 1.International Diabetes Federation. Diabetes Atlas. 4th ed. Brussels: International Diabetes Federation; 2009. ISBN-13: 978-2-930229-71-3. Available: http://www.diabetesatlas.org/content/diabetes.
- 9.Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;(2):CD000011.Google Scholar
- 14.Lyra-Júnior DP, Marcellini PS, Pelá IR. Effect of pharmaceutical care intervention on blood pressure of elderly outpatients with hypertension. Braz J Pharm Sci. 2008;44(3):451–7.Google Scholar
- 15.Obreli-Neto PR, Cuman RKN. Pharmaceutical care program for the rational use of drugs in the elderly users of a Basic Health Unit in the Sao Paulo State, Brazil. Lat Am J Pharm. 2010;29(3):333–9.Google Scholar
- 17.Brazilian Society of Cardiology, Brazilian Society of Hypertension, Brazilian Society of Nephrology. V Brazilian guidelines on hypertension. Arq Bras Cardiol. 2007;89(3):24–79.Google Scholar
- 18.Brazilian Society of Diabetes. Brazilian Society of Diabetes’ Guidelines 2009. Rio de Janeiro, RJ: Diagraphic Editora; 2009.Google Scholar
- 27.Lyra-Júnior DP, Kheir N, Abriata JP, Rocha CE, Santos CB, Pela IR. Impact of pharmaceutical care interventions in the identification and resolution of drug-related problems and on quality of life in a group of elderly outpatients in Ribeirào Preto (SP), Brazil. Ther Clin Risk Manag. 2007;3(6):989–98.Google Scholar
- 29.Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the clinician’s guide. New York, NY: The McGraw-Hill Companies; 2004. ISBN: 10: 0-07-136259-2.Google Scholar
- 31.Kicklighter CE, Nelson KM, Humphries TL, Delate T. An evaluation of a clinical pharmacy-directed intervention on blood pressure control. Pharm Practice. 2006;4(3):110–6.Google Scholar