To systematically review the impact of interventions by community pharmacists on patients' adherence with chronic medication.
DATA SOURCES:
A MEDLINE search (1966–November 30, 2003) and a review of reference sections were done to identify all pertinent English- and German-language journal articles. Search terms included compliance, adherence, persistence, discontinuation, pharmacist, and intervention.
STUDY SELECTION AND DATA EXTRACTION:
From each relevant study, the following data were extracted: study design, country, disease, number of patients, patients' age and gender, type of intervention, duration of follow-up, method of measurement of adherence and adherence rate, and data concerning the quality of the included studies.
DATA SYNTHESIS:
A total of 162 studies were identified, of which 18 matched our inclusion criteria. Twelve were randomized controlled trials and 6 were non-crossover single-group trials. Eight studies showed significant improvement of adherence at one or more time points. Eight studies did not show any effect, 7 of which were randomized controlled trials. In most studies, adherence rates at baseline were high compared with rates reported in the general population. Counseling, monitoring, and education during weekly or monthly appointments showed some effect. However, these same types of interventions showed no effect in other studies. The overall quality of the included studies was low.
CONCLUSIONS:
Currently, it is impossible to identify an overall successful adherence-improving strategy performed by pharmacists. More well-designed and well-conducted studies on the effectiveness of interventions by a community pharmacist to improve patient adherence to chronic medication need to be performed.
BaumanLJWrightELeicklyFECrainEKruszon-MoranDWadeSLRelationship of adherence to pediatric asthma morbidity among inner-city children (abstract). Pediatrics2002;110(1 pt 1):e6.
2.
BrownJBNicholsGAGlauberHSBakstA.Ten-year follow-up of antidiabetic drug use, nonadherence, and mortality in a defined population with type 2 diabetes mellitus. Clin Ther1999;21: 1045–57.
3.
DewMAKormosRLRothLHMuraliSDiMartiniAGriffithBP.Early post-transplant medical compliance and mental health predict physical morbidity and mortality one to three years after heart transplantation. J Heart Lung Transplant1999;18: 549–62.
4.
BanderSJWaltersBA.Hemodialysis morbidity and mortality: Links to patient non-compliance. Curr Opin Nephrol Hypertens1998;7: 649–53.
5.
MiuraTKojimaRMizutaniMShigaYTakatsuFSuzukiY.Effect of digoxin noncompliance on hospitalization and mortality in patients with heart failure in long-term therapy: A prospective cohort study. Eur J Clin Pharmacol2001;57: 77–83.
6.
CleemputIKestelootKDeGeestS.A review of the literature on the economics of noncompliance. Room for methodological improvement. Health Policy2002;59: 65–94.
7.
FIP statements on professional standards. Pharmaceut J1998;261: 427–9.
8.
PerrinECNewacheckPPlessIBDrotarDGortmakerSLLeventhalJIssues involved in the definition and classification of chronic health conditions. Pediatrics1993;91: 787–93.
WeinbergerMMurrayMDMarreroDGBrewerNLykensMHarrisLEEffectiveness of pharmacist care for patients with reactive airways disease: A randomized controlled trial. JAMA2002;288: 1594–602.
11.
BerringerRShibleyMCCaryCCPughCBPowersPARafiJA.Outcomes of a community pharmacy-based diabetes monitoring program. J Am Pharm Assoc (Wash)1999;39: 791–7.
12.
DumasJMatteJ.Characteristics of pharmaceutical opinions written in a Quebec community pharmacy. Ann Pharmacother1992;26: 835–9.
13.
CordinaMMcElnayJCHughesCM.Assessment of a community pharmacy-based program for patients with asthma. Pharmacotherapy2001;21: 1196–203.
14.
OdedinaFLeaderAVenkataramanKColeRStormA.Feasibility of a Community Asthma Management Network (CAMN) program: Lessons learnt from an exploratory investigation. J Social Administrative Pharm2000;17: 15–24.
15.
ParkJJKellyPCarterBLBurgessPP.Comprehensive pharmaceutical care in the chain setting. J Am Pharm Assoc (Wash)1996;NS36:443–51.
16.
McKenneyJMSliningJMHendersonHRDevinsDBarrM.The effect of clinical pharmacy services on patients with essential hypertension. Circulation1973;48: 1104–11.
17.
VolumeCIFarrisKBKassamRCoxCECaveA.Pharmaceutical care research and education project: Patient outcomes. J Am Pharm Assoc (Wash)2001;41: 411–20.
18.
BarnettCWNykampDEllingtonAM.Patient-guided counseling in the community pharmacy setting. J Am Pharm Assoc (Wash)2000;40: 765–72.
19.
BlumlBMMcKenneyJMCzirakyMJ.Pharmaceutical care services and results in project ImPACT: Hyperlipidemia. J Am Pharm Assoc (Wash)2000;40: 157–65.
20.
McKenneyJMBrownED.Effect of pharmacist drug monitoring and patient education on hypertensive patients. Contemp Pharm Pract1978;1: 50–6.
21.
SlamaPJGurwichEL.Effect of pharmacist consultation on medication compliance. Contemp Pharm Pract1978;1: 71–7.
22.
GrantRWDevitaNGSingerDEMeigsJB.Improving adherence and reducing medication discrepancies in patients with diabetes. Ann Pharmacother2003;37: 962–9. DOI 10.1345/aph.1C452.
23.
ChabotIMoisanJGrégoireJPMilotA.Pharmacist intervention program for control of hypertension. Ann Pharmacother2003;37: 1186–93. DOI 10.1345/aph.1C267.
24.
BouvyMLHeerdinkERUrquhartJGrobbeeDEHoeAWLeufkensHG.Effect of a pharmacist-led intervention on diuretic compliance in heart failure patients: A randomized controlled study. J Card Fail2003;9: 404–11.
25.
AliFLaurinMYLariviereCTremblayDCloutierD.The effect of pharmacist intervention and patient education on lipid-lowering medication compliance and plasma cholesterol levels. Can J Clin Pharmacol2003;10: 101–6.
26.
SturgessIKMcElnayJCHughesCMCrealeyG.Community pharmacy based provision of pharmaceutical care to older patients. Pharm World Sci2003;25: 218–26.
27.
McDonoughRPDoucetteWR.Drug therapy management: An empirical report of drug therapy problems, pharmacists' interventions, and results of pharmacists' actions. J Am Pharm Assoc (Wash)2003;43: 511–8.
28.
HaynesRBMcDonaldHGargAXMontagueP.Interventions for helping patients to follow prescriptions for medications. Cochrane Database Syst Rev2002:CD000011.
SchroederKFaheyTEbrahimS.Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings. Cochrane Database Syst Rev2004:CD004804.
31.
HaddadMInchCGlazierRHWilkinsALUrbshottGBayoumiAPatient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochrane Database Syst Rev2000:CD001442.
32.
EggerMZellweger-ZahnerTSchneiderMJunkerCLengelerCAntesG.Language bias in randomised controlled trials published in English and German. Lancet1997;350: 326–9.
33.
DiezelKPharoahFMAdamsCE.Abstracts of trials presented at the Vth World Congress of Psychiatry (Mexico, 1971): A cohort study. Psychol Med1999;29: 491–4.
34.
HeplerCDStrandLM.Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm1990;47: 533–43.
35.
De YoungM.Research on the effects of pharmacist-patient communication in institutions and ambulatory care sites, 1969–1994. Am J Health Syst Pharm1996;53: 1277–91.
36.
TullyMPSestonEM.Impact of pharmacists providing a prescription review and monitoring service in ambulatory care or community practice. Ann Pharmacother2000;34: 1320–31. DOI 10.1345/aph.19374.
37.
SinghalPKRaischDWGupchupGV.The impact of pharmaceutical services in community and ambulatory care settings: Evidence and recommendations for future research. Ann Pharmacother1999;33: 1336–55. DOI 10.1345/aph.18440.
38.
MorrisonAWertheimerAI.Evaluation of studies investigating the effectiveness of pharmacists' clinical services. Am J Health Syst Pharm2001;58: 569–77.
39.
UlmerFC.The Hawthorne effect. Educ Dir Dent Aux1976;1:28.
40.
SoumeraiSBSalem-SchatzSAvornJCasterisCSRoss-DegnanDPopovskyMA.A controlled trial of educational outreach to improve blood transfusion practice. JAMA1993;270: 961–6.
41.
PayneKAEsmonde-WhiteS.Observational studies of antihypertensive medication use and compliance: Is drug choice a factor in treatment adherence?Curr Hypertens Rep2000;2: 515–24.
42.
DusingR.Adverse events, compliance, and changes in therapy. Curr Hypertens Rep2001;3: 488–92.
43.
DonnanPTMacDonaldTMMorrisAD.Adherence to prescribed oral hypoglycaemic medication in a population of patients with type 2 diabetes: A retrospective cohort study. Diabet Med2002;19: 279–84.
44.
MelikianCWhiteTJVanderplasADeziiCMChangE.Adherence to oral antidiabetic therapy in a managed care organization: A comparison of monotherapy, combination therapy, and fixed-dose combination therapy. Clin Ther2002;24: 460–7.
45.
JonassonGCarlsenKHMowinckelP.Asthma drug adherence in a long term clinical trial. Arch Dis Child2000;83: 330–3.
46.
CochraneGMHorneRChanezP.Compliance in asthma. Respir Med1999;93: 763–9.
47.
ChooPWRandCSInuiTSLeeMLCainECordeiro-BreaultMValidation of patient reports, automated pharmacy records, and pill counts with electronic monitoring of adherence to antihypertensive therapy. Med Care1999;37: 846–57.
48.
ConlinPRGerthWCFoxJRoehmJBBoccuzziSJ.Four-year persistence patterns among patients initiating therapy with the angiotensin II receptor antagonist losartan versus other antihypertensive drug classes. Clin Ther2001;23: 1999–2010.
49.
GregoireJPMoisanJGuibertRCiampiAMilotAGaudetMDeterminants of discontinuation of new courses of antihypertensive medications. J Clin Epidemiol2002;55: 728–35.
50.
CatalanVSCoutureJALeLorierJ.Predictors of persistence of use of the novel antidiabetic agent acarbose. Arch Intern Med2001;161: 1106–12.
51.
Mantel-TeeuwisseAKKlungelOHEgbertsTCVerschurenWMPorsiusAJde BoerA.Failure to continue lipid-lowering drug use following the withdrawal of cerivastatin. Drug Saf2004;27: 63–70.
