A Pharmaceutical Care Program to Improve Adherence to Statin Therapy: A Randomized Controlled Trial

Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands.
Annals of Pharmacotherapy (Impact Factor: 2.06). 12/2010; 44(12):1905-13. DOI: 10.1345/aph.1P281
Source: OAI

ABSTRACT Despite the well-known beneficial effects of statins, many patients do not adhere to chronic medication regimens.
To implement and assess the effectiveness of a community pharmacy-based pharmaceutical care program developed to improve patients' adherence to statin therapy.
An open-label, prospective, randomized controlled trial was conducted at 26 community pharmacies in the Netherlands. New users of statins who were aged 18 years or older were randomly assigned to receive either usual care or a pharmacist intervention. The intervention consisted of 5 individual counseling sessions by a pharmacist during a 1-year period. During these sessions, patients received structured education about the importance of medication adherence, lipid levels were measured, and the association between adherence and lipid levels was discussed. Adherence to statin therapy was assessed as discontinuation rates 6 and 12 months after statin initiation, and as the medication possession ratio (MPR), and compared between the pharmaceutical care and usual care groups.
A total of 899 subjects (439 in the pharmaceutical care group and 460 in the usual care group) were evaluable for effectiveness analysis. The pharmaceutical care program resulted in a significantly lower rate of discontinuation within 6 months after initiating therapy versus usual care (HR 0.66, 95% CI 0.46 to 0.96). No significant difference between groups was found in discontinuation at 12 months (HR 0.84, 95% CI 0.65 to 1.10). Median MPR was very high (>99%) in both groups and did not differ between groups.
These results demonstrate the feasibility and effectiveness of a community pharmacy-based pharmaceutical care program to improve medication adherence in new users of statins. Frequent counseling sessions (every 3 months) are necessary to maintain the positive effects on discontinuation. Although improvements are modest, the program can be applied easily to a larger population and have a large impact, as the interventions are relatively inexpensive and easy to implement in clinical practice.

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Available from: O.H. Klungel, Sep 27, 2015
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    • "Interventions commonly involved multiple avenues for interaction with patients, including face-to-face and telephone encounters. Although the majority of these interventions included populations with complex medication needs, a number of interventions focused on specific chronic conditions [41;42;45-47;50] or specific medications [41]. "
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    ABSTRACT: Objective Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior. Methods We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013. Two reviewers abstracted information and categorized studies by intervention type. Results We identified 60 studies, of which 40% focused on patient education. Other intervention types included augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. Medication adherence was an outcome in most (70%) of the studies, although 50% also examined patient-centered outcomes. Conclusions We identified a large number of medication management interventions that incorporated patient-centered care and improved patient outcomes. We were unable to determine whether these interventions are more effective than traditional medication adherence interventions. Practice Implications Additional research is needed to identify effective and feasible approaches to incorporate patient-centeredness into the medication management processes of the current health care system, if appropriate.
    Patient Education and Counseling 09/2014; 97(3). DOI:10.1016/j.pec.2014.08.021 · 2.20 Impact Factor
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    ABSTRACT: Purpose Effective treatment of hyperlipidemia is an important precondition for cardiovascular diseases. Unfortunately, adherence to lipid-lowering treatment is unsatisfactory. In order to improve adherence to statins, an intervention combining educational and behavioural components was tested in general practice settings. Methods A total of 198 outpatients with untreated hyperlipidemia were enrolled in this open-label, prospective, randomised study. Patients were prescribed simvastatin, in initial dosage of 20 mg daily, and followed for 48 weeks. Intervention group received educational counseling at each visit (that is every 8 weeks); and were also asked to adopt a routine evening activity of their choice for a reminder. Control group obtained usual care. Primary outcome measure was patient adherence, expressed as medication possession ratio (MPR). Results Patients’ mean age was 59.6 +/- 9.1 years. Study arms differed in their level of adherence: mean ± SD MPR was 95.4±53.7% and 81.7±31.0%, for intervention and control group, respectively (P<0.05). Patients from intervention group found a reminder activity useful in over 90% of cases. Conclusions Simple inexpensive educational-behavioural intervention proved to be effective in enhancing adherence to statins in hyperlipidemia. Given the health and economic consequences of non-adherence, these results may have high clinical, and practical usefulness.
    Central European Journal of Medicine 10/2013; 8(5). DOI:10.2478/s11536-013-0170-9 · 0.15 Impact Factor
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    ABSTRACT: Interventions to improve adherence with medicines have been studied for many years. The outcomes, both for improved adherence and clinical indicators, have not been as positive as expected or hoped for. Any improvement in adherence that may occur has not necessarily translated to improved clinical outcomes. The studies are heterogeneous, often of poor quality, with different outcomes and measures of outcome, and with ill-defined interventions, such as a lack of information on specific content of an 'educational' intervention. It appears that interventions are very resource intensive with no cost-effectiveness studies. More research is required into interventions to improve medicines adherence before more health care funding is invested in labour-intensive interventions that appear logical but are not supported by evidence from quality research.
    Journal of primary health care 01/2011; 3(3):240-3.
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