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International Journal of Clinical Pharmacy

, Volume 36, Issue 1, pp 163–171 | Cite as

Impact of pharmaceutical care on adherence, hospitalisations and mortality in elderly patients

  • Charlotte OlesenEmail author
  • Philipp Harbig
  • Kirsten Marie Buus
  • Ishay Barat
  • Else Marie Damsgaard
Research Article

Abstract

Background Elderly polypharmacy patients may be more at risk of not adhering to medication. If so, the underlying reasons may be more readily disclosed during private discussions with patients. Hence pharmaceutical care discussions at home might improve treatment adherence. Objective The aim of this study was to investigate the impact of pharmaceutical care on medication adherence, hospitalisation and mortality in elderly patients prescribed polypharmacy. Setting Pharmaceutical care discussed at home. Methods A randomised controlled trial with two arms; pharmaceutical care (n = 315) and controls (n = 315) was designed. It involved patients aged 65+ years living in Aarhus, Denmark who used five drugs or more without assistance. Pharmacists visited the pharmaceuticalcare patients at home, once only, and followed them during the subsequent year with three telephone calls. Non-adherence was measured by a pill-count. Patients were categorised as non-adherent if their mean adherence rate for all drugs consumed was <80 %. The impact of pharmaceutical care on non-adherence and hospitalisation was analysed by 2 × 2 tables, and mortality by Cox regression. Main outcome measure Medication adherence, hospitalisation and mortality. Results The final analyses included 517 patients (median age 74 years; females 52 %). Dropouts were more frequent for the pharmaceutical-care group than for controls. Pharmacists encountered drug-related problems amongst 72 % of pharmaceutical-care patients. Pharmaceutical-care patients (11 %) and control patients (10 %) were similarly nonadherent (Odds ratio 1.14; 95 % confidence interval 0.65–2.00), and similar with respect to hospitalisation frequency (30 vs. 28 %; Odds ratio 1.14; 95 % confidence interval 0.78–1.67) and mortality (7.5 vs. 5 %; Hazard ratio 1.41; 95 % confidence interval 0.71–2.82). Conclusions Pharmaceutical care given to our elderly polypharmacy patients made no significant impact on medication adherence, hospitalisation or mortality, when compared to comparable control patients.

Keywords

Denmark Drug-related problems Elderly Hospitalisation Medication adherence Mortality Pharmaceutical care Polypharmacy 

Notes

Acknowledgments

We wish to thank all staff members in the MICMI study and all pharmacists who took part in the pharmaceutical care intervention. We wish to thank the Danish Ministry of Health and the Association of Danish Pharmacies for funding.

Funding

This study was supported by the Danish Ministry of Health and the Association of Danish Pharmacies.

Conflicts of interest

The authors have no conflicts of interest to declare.

References

  1. 1.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533–43.PubMedGoogle Scholar
  2. 2.
    MacKeigan LD, Nissen LM. Clinical pharmacy services in the home. Dis Manage Health Outcomes. 2008;16(4):227–44.CrossRefGoogle Scholar
  3. 3.
    Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. J Am Med Assoc. 2006;296(21):2563–71.CrossRefGoogle Scholar
  4. 4.
    Naunton M, Peterson GM. Evaluation of home-based follow-up of high-risk elderly patients discharged from hospital. J Pharm Res. 2003;33(3):176–82.Google Scholar
  5. 5.
    Lowe CJ, Raynor DK, Purvis J, Farrin A, Hudson J. Effects of a medicine review and education programme for older people in general practice. Br J Clin Pharmacol. 2000;50(2):172–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Goodyer L, Miskelly F, Milligan P. Does encouraging good compliance improve patients’ clinical condition in heart failure? Br J Clin Pract. 1995;49(4):173–6.PubMedGoogle Scholar
  7. 7.
    Begley S, Livingstone C, Hodges N, Williamson V. Impact of domiciliary pharmacy visits on medication management in an elderly population. Int J Pharm Pract. 1997;5(3):111–21.CrossRefGoogle Scholar
  8. 8.
    Nazareth I, Burton A, Shulman S, Smith P, Haines A, Timberall H. A pharmacy discharge plan for hospitalized elderly patients—a randomized controlled trial. Age Ageing. 2001;30(1):33–40.PubMedCrossRefGoogle Scholar
  9. 9.
    Grymonpre RE, Williamson DA, Montgomery PR. Impact of a pharmaceutical care model for non-institutionalised elderly: results of a randomised, controlled trial. Int J Pharm Pract. 2001;9(4):235–41.CrossRefGoogle Scholar
  10. 10.
    Sidel VW, Beizer JL, Lisi-Fazio D, Kleinmann K, Wenston J, Thomas C, et al. Controlled study of the impact of educational home visits by pharmacists to high-risk older patients. J Community Health. 1990;15(3):163–74.PubMedCrossRefGoogle Scholar
  11. 11.
    George J, Elliott RA, Stewart DC. A systematic review of interventions to improve medication taking in elderly patients prescribed multiple medications. Drugs Aging. 2008;25(4):307–24.PubMedCrossRefGoogle Scholar
  12. 12.
    World Health Organization. Adherence to long-term therapies: evidence for action. [S.l.]: WHO; 2003.Google Scholar
  13. 13.
    Vik SA, Maxwell CJ, Hogan DB. Measurement, correlates, and health outcomes of medication adherence among seniors. Ann Pharmacother. 2004;38(2):303–12.PubMedCrossRefGoogle Scholar
  14. 14.
    Lenaghan E, Holland R, Brooks A. Home-based medication review in a high risk elderly population in primary care—the POLYMED randomised controlled trial. Age Ageing. 2007;36(3):292–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Krska J, Cromarty JA, Arris F, Jamieson D, Hansford D, Duffus PRS, et al. Pharmacist-led medication review in patients over 65: a randomized, controlled trial in primary care. Age Ageing. 2001;30(3):205–11.PubMedCrossRefGoogle Scholar
  16. 16.
    Graffen M, Kennedy D, Simpson M. Quality use of medicines in the rural ambulant elderly: a pilot study. Rural Remote Health. 2004;4(3):184.PubMedGoogle Scholar
  17. 17.
    Holland R, Lenaghan E, Harvey I, Smith R, Shepstone L, Lipp A, et al. Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial. Br Med J. 2005;330(7486):293–5.CrossRefGoogle Scholar
  18. 18.
    Wu JYF, Leung WYS, Chang S, Lee B, Zee B, Tong PCY, et al. Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial. Br Med J. 2006;333(7567):522–5.CrossRefGoogle Scholar
  19. 19.
    Elliott RA, Barber N, Clifford S, Horne R, Hartley E. The cost effectiveness of a telephone-based pharmacy advisory service to improve adherence to newly prescribed medicines. Pharm World Sci. 2008;30(1):17–23.PubMedCrossRefGoogle Scholar
  20. 20.
    Harbig P. Methods for Improving Compliance with Medicine Intake (MICMI). 2012; Available at: www.sites.google.com/site/micmiproject. Accessed August 2013, 2012.
  21. 21.
    Harbig P, Barat I. Lund Nielsen P, Damsgaard EM. Instantaneous detection of nonadherence: quality, strength, and weakness of an electronic prescription database. Pharmacoepidemiol Drug Saf. 2012;21(3):323–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Danmarks Apotekerforening, Pharmakon. Medicingennemgang Få styr på medicinen (Medication review-Managing medication manual. In Danish). 2004.Google Scholar
  23. 23.
    Halpern MT, Khan ZM, Schmier JK, Burnier M, Caro JJ, Cramer J, et al. Recommendations for evaluating compliance and persistence with hypertension therapy using retrospective data. Hypertension. 2006;47(6):1039–48.PubMedCrossRefGoogle Scholar
  24. 24.
    Wong ICK. Randomised controlled trials (RCTs) to evaluate complex healthcare interventions-a case study. Pharm World Sci. 2004;26(5):247–52.PubMedCrossRefGoogle Scholar
  25. 25.
    Van Wijk BLG, Klungel OH, Heerdink ER, De Boer A. Effectiveness of interventions by community pharmacists to improve patient adherence to chronic medication: a systematic review. Ann Pharmacother. 2005;39(2):319–28.PubMedCrossRefGoogle Scholar
  26. 26.
    Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008;(2):CD000011. doi(2):CD000011.Google Scholar
  27. 27.
    Wong IC. RESPECT Team. Randomised controlled trials (RCTs) to evaluate complex healthcare interventions–a case study. Pharm World Sci. 2004;26(5):247–52.PubMedCrossRefGoogle Scholar
  28. 28.
    Krska J, Hansford D, Seymour DG, Farquharson J. Is hospital admission a sufficiently sensitive outcome measure for evaluating medication review services? A descriptive analysis of admissions within a randomised controlled trial. Int J Pharm Pract. 2007;15(2):85–91.CrossRefGoogle Scholar
  29. 29.
    Halvorsen KH, Ruths S, Granas AG, Viktil KK. Multidisciplinary intervention to identify and resolve drug-related problems in Norwegian nursing homes. Scand J Prim Health Care. 2010;28(2):82–8.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Kersten H, Molden E, Tolo IK, Skovlund E, Engedal K, Wyller TB. Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2013;68(3):271–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97.PubMedCrossRefGoogle Scholar
  32. 32.
    Grymonpre RE, Didur CD, Montgomery PR, Sitar DS. Pill count, self-report, and pharmacy claims data to measure medication adherence in the elderly. Ann Pharmacother. 1998;32(7–8):749–54.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Charlotte Olesen
    • 1
    Email author
  • Philipp Harbig
    • 1
  • Kirsten Marie Buus
    • 1
  • Ishay Barat
    • 2
  • Else Marie Damsgaard
    • 1
  1. 1.Department of GeriatricsAarhus University HospitalÅrhus CDenmark
  2. 2.Department of Medicine/GeriatricsHorsens HospitalHorsensDenmark

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