Pharmacists well-placed to help tackle non-adherence

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A new Cochrane review has looked at medication non-adherence in older Australians, and how behavioural and educational interventions can help

Researchers from Monash University’s Centre for Medicine Use and Safety have published a review in the Cochrane Library about improving medication adherence in older populations.

The review, Interventions for improving medication‐taking ability and adherence in older adults prescribed multiple medications, found that behavioural-only or mixed educational and behavioural interventions, especially those initiated at the hospital-community/primary care interface, may improve the proportion of older adults who stick to their medication schedules.

Lead researcher Dr Amanda Cross highlighted the importance of pharmacists in this space.

“Pharmacists are particularly well positioned to support these patients with their medication use, especially across transitions of care, for example when they are discharged from hospital and preparing to go home,” she said.

The review, led by Dr Cross and Dr Johnson George from the CMUS, identified 50 studies with more than 14,000 participants.

The impact of interventions on clinical health outcomes was also explored and it was found that mixed educational and behavioural interventions may improve older people’s medication knowledge and reduce the number of ED/hospital admissions.

“Polypharmacy is becoming a growing issue within Australia and we know that poor adherence contributes to adverse drug events and increases risk of hospitalisations,” Dr Cross said.

“Our review has shown that mixed behavioural and educational interventions may help to improve adherence and reduce hospital admissions among older adults taking multiple medications.

“Highlighting the importance of behavioural interventions, either alone or in combination with education, has implications for health-care providers.

“Pharmacists in particular are uniquely placed to implement behavioural interventions, including simplifying medication regimens or organising dose administration aids.”

The researchers noted that the studies they used involved a range of interventions, from simple to complex; because of significant variation between studies, they sorted them into three broad groups: educational interventions, behavioural and mixed interventions.

Across the studies, pharmacists were the group most likely to perform such interventions (31 studies), followed by nurses (17 studies), and physicians (15 studies), either alone (31 studies) or in multidisciplinary teams.

The researchers noted that recent changes that allow pharmacists to complete follow-up visits after medication reviews provide a “great avenue” for identifying patient-specific barriers to adherence and tailoring interventions to help patients stick to their medication schedules.

“The other key finding from our review is the need for further robust randomised controlled trials of behavioural and educational interventions, particularly ones that evaluate medication-taking ability and cost-effectiveness,” Dr Cross said.

“This evidence is required in order to see wide-spread policy and practice change.”

Dr Cross said while the review highlighted the value of behavioural interventions, the quality of the wider body of evidence was low and further well-designed studies and innovations are needed to improve medication taking.

The review can be accessed here.

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1 Comment

  1. Greg Kyle

    While I do not doubt the evidence reviewed, my age old question about studies that hold up the ‘holy grail’ of increasing adherence is “Why is there non-adherence in the first place?”. This is the question that needs to be answered, but it presents a much more tricky problem than “You’re not taking your medicine(s) as prescribed Mr/Mrs/Ms Smith”.

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