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Role of the Pharmacist in Supporting Adherence

  • Marie P. Schneider
  • Parisa Aslani
Chapter
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)

Abstract

In the era of chronic diseases and polypharmacy, patient nonadherence is a silent and worldwide endemic issue that contributes to extra morbidity/mortality and healthcare costs. Nonadherence can be reduced when addressed by educated healthcare teams, pharmacists being part of them. Pharmacists’ activities have switched from a medication-oriented activity to a patient-centred perspective in order to support patient’s self-management. In collaboration with other healthcare providers, they screen, resolve and prevent medication nonadherence. In parallel to a critical review and a reconciliation of the patient’s treatment, they provide patients with therapeutic education and behavioural support. Pharmacists are trained in communication skills and have many opportunities to monitor patient’s medication-taking behaviour and promote adherence from medication initiation to implementation and persistence. The pharmacist uses tools and strategies for screening (medication computerized histories) and for addressing both intentional and unintentional medication nonadherence. Leaflets are part of educational strategies, whereas medication synchronization approaches, pillboxes, Direct Observed Therapy (D.O.T.) or mHealth are more behavioural.

There is an important body of literature showing the positive impact of pharmacist interventions to support pharmacotherapy, medication adherence and clinical targets in patients with cardiovascular disease (CVD). The most successful pharmacist interventions are multifaceted. However, despite the evidence on their effectiveness, few programmes have been implemented in real-world settings. Such a translation can be made possible through healthcare provider interprofessional education and through new policies. This chapter aims at describing the role of the pharmacist in addressing medication adherence, particularly in cardiovascular patients.

Keywords

Pharmacist Pharmacy Medication adherence Intervention strategies Communication skills Effectiveness Interprofessionality 

References

  1. 1.
    Cutler DM, Everett W. Thinking outside the pillbox—medication adherence as a priority for health care reform. N Engl J Med. 2010;362(17):1553–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Bosworth HB, Granger BB, Mendys P, Brindis R, Burkholder R, Czajkowski SM, et al. Medication adherence: a call for action. Am Heart J. 2011;162(3):412–24.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Chiatti C, Sustacchini S, Furneri G, Mantovani L, Cristiani M, Misuraca C, et al. The economic burden of inappropriate drug prescribing, lack of adherence and compliance, adverse drug events in older people a systematic review. Drug Saf. 2012;35:73–87.CrossRefPubMedGoogle Scholar
  4. 4.
    Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract. 2017;6:37–46.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    van Driel ML, Morledge MD, Ulep R, Shaffer JP, Davies P, Deichmann R. Interventions to improve adherence to lipid-lowering medication. Cochrane Database Syst Rev. 2016;12:CD004371.PubMedGoogle Scholar
  6. 6.
    Joint FIP/WHO Guidelines on GPP: standards for quality of pharmacy services. 2011.Google Scholar
  7. 7.
    WHO Framework on integrated people-centred health services [23.08.2017]. http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/.
  8. 8.
    Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012;73(5):691–705.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Saseen JJ, Ripley TL, Bondi D, Burke JM, Cohen LJ, McBane S, et al. ACCP clinical pharmacist competencies. Pharmacotherapy. 2017;37(5):630–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Horne R, Chapman SC, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One. 2013;8(12):e80633.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lambert-Kerzner A, Havranek EP, Plomondon ME, Fagan KM, McCreight MS, Fehling KB, et al. Perspectives of patients on factors relating to adherence to post-acute coronary syndrome medical regimens. Patient Prefer Adherence. 2015;9:1053–9.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Miller WR, Rollnick S. Motivational interviewing: helping people change. New York: Guilford Press; 2012. 482 p.Google Scholar
  13. 13.
    Hedegaard U, Hallas J, Ravn-Nielsen LV, Kjeldsen LJ. Process- and patient-reported outcomes of a multifaceted medication adherence intervention for hypertensive patients in secondary care. Res Social Adm Pharm. 2016;12(2):302–18.CrossRefPubMedGoogle Scholar
  14. 14.
    Lelubre M, Kamal S, Genre N, Celio J, Gorgerat S, Hugentobler Hampai D, et al. Interdisciplinary medication adherence program: the example of a university community pharmacy in Switzerland. BioMed Res Int. 2015;2015:103546.CrossRefPubMedGoogle Scholar
  15. 15.
    Svarstad BL, Kotchen JM, Shireman TI, Brown RL, Crawford SY, Mount JK, et al. Improving refill adherence and hypertension control in black patients: Wisconsin TEAM trial. J Am Pharm Assoc. 2013;53(5):520–9.CrossRefGoogle Scholar
  16. 16.
    Svarstad BL, Chewning BA, Sleath BL, Claesson C. The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999;37(2):113–24.CrossRefPubMedGoogle Scholar
  17. 17.
    Heisler M, Hofer TP, Klamerus ML, Schmittdiel J, Selby J, Hogan MM, et al. Study protocol: the Adherence and Intensification of Medications (AIM) study—a cluster randomized controlled effectiveness study. Trials. 2010;11:95.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Stuurman-Bieze AG, Hiddink EG, van Boven JF, Vegter S. Proactive pharmaceutical care interventions improve patients’ adherence to lipid-lowering medication. Ann Pharmacother. 2013;47(11):1448–56.CrossRefPubMedGoogle Scholar
  19. 19.
    Puspitasari HP, Aslani P, Krass I. The influence of pharmacy and pharmacist characteristics on the secondary prevention of cardiovascular disease. Int J Clin Pharm. 2015;37(5):834–43.CrossRefPubMedGoogle Scholar
  20. 20.
    Mossialos E, Courtin E, Naci H, Benrimoj S, Bouvy M, Farris K, et al. From “retailers” to health care providers: transforming the role of community pharmacists in chronic disease management. Health Policy. 2015;119(5):628–39.CrossRefPubMedGoogle Scholar
  21. 21.
    Scahill SL, Atif M, Babar ZU. Defining pharmacy and its practice: a conceptual model for an international audience. Integr Pharm Res Pract. 2017;6:121–9.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Schneider MP, Aslani P. Adherence policy, education and practice—an international perspective. Pharm Pract. 2010;8(4):209–12.Google Scholar
  23. 23.
    Hatah E, Braund R, Tordoff J, Duffull SB. A systematic review and meta-analysis of pharmacist-led fee-for-services medication review. Br J Clin Pharmacol. 2014;77(1):102–15.CrossRefPubMedGoogle Scholar
  24. 24.
    Blenkinsopp A, Bond C, Raynor DK. Medication reviews. Br J Clin Pharmacol. 2012;74(4):573–80.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Doshi JA, Lim R, Li P, Young PP, Lawnicki VF, State JJ, et al. A synchronized prescription refill program improved medication adherence. Health Aff (Millwood). 2016;35(8):1504–12.CrossRefPubMedGoogle Scholar
  26. 26.
    Nguyen E, Sobieraj DM. The impact of appointment-based medication synchronization on medication taking behaviour and health outcomes: a systematic review. J Clin Pharm Ther. 2017;42(4):404–13.CrossRefPubMedGoogle Scholar
  27. 27.
    Andrews SB, Marcy TR, Osborn B, Planas LG. The impact of an appointment-based medication synchronization programme on chronic medication adherence in an adult community pharmacy population. J Clin Pharm Ther. 2017;42(4):461–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Krumme AA, Isaman DL, Stolpe SF, Dougherty S, Choudhry NK. Prevalence, effectiveness, and characteristics of pharmacy-based medication synchronization programs. Am J Manag Care. 2016;22(3):179–86.PubMedGoogle Scholar
  29. 29.
    Taitel MS, Mu Y, Gooptu A, Lou Y. Impact of late-to-refill reminder calls on medication adherence in the Medicare Part D population: evaluation of a randomized controlled study. Patient Prefer Adherence. 2017;11:373–9.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Mansoor SM, Krass I, Costa DS, Aslani P. Factors influencing the provision of adherence support by community pharmacists: a structural equation modeling approach. Res Social Adm Pharm. 2015;11(6):769–83.CrossRefPubMedGoogle Scholar
  31. 31.
    Guignard E, Bugnon O. Pharmaceutical care in community pharmacies: practice and research in Switzerland. Ann Pharmacother. 2006;40(3):512–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Demonceau J, Ruppar T, Kristanto P, Hughes DA, Fargher E, Kardas P, et al. Identification and assessment of adherence-enhancing interventions in studies assessing medication adherence through electronically compiled drug dosing histories: a systematic literature review and meta-analysis. Drugs. 2013;73(6):545–62.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Schneider MP, Wuerner G, Celio J, Tremblay S, Burnier M. Clinical interprofessional algorithm for the management of resistant hypertension in Lausanne University Hospital, Switzerland. Personal communication 2015.Google Scholar
  34. 34.
    Dickinson R, Hamrosi K, Knapp P, Aslani P, Sowter J, Krass I, et al. Suits you? A qualitative study exploring preferences regarding the tailoring of consumer medicines information. Int J Pharm Pract. 2013;21(4):207–15.CrossRefPubMedGoogle Scholar
  35. 35.
    Hamrosi KK, Aslani P, Raynor DK. Beyond needs and expectations: identifying the barriers and facilitators to written medicine information provision and use in Australia. Health Expect. 2014;17(2):220–31.CrossRefPubMedGoogle Scholar
  36. 36.
    Hamrosi KK, Raynor DK, Aslani P. Enhancing provision of written medicine information in Australia: pharmacist, general practitioner and consumer perceptions of the barriers and facilitators. BMC Health Serv Res. 2014;14:183.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Santo K, Richtering SS, Chalmers J, Thiagalingam A, Chow CK, Redfern J. Mobile phone apps to improve medication adherence: a systematic stepwise process to identify high-quality apps. JMIR mHealth uHealth. 2016;4(4):e132.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Morton K, Dennison L, May C, Murray E, Little P, McManus RJ, et al. Using digital interventions for self-management of chronic physical health conditions: a meta-ethnography review of published studies. Patient Educ Couns. 2017;100(4):616–35.CrossRefPubMedGoogle Scholar
  39. 39.
    Hameed MA, Tebbit L, Jacques N, Thomas M, Dasgupta I. Non-adherence to antihypertensive medication is very common among resistant hypertensives: results of a directly observed therapy clinic. J Hum Hypertens. 2016;30(2):83–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Ruzicka M, McCormick B, Leenen FH, Froeschl M, Hiremath S. Adherence to blood pressure-lowering drugs and resistant hypertension: should trial of direct observation therapy be part of preassessment for renal denervation? Can J Cardiol. 2013;29(12):1741.e1–3.CrossRefGoogle Scholar
  41. 41.
    Santschi V, Chiolero A, Colosimo AL, Platt RW, Taffe P, Burnier M, et al. Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials. J Am Heart Assoc. 2014;3(2):e000718.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Rotta I, Salgado TM, Silva ML, Correr CJ, Fernandez-Llimos F. Effectiveness of clinical pharmacy services: an overview of systematic reviews (2000-2010). Int J Clin Pharm. 2015;37(5):687–97.CrossRefPubMedGoogle Scholar
  43. 43.
    Mansoor SM, Krass I, Aslani P. Multiprofessional interventions to improve patient adherence to cardiovascular medications. J Cardiovasc Pharmacol Ther. 2013;18(1):19–30.CrossRefPubMedGoogle Scholar
  44. 44.
    Sapkota S, Brien JA, Greenfield J, Aslani P. A systematic review of interventions addressing adherence to anti-diabetic medications in patients with type 2 diabetes—impact on adherence. PLoS One. 2015;10(2):e0118296.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Sapkota S, Brien JA, Greenfield JR, Aslani P. A systematic review of interventions addressing adherence to anti-diabetic medications in patients with Type 2 diabetes—components of interventions. PLoS One. 2015;10(6):e0128581.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Cutrona SL, Choudhry NK, Fischer MA, Servi A, Liberman JN, Brennan TA, et al. Modes of delivery for interventions to improve cardiovascular medication adherence. Am J Manag Care. 2010;16(12):929–42.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Aslani P, Rose G, Chen TF, Whitehead PA, Krass I. A community pharmacist delivered adherence support service for dyslipidaemia. Eur J Pub Health. 2011;21(5):567–72.CrossRefGoogle Scholar
  48. 48.
    Bouvy ML, Heerdink ER, Urquhart J, Grobbee DE, Hoes AW, Leufkens HG. Effect of a pharmacist-led intervention on diuretic compliance in heart failure patients: a randomized controlled study. J Card Fail. 2003;9(5):404–11.CrossRefPubMedGoogle Scholar
  49. 49.
    Chabot I, Moisan J, Gregoire JP, Milot A. Pharmacist intervention program for control of hypertension. Ann Pharmacother. 2003;37(9):1186–93.CrossRefPubMedGoogle Scholar
  50. 50.
    Heisler M, Hofer TP, Schmittdiel JA, Selby JV, Klamerus ML, Bosworth HB, et al. Improving blood pressure control through a clinical pharmacist outreach program in patients with diabetes mellitus in 2 high-performing health systems: the adherence and intensification of medications cluster randomized, controlled pragmatic trial. Circulation. 2012;125(23):2863–72.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Krass I, Taylor SJ, Smith C, Armour CL. Impact on medication use and adherence of Australian pharmacists’ diabetes care services. J Am Pharm Assoc (2003). 2005;45(1):33–40.CrossRefGoogle Scholar
  52. 52.
    Lowrie R, Johansson L, Forsyth P, Bryce SL, McKellar S, Fitzgerald N. Experiences of a community pharmacy service to support adherence and self-management in chronic heart failure. Int J Clin Pharm. 2014;36(1):154–62.CrossRefPubMedGoogle Scholar
  53. 53.
    Marra C, Johnston K, Santschi V, Tsuyuki RT. Cost-effectiveness of pharmacist care for managing hypertension in Canada. Can Pharm J/Revue des pharmaciens du Canada. 2017;150(3):184–97.CrossRefPubMedGoogle Scholar
  54. 54.
    Roebuck MC, Liberman JN, Gemmill-Toyama M, Brennan TA. Medication adherence leads to lower health care use and costs despite increased drug spending. Health Aff (Millwood). 2011;30(1):91–9.CrossRefGoogle Scholar
  55. 55.
    Stewart K, George J, Mc Namara KP, Jackson SL, Peterson GM, Bereznicki LR, et al. A multifaceted pharmacist intervention to improve antihypertensive adherence: a cluster-randomized, controlled trial (HAPPy trial). J Clin Pharm Ther. 2014;39(5):527–34.CrossRefPubMedGoogle Scholar
  56. 56.
    Burnier M, Schneider MP, Chiolero A, Stubi CL, Brunner HR. Electronic compliance monitoring in resistant hypertension: the basis for rational therapeutic decisions. J Hypertens. 2001;19(2):335–41.CrossRefPubMedGoogle Scholar
  57. 57.
    Hedegaard U, Kjeldsen LJ, Pottegard A, Henriksen JE, Lambrechtsen J, Hangaard J, et al. Improving medication adherence in patients with hypertension: a randomized trial. Am J Med. 2015;128(12):1351–61.CrossRefPubMedGoogle Scholar
  58. 58.
    Ho PM, Lambert-Kerzner A, Carey EP, Fahdi IE, Bryson CL, Melnyk SD, et al. Multifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge: a randomized clinical trial. JAMA Intern Med. 2014;174(2):186–93.CrossRefPubMedGoogle Scholar
  59. 59.
    Jarab AS, Alqudah SG, Mukattash TL, Shattat G, Al-Qirim T. Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan. J Manag Care Pharm. 2012;18(7):516–26.PubMedGoogle Scholar
  60. 60.
    Mino-Leon D, Reyes-Morales H, Flores-Hernandez S. Effectiveness of involving pharmacists in the process of ambulatory health care to improve drug treatment adherence and disease control. J Eval Clin Pract. 2015;21(1):7–12.CrossRefPubMedGoogle Scholar
  61. 61.
    Morgado M, Rolo S, Castelo-Branco M. Pharmacist intervention program to enhance hypertension control: a randomised controlled trial. Int J Clin Pharm. 2011;33(1):132–40.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D, et al. Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med. 2007;146(10):714–25.CrossRefPubMedGoogle Scholar
  63. 63.
    Neto PR, Marusic S, de Lyra Junior DP, Pilger D, Cruciol-Souza JM, Gaeti WP, et al. Effect of a 36-month pharmaceutical care program on the coronary heart disease risk in elderly diabetic and hypertensive patients. J Pharm Pharm Sci. 2011;14(2):249–63.CrossRefPubMedGoogle Scholar
  64. 64.
    Santschi V, Tsuyuki RT, Paradis G. Evidence for pharmacist care in the management of hypertension. Can Pharm J/Revue des pharmaciens du Canada. 2015;148(1):13–6.CrossRefGoogle Scholar
  65. 65.
    Wong MC, Liu KQ, Wang HH, Lee CL, Kwan MW, Lee KW, et al. Effectiveness of a pharmacist-led drug counseling on enhancing antihypertensive adherence and blood pressure control: a randomized controlled trial. J Clin Pharmacol. 2013;53(7):753–61.CrossRefPubMedGoogle Scholar
  66. 66.
    Al Mazroui NR, Kamal MM, Ghabash NM, Yacout TA, Kole PL, McElnay JC. Influence of pharmaceutical care on health outcomes in patients with Type 2 diabetes mellitus. Br J Clin Pharmacol. 2009;67(5):547–57.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Stange D, Kriston L, von-Wolff A, Baehr M, Dartsch DC. Reducing cardiovascular medication complexity in a German university hospital: effects of a structured pharmaceutical management intervention on adherence. J Manag Care Pharm. 2013;19(5):396–407.PubMedGoogle Scholar
  68. 68.
    Abughosh SM, Wang X, Serna O, Henges C, Masilamani S, Essien EJ, et al. A pharmacist telephone intervention to identify adherence barriers and improve adherence among nonadherent patients with comorbid hypertension and diabetes in a Medicare Advantage Plan. J Manag Care Spec Pharm. 2016;22(1):63–73.CrossRefPubMedGoogle Scholar
  69. 69.
    Simoens S, Spinewine A, Foulon V, Paulus D. Review of the cost-effectiveness of interventions to improve seamless care focusing on medication. Int J Clin Pharm. 2011;33(6):909–17.CrossRefPubMedGoogle Scholar
  70. 70.
    Santschi V, Chiolero A, Paradis G, Colosimo AL, Burnand B. Pharmacist interventions to improve cardiovascular disease risk factors in diabetes: a systematic review and meta-analysis of randomized controlled trials. Diabetes Care. 2012;35(12):2706–17.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Santschi V, Chiolero A, Burnand B, Colosimo AL, Paradis G. Impact of pharmacist care in the management of cardiovascular disease risk factors: a systematic review and meta-analysis of randomized trials. Arch Intern Med. 2011;171(16):1441–53.CrossRefPubMedGoogle Scholar
  72. 72.
    St Peter WL, Farley TM, Carter BL. Role of collaborative care models including pharmacists in improving blood pressure management in chronic kidney disease patients. Curr Opin Nephrol Hypertens. 2011;20(5):498–503.CrossRefPubMedGoogle Scholar
  73. 73.
    La Caze A, Gujral G, Cottrell WN. How do we better translate adherence research into improvements in patient care? Int J Clin Pharm. 2014;36(1):10–4.CrossRefPubMedGoogle Scholar
  74. 74.
    Marquis J, Schneider MP, Spencer B, Bugnon O, Du Pasquier S. Exploring the implementation of a medication adherence programme by community pharmacists: a qualitative study. Int J Clin Pharm. 2014;36(5):1014–22.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Community Pharmacy, Department of Ambulatory Care and Community MedicineUniversity of LausanneLausanneSwitzerland
  2. 2.Community Pharmacy, School of Pharmaceutical SciencesUniversity of Geneva, University of LausanneLausanneSwitzerland
  3. 3.Faculty of PharmacyThe University of SydneySydneyAustralia

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