Using Theory to Guide Simple, Effective Interventions

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When pharmacists and researchers discuss medication adherence, they often place the conversation within the context of chronic medication therapy. However, adherence is also important for short-term courses of therapy, such as with antibiotics. Non-adherence can result in treatment failure, antibiotic resistance, and medication wastage.

West and Cordina conducted an intervention to determine if an educational leaflet could enhance adherence and reduce cost in relation to wastage of unused antibiotics.1 They described past interventions such as telephone reminders that were not very successful. They contend that information needs to be conveyed in a way that is easily readable and understood. They stated further that interventions developed to enhance adherence to short-term antibiotics should be easily implementable and should mirror real-life scenarios. A useful theoretical framework from which to design interventions is Normalization Process Theory, which identifies factors that encourage and hinder implementation into routine practice. It emphasizes coherence, cognitive participation, collective action, and reflexive monitoring. These principles were used as the basis for design of the educational leaflet. The top of the leaflet provided space for tailored, handwritten information, and the bottom contained information on storage, disposal, and risk of resistance. Adherence and other parameters were measured against a control group. As a result, 10% of patients in the leaflet group were nonadherent, as opposed to 24% from the control group. There was also a statistical difference in total days of therapy used (taken). The control group wasted significantly more antibiotics, as measured in doses and in cost, with over 10% of wastage in the control group, versus only 3.6% in the leaflet group. There was also a higher “general medicines” belief among the patients in the leaflet group.

A simple intervention was associated with greater adherence, less medication wastage, and greater beliefs in the effectiveness of their medication. This was performed using easily constructed leaflets disseminated with the prescription and could easily be tailored for other medications, such as opioids or other pain regimens. Pharmacy managers can invest small amounts of time and very little if any capital to design interventions that can make a significant impact for certain patients on particular types of medications. Doing so is good for them and good for the business. One need not be a theoretician to find solid guiding principles in the literature from which to base these interventions.

Additional information about Implementing Value-Added Services can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1West LM, Cordina C. Educational intervention to enhance adherence to short-term use of antibiotics. Res Social Adm Pharm. 2019;15(2):193-201.

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California

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Shane Desselle 4 months ago

Formerly, pharmacy curriculums did not spend much time on theory. You might have spent s bit more. Are you ready to employ any of then to improve patient care?