It is important for pharmacists to understand the relationship between medication adherence and patient outcomes.
This is not the first nor will it be the last thing you read about patient adherence to drug therapy. 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. Therefore, it is useful to examine attempts to promote patient adherence in everyday practice and also within the context of specific value-added services led by pharmacists. It is that much more important for us to understand the relationship between medication adherence and patient outcomes.
A systematic review of pharmacist-led interventions and their impact on adherence and other outcomes was published in the International Journal of Pharmacy Practice.1 The investigators’ search of literature 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 other studies used patient self-report measures.
The review looked at clinical outcomes including blood pressure, HbA1c for blood glucose, blood lipids, respiratory disease control, such as decreased use of rescue medications and patient forced expiratory volume; 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 that many of the studies could have been biased because 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. Promoting adherence will continue to be among our primary callings, even as we expand our activities further into public health domains.
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. Although pharmacy personnel generally understand the importance of medication adherence, managers can emphasize this as the pharmacy’s core value and keep abreast of technologies, interventions, and educational approaches that maximize medication adherence.
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.
Shane P. Desselle, RPh, PhD, FAPhA, Professor Social/Behavioral Pharmacy at Touro University California in Vallejo.
Minosavljevic 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.