This is not the first Tip of the Week to discuss some aspect of patient medication adherence nor will it be the last. Again, assuring or at least promoting or facilitating adherence to medications is one of the most salient unmet needs in health care and is a true calling to the pharmacy profession. It is useful to examine adherence within the context of everyday pharmacy practice and also within the context of specific value-added services led by pharmacists to promote medication adherence. It is even more beneficial for us to know whether such adherence leads to improvement in patient outcomes.
Milosavljevic et al undertook a systematic review of pharmacist-led interventions and their impact on adherence and other outcomes.1 Their search of literature involving all the major medical and health databases found 22 studies reported in 26 different peer-reviewed articles. In some cases, adherence was measured using objective methods such as pill counts and medication event monitoring system (MEMS) caps on drug vials, whereas others used patient self-report measures. The study looked at clinical outcomes such as blood pressure, HbA1c for blood glucose, blood lipids, respiratory disease control (eg, decreased use of rescue medications and patient FEV), symptoms of depression, patient knowledge, patient satisfaction, patient quality of life, and economic outcomes. Community pharmacist-led interventions were shown to improve patients’ adherence and contribute to better blood pressure control, cholesterol management, chronic obstructive pulmonary disease and asthma control, and a mixed bag on outcomes such as quality of life and economic indicators. Studies in this review, however, did not report statistically significant effects of interventions on diabetes or depression control. The authors caution also that many of the studies could have been biased by the fact that it was the pharmacists, themselves, reporting patient outcomes.
Pharmacists can provide a tremendous amount of public good in the services they provide. Models exist for pharmacists to have positive effects on patient outcomes across a number of diseases, and we can learn from past efforts to improve our attempts in other disease states. Pharmacy managers can use the literature as a blueprint for success and must document the outcomes being improved so as to better justify payment for these value-added services.
Additional information about Value-Added Services as a Component of Enhancing Pharmacists’ Roles in Public Health 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.
1Minosavljevic A, Aspden T, Harrison J. Community pharmacist-led interventions and their impact on patients’ medication adherence and other health outcomes: A systematic review. Int J Pharm Pract. 2018;26:387-397.