Weekly pharmacist contact boosts compliance

cartoon heart dressed as doctor

Elderly patients with heart failure who see a pharmacist once a week are more likely to take their medication and be active daily, new research has found

The late-breaking research from the PHARM-CHF randomised controlled trial was presented at Heart Failure 2019, a scientific congress of the European Society of Cardiology.

“Adhering to a complex medication regimen is a huge challenge for elderly patients with heart failure,” said co-principal investigator Professor Martin Schulz, of the Department of Clinical Pharmacy, Freie Universitaet Berlin, Germany.

“It is estimated that 30% to 50% of patients in Europe are nonadherent to heart failure medications, which results in increased frequency and severity of symptoms such as breathlessness, worsening heart failure and consequent hospitalisations, and higher mortality.”

The researchers define nonadherence as not collecting scripts, taking a lower dose or fewer pills than prescribed, taking “drug holidays” – for example, on weekends or holidays or when a patient is feeling better – or completely ceasing to take one or more medicines.

The trial examined whether regular contact with a pharmacist could improve adherence to heart failure medications.

It included 237 ambulatory chronic heart failure patients aged 60 years of age and up, who were randomly assigned to usual care, or a pharmacy intervention, with a follow-up for a median of two years.

The average age was 74 years, 62% were male, and the median number of different drugs was nine.

The intervention arm of the trial saw patients begin with a medicines review, in which they brought their medicines to a pharmacist, who then looked for drug interactions and doubled-up medicines. The pharmacist then contact the prescriber about any risks they had spotted, and made a medication plan.

These patients then visited the pharmacy every eight to 10 days to discuss adherence and any symptoms, and have their blood pressure and pulse rate checked.

The medicines were prescribed in a pillbox with labelled compartments for morning, noon, evening and night each 24 hours.

The pharmacist updated the medication plan if needed and contacted the doctor with new drug-related problems or significant changes in vital signs.

The primary efficacy endpoint was the proportion of days three heart failure medications were collected (using pharmacy claims data) in the year after randomisation. The drugs were beta blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and mineralocorticoid receptor antagonists.

Compared to usual care, the intervention resulted in a 5.7% absolute increase in collection.

The researchers also calculated the proportion of patients who collected the three drugs at least 80% of the days under study (defined as adherent) compared to baseline.

The proportion of adherent patients increased from 44% to 86% in the pharmacy group and from 42% to 68% in the usual care group: a difference of 18% points between the two groups.

Patients in the pharmacy group were three times more likely to become adherent compared to the usual care group.

There was no difference between groups in the primary composite safety endpoint of days lost in the year following randomisation due to unplanned cardiovascular hospitalisations or all-cause death.

Improvement in quality of life was more pronounced in the pharmacy group after one year and significantly better compared to the usual care group after two years.

This meant patients in the pharmacy group were less limited in their daily activities and less worried about their disease.

Professor Schulz, who is also director of the Department of Medicine at ABDA – Federal Union of German Associations of Pharmacists, said patients would need to see the pharmacist every week for the rest of their lives for the benefits to continue.

“The key point is that pharmacy visits need to be used as an opportunity to provide structured care.”

Co-principal investigator Professor Ulrich Laufs, director of the Department of Cardiology, Leipzig University, Germany, said, “Cardiologists and general practitioners would welcome this type of intervention since it does not change the medication that is prescribed but helps patients to follow the treatment strategy.”

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