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Medication adherence rates are only temporarily improved by pharmacist interventions, Australian study reveals

Intervention by pharmacists to promote medication adherence by patients does not appear to lead to sustained improvements, new Australian research has revealed.

A study of data from the Guildlink MedScreen Compliance Program has show an initial improvement in rates of adherence to three key medications, but these rates then declined by around a year after the intervention.

The authors collated data on 20,335 patients from 1805 pharmacies – 11,257 of the patients were using rosuvastatin, 6797 using irbesartan and 2281 were on desvenlafaxine.

They found adherence rates increased from 50.2% to 66.9% for rosuvastatin users, with similar increases (50% to 68%) for irbesartan and (47% to 66%) for desvenlafaxine over the first three months following the intervention.

These rates then declined to 62% for rosuvastatin and irbesartan, and 58% to desvenlafaxine.

The authors, who included Professor SI ‘Charlie’ Benrimoj, former Dean of the Graduate School of Health at the University of Technology Sydney said that trends observed before and after the intervention in each of the drugs were:

  • A gradual decrease in average Proportion of Days Covered (PDC) rates during a 1 year pre-intervention
  • An increase after the pharmacist’s intervention was delivered, followed by
  • A subsequent decrease over time

“This is consistent with previous evidence, which highlights the dynamic nature of medication adherence over time,” they concluded.

The authors said pharmacist intervention programs may need to incorporate detailed follow-up mechanisms and schemes, or include a more complex approach to the reasons for undertaking an intervention.

“Medication non-adherence is a complex and multifactorial problem influenced by multiple
determinants across different domains. This might be the reason why complex and multi-component interventions are often seen as the most effective strategies for improving adherence,” they said.

“Potential approaches to improve the current MedScreen Compliance GuildCare adherence intervention might include the use of the perceptions and practicalities approach, distinguishing between unintentional and intentional non-adherence. This would allow a more tailored approach to the problem, increasing the likelihood of success.”

They also suggested the use of SMS reminders or alarms to help patients adopt a medication taking routine.

“Establishing follow-up mechanisms, enhancement of the intervention using an evidence based approach and incorporating a more accurate method for the real time analysis of dispensing data by using big data techniques would assist community pharmacists in improving medication adherence,” they concluded.

The research was published in the journal Frontiers in Pharmacology.

 

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2 Comments

  1. Debbie Rigby
    22/03/2019

    Improving medication adherence and persistence requires a multifaceted approach. SMS reminders, DAAs, apps are only part of the solution. Our dispensing software needs to be improved to flag poor adherence and not refilling repeat prescriptions. But more than anything, it’s the relationships and conversation we can have with our patients that will make a difference. Understanding the concepts of health behaviour change. Using funded programs such as MedsCheck and HMRs to their fullest capacity. Being proactive. Being ‘kind and careful’.

  2. Jarrod McMaugh
    22/03/2019

    “The authors said pharmacist intervention programs may need to incorporate detailed follow-up mechanisms and schemes, or include a more complex approach to the reasons for undertaking an intervention.”

    I would suggest that simpler interactions more often (such as monthly contact that includes actual clinical input rather than transactional supply) would have a better impact than complex approaches.

    The key is clinical input; otherwise, get a vending machine to dispense

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