[show abstract][hide abstract] ABSTRACT: Patient adherence to medications has been an issue challenging healthcare professionals for decades. Adherence rates, causes of non-adherence, barriers and enablers to medication taking, interventions to promote adherence, and the impact of non-adherence on health outcomes, have been extensively studied. In light of this, the area of adherence research has progressed conceptually and practically. This special issue contains a range of articles which focus on different aspects of adherence, from standardising terminology and methods of measurement, to non-adherence in a broad range of patient populations, and to interventions to promote adherence.
International journal of clinical pharmacy. 12/2013;
[show abstract][hide abstract] ABSTRACT: Suboptimal adherence to treatment regimens is a major obstacle to treatment efficacy and positive outcomes for patients. While poor adherence is common across a variety of chronic conditions, an area which presents unique challenges to clinicians and researchers is non-adherence among pediatric populations. These challenges are well illustrated by the management of attention-deficit/hyperactivity disorder (ADHD), a pervasive pediatric psychiatric condition. The average rates of non-adherence in children and adults ranged between 15 and 87%. Factors predicting increased adherence/persistence included the use of long-acting formulations, younger age, Caucasian background, family structure and the presence and treatment of comorbidities. Decreased adherence/persistence were predicted by multiple daily dosing, family history of ADHD, experiences of adverse effects, stigma and treatment inefficacy. The broad range of non-adherence rates identified reflects the complexities of adherence research in ADHD, and highlights the need for better standardization of adherence/persistence definitions and measurement approaches.
Expert Review of Pharmacoeconomics & Outcomes Research 12/2013; 13(6):791-815. · 1.67 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background Adherence to chronic therapy is a key determinant of patient health outcomes in chronic disease. However, only about 50 % of patients adhere to chronic therapy. One of the challenges in promoting adherence is having an accurate understanding of adherence rates and the factors that contribute to non-adherence. There are many measures available to assess patient medication adherence. Aim of the review This review aims to present the commonly used indirect methods available for measuring medication adherence in routine healthcare and research studies. Method A literature review on medication adherence measures in patient populations with chronic conditions taking chronic medications was conducted through Medline (2003-2013). A complementary manual search of references cited in the retrieved studies was performed in order to identify any additional studies. Results Of the 238 initial Medline search results, 57 full texts were retrieved. Forty-seven articles were included as a result of the manual search. Adherence measures identified were: self-report (reported in 50 publications), electronic measures (33), pharmacy refills and claims data (26) and pill counts (25). Patient self-report, electronic measures, pharmacy refill and claims data were the most commonly used measures of adherence in research, routine practice, epidemiological and intervention studies. These methods, and their strengths and limitations have been described in this paper. Conclusion A multitude of indirect measures of adherence exist in the literature, however, there is no "gold" standard for measuring adherence to medications. Triangulation of methods increases the validity and reliability of the adherence data collected. To strengthen the adherence data collected and allow for comparison of data, future research and practice interventions should use an internationally accepted, operational standardized definition of medication adherence and clearly describe the medication adherence methods used.
International journal of clinical pharmacy. 10/2013;
[show abstract][hide abstract] ABSTRACT: Providing written medicine information to consumers enables them to make informed decisions about their medicines, playing an important role in educating and improving health literacy. In Australia, standardized written medicine information called Consumer Medicine Information (CMI) is available for medicines as package inserts, computer prints, or leaflets. Consumers want and read CMI, but may not always ask for it. General practitioners (GPs) and pharmacists are an important source of written medicine information, yet may not always provide CMI in their practice.
To examine and compare the awareness, use and provision of CMI by consumers, pharmacists and general practitioners (GPs).
Based on previous studies, structured questionnaires were developed and administered to a national sample of consumers (phone survey); community pharmacists and GPs (postal surveys) about utilization of CMI. Descriptive, comparative and logistic regression analyses were conducted.
The respondents comprised of 349 pharmacists, 181 GPs and 1000 consumers. Two-thirds of consumers, nearly all (99%) pharmacists and 90% of GPs were aware of CMI. About 88% of consumers reported receiving CMI as a package insert, however most pharmacists (99%) and GPs (56%) reported providing computer-generated CMI. GPs' and pharmacists' main reason for providing CMI was on patient request. Reasons for not providing were predominantly because consumers were already taking the medicine, concerns regarding difficulty understanding the information, or potential non-adherence. Of the 691 consumers reportedly reading CMI, 35% indicated concerns after reading. Factors associated with reading included gender, type of CMI received and frequency of provision.
Consumers want and read information about their medicines, especially when received from their GP or pharmacist. Healthcare professionals report usually discussing CMI when providing it to patients, although continued improvements in dissemination rates are desirable. Regular use of CMI remains a challenge, and ongoing strategies to promote CMI use are necessary to improve uptake of CMI in Australia.
Research in Social and Administrative Pharmacy 10/2013; · 2.35 Impact Factor
[show abstract][hide abstract] ABSTRACT: It is well known that patient adherence to appropriately prescribed medications is essential for treatment efficacy and positive therapeutic outcomes. It is also understood that patients who are prescribed medications do not necessarily take them as prescribed. Indeed, variation in patients' medication-taking is an age old conundrum which remains the focus of much interest amongst researchers and clinicians owing to its far-reaching consequences. Despite the extensive adherence-related research over the last four decades and a recent surge in this field, there remains a lack of uniformity in the terminology used to describe adherence and its related concepts. In turn, it is often difficult to conduct comparisons between adherence-related studies, which may be associated with the non-cumulative nature of work in this field. The purpose of this commentary is to provide an overview of key terminology relating to the field of adherence research.
International journal of clinical pharmacy. 10/2013;
[show abstract][hide abstract] ABSTRACT: Background: Pharmacists are well placed to identify, prevent and resolve medicine related problems as well as monitor the effectiveness of treatments in cardiovascular disease (CVD). Pharmacists' interventions in CVD secondary prevention have been shown to improve outcomes for clients with established CVD. Objective: To explore the scope of pharmacists' activities in supporting CVD secondary prevention. Setting: Community pharmacies in New South Wales, Australia. Methods: Twenty-one in-depth, semi-structured interviews with a range of community pharmacists were conducted. All interviews were audio-recorded and transcribed ad verbatim. Data were analyzed using a 'grounded-theory' approach by applying methods of constant comparison. Main outcome measure: Community pharmacists' awareness and current practice in supporting secondary prevention of CVD. Results: Four key themes identified included 'awareness', 'patient counselling', 'patient monitoring', and 'perceptions of the role of pharmacists in CVD secondary prevention'. The pharmacists demonstrated a moderate understanding of CVD secondary prevention. There was considerable variability in the scope of practice among the participants, ranging from counselling only about medicines to providing continuity of care. A minority of pharmacists who had negative beliefs about their roles in CVD secondary prevention offered limited support to their clients. The majority of pharmacists, however, believed that they have an important role to play in supporting clients with established CVD. Conclusion: Community pharmacists in Australia make a contribution to the care of clients with established CVD despite the gap in their knowledge and understanding of CVD secondary prevention. The scope of practice in CVD secondary prevention ranged from only counselling about medicines to offering continuity of care. The extent of pharmacists' involvement in offering disease management appears to be influenced by their beliefs regarding what is required within their scope of practice.
International journal of clinical pharmacy. 09/2013;
[show abstract][hide abstract] ABSTRACT: Objective: The aim of the present study was to explore factors influencing parents' decisions to adhere and persist with ADHD pharmacotherapy in children. Method: Focus groups (n = 3) were conducted with 16 parents recruited from metropolitan Sydney. Group discussions explored factors impacting on treatment initiation, continuation, and cessation. Focus groups were audio-recorded, transcribed verbatim, and thematically content analyzed. Results: Parents commenced and continued pharmacotherapy due to its positive impact on their child's behavior. Improvements in the child's academic performance and social interactions encouraged persistence with therapy. Parents elected to cease therapy after their children experienced side effects including appetite suppression, weight loss, and sleep disturbances. Concerns about long-term effects of ADHD medication use including potential for addiction and growth stunting, in addition to the stigma surrounding ADHD also contributed to parents ceasing treatment. Conclusion: The findings highlight a need for the provision of accurate information about ADHD and its treatments to parents to empower their treatment decisions and promote adherence. (J. of Att. Dis. 2013; XX(X) XX-XX).
Journal of Attention Disorders 08/2013; · 2.16 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background Adherence to therapy is a key to achieving good clinical outcomes. Promoting medication adherence requires a range of strategies that primarily focus on fostering behavioral change. Community pharmacists are well placed to deliver adherence support to patients. Aim To investigate community pharmacists' activities in supporting patient medication adherence in their practice; and to assess pharmacists' attitudes and barriers to adherence support. Method A sample of 500 pharmacies was randomly selected from a list of community pharmacies in the state of New South Wales (Australia) and mailed a questionnaire focusing on provision of adherence support, pharmacists' attitudes, and barriers to adherence support. Two follow-up reminders were sent to non-responding pharmacies after 2 and 6 weeks. Result A response rate of 27.6 % was achieved (n = 126), consistent with recent research studies. For less than half (42 %) of prescriptions dispensed, pharmacists reported providing strategies to identify non-adherent patients. Providing dose administration aids was the most common method to support adherence used by pharmacists (95 %). Most (98 %) agreed that it was their role to promote patients' adherence. However 64 and 52 % reported that patients' time pressures and poor health literacy, respectively, were the main barriers to provision of adherence support. Around 25 % of respondents reported that they had received training programs on providing medication adherence support. Conclusion Community pharmacists employed a limited range of strategies to identify and address non-adherence to medications. Moreover, the provision of adherence support was episodic and infrequent. However, the majority of pharmacists believed that it is their role to promote patients adherence. Time pressures for both pharmacists and patients were perceived to be a major barrier.
International journal of clinical pharmacy. 08/2013;
[show abstract][hide abstract] ABSTRACT: Effective communication between community pharmacists and patients, particularly with a patient-centered approach, is important to address patients' concerns relating to antidepressant medication use. However, few studies have investigated community pharmacists' communication behaviors in depression care.
To characterize community pharmacist-patient interactions during consultations involving use of antidepressants.
Twenty community pharmacists received 3 simulated patient visits involving issues related to the use of antidepressants: 1) patient receiving a first-time antidepressant prescription; 2) patient perceiving lack of efficacy of antidepressants after 2 weeks of treatment, and 3) patient intending to discontinue treatment prematurely. All 60 encounters were audio-recorded and analyzed using the Roter Interaction Analysis System (RIAS), a quantitative coding system that characterizes communication behaviors through discrete categories. A patient-centeredness score was calculated for each encounter.
The majority of pharmacist communication was biomedical in nature (50.7%), and focused on providing therapeutic information and advice on the antidepressant regimen. In contrast, only 5.4% of pharmacist communication was related to lifestyle/psychosocial exchanges. There were also few instances of emotional rapport-building behaviors (8.6%) or information gathering (6.6%). Patient-centered scores were highest in the scenario involving a first-time antidepressant user, as compared to other scenarios involving issues with continued therapy.
Community pharmacists appeared to adopt a "medication-centered" approach when counseling on antidepressant issues. There is scope for improvement in patient-centered communication behaviors, particularly lifestyle/psychosocial discussions, facilitating patient participation, and emotional rapport-building. The RIAS appears suited to characterize brief consultations in community pharmacies and can provide a framework in guiding communication training efforts. Further research is needed to assess the impact of pharmacist communication behaviors on patient care outcomes.
Research in Social and Administrative Pharmacy 06/2013; · 2.35 Impact Factor
[show abstract][hide abstract] ABSTRACT: Abstract Shared decision-making and interprofessional collaboration are important approaches to achieving consumer-centered care. The concept of shared decision-making has been expanded recently to include the interprofessional healthcare team. This study explored healthcare providers' perceptions of barriers and facilitators to both shared decision-making and interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers, including medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Healthcare providers identified several factors as barriers to, and facilitators of shared decision-making that could be categorized into three major themes: factors associated with mental health consumers, factors associated with healthcare providers and factors associated with healthcare service delivery. Consumers' lack of competence to participate was frequently perceived by mental health specialty providers to be a primary barrier to shared decision-making, while information provision on illness and treatment to consumers was cited by healthcare providers from all professions to be an important facilitator of shared decision-making. Whilst healthcare providers perceived interprofessional collaboration to be influenced by healthcare provider, environmental and systemic factors, emphasis of the factors differed among healthcare providers. To facilitate interprofessional collaboration, mental health specialty providers emphasized the importance of improving mental health expertise among general practitioners and community pharmacists, whereas general health providers were of the opinion that information sharing between providers and healthcare settings was the key. The findings of this study suggest that changes may be necessary at several levels (i.e. consumer, provider and environment) to implement effective shared decision-making and interprofessional collaboration in mental healthcare.
Journal of Interprofessional Care 05/2013; · 1.48 Impact Factor
[show abstract][hide abstract] ABSTRACT: Abstract Background: Attention-deficit/hyperactivity disorder (ADHD) is a pediatric psychological condition commonly treated with stimulant medications. Negative media reports and stigmatizing societal attitudes surrounding the use of these medications make it difficult for parents of affected children to accept stimulant treatment, despite it being first line therapy. Objective: The purpose of this study was to identify factors that influence parental decision making regarding stimulant treatment for ADHD. Methods: A systematic review of the literature was conducted to identify studies: 1) that employed qualitative methodology, 2) that highlighted treatment decision(s) about stimulant medication, 3) in which the decision(s) were made by the parent of a child with an official ADHD diagnosis, and 4) that examined the factors affecting the decision(s) made. Individual factors influencing parental treatment decision making, and the major themes encompassing these factors, were identified and followed by a thematic analysis. Results: Eleven studies reporting on the experiences of 335 parents of children with ADHD were included. Four major themes encompassing influences on parents' decisions were derived from the thematic analysis performed: confronting the diagnosis, external influences, apprehension regarding therapy, and experience with the healthcare system. Conclusions: The findings of this systematic review reveal that there are multiple factors that influence parents' decisions about stimulant therapy. This information can assist clinicians in enhancing information delivery to parents of children with ADHD, and help reduce parental ambivalence surrounding stimulant medication use. Future work needs to address parental concerns about stimulants, and increase their involvement in shared decision making with clinicians to empower them to make the most appropriate treatment decision for their child.
Journal of child and adolescent psychopharmacology 04/2013; · 2.59 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Written medicine information is an important aspect of patient education, increasing patient knowledge and satisfaction. It can play an important role in promoting education, communication, and improving health literacy. In Australia, standardized, comprehensive written medicine information is available for all medicines. Patients' want such written information, however they report it is generally not supplied or there is limited interaction between healthcare professionals and patients when provided. OBJECTIVE: A qualitative study was conducted to explore the opinions and attitudes of healthcare professionals toward the use of written medicine information in practice. METHOD: The study involved focus groups with 32 general practitioners (4 groups), 29 community pharmacists (4 groups) and 7 hospital pharmacists (1 group) in Sydney and rural New South Wales. All discussions were transcribed verbatim and analyzed using thematic content analysis. FINDINGS: Across the groups, professionals were aware of patients' needs for medicine information, but provision to patients in practice appeared the exception rather than the rule. Common reasons for non-provision were lack of time, possible creation of patient anxiety, low literacy, and perceived length and complexity of the information. Many desired more balanced information for patients on both benefits and risks. Most felt current materials were not useful information-sharing tools; some perceived that it undermined their relationship with patients. Improvement strategies proposed included increased consultation times and improved quality of the information. CONCLUSION: Participants were ambivalent about supplying written medicine information to their patients and concerned about its impact on the patient-provider relationship. This contributed to limited provision, despite the information being available for all medicines. A tailored approach to meet individual patient information preferences, together with efforts to support professionals as facilitators of information may increase written medicine information utilization as an information-sharing tool to improve health literacy and patient engagement.
Research in Social and Administrative Pharmacy 04/2013; · 2.35 Impact Factor
[show abstract][hide abstract] ABSTRACT: Aim: To explore access, satisfaction, awareness and needs for medicines and disease information (MADI) sources for older Arabic-speaking Australians. Method: Five focus groups were conducted (in Arabic) with 29 participants with a chronic disease, aged over 65 years, and unable to speak or read English fluently. Discussions were audiotape recorded, simultaneously interpreted into English, transcribed verbatim and content analysed. Results: Arabic-speaking general practitioners were identified as the main source of MADI, despite dissatisfaction with their counselling. Written Arabic MADI was not accessed by participants, who revealed low English and Arabic literacy levels and a reliance on family members to act as interpreters. Male participants were more concerned and active about their health and medicine information than female participants. Conclusions: This study highlighted limited availability and access to Arabic MADI for older Arabic-speaking Australians, with reliance on Arabic-speaking health-care professionals for information and family members as interpreters. An accessible and sustainable system for MADI is required.
Australasian Journal on Ageing 03/2013; 32(1):28-33. · 0.94 Impact Factor
[show abstract][hide abstract] ABSTRACT: Shared decision-making is an essential element of patient-centered care in mental health. Since mental health services involve healthcare providers from different professions, a multiple perspective to shared decision-making may be valuable. The objective of this study was to explore the perceptions of different healthcare professionals on shared decision-making and current interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers from a range of professions, which included medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Findings indicated that healthcare providers supported the notion of shared decision-making in mental health, but felt that it should be condition dependent. Medical practitioners advocated a more active participation from consumers in treatment decision-making; whereas other providers (e.g. pharmacists, occupational therapists) focused more toward acknowledging consumers' needs in decisions, perceiving themselves to be in an advisory role in supporting consumers' decision-making. Although healthcare providers acknowledged the importance of interprofessional collaboration, only a minority discussed it within the context of shared decision-making. In conclusion, healthcare providers appeared to have differing perceptions on the level of consumer involvement in shared decision-making. Interprofessional roles to facilitate shared decision-making in mental health need to be acknowledged, understood and strengthened, before an interprofessional approach to shared decision-making in mental health can be effectively implemented.
Journal of Interprofessional Care 02/2013; · 1.48 Impact Factor
[show abstract][hide abstract] ABSTRACT: Recent studies have shown that pharmacists have a role in addressing antidepressant nonadherence. However, few studies have explored community pharmacists' actual counseling practices in response to antidepressant adherence-related issues at various phases of treatment. The purpose of this study was to evaluate counseling practices of community pharmacists in response to antidepressant adherence-related issues.
A simulated patient method was used to evaluate pharmacist counseling practices in Sydney, Australia. Twenty community pharmacists received three simulated patient visits concerning antidepressant adherence-related scenarios at different phases of treatment: 1) patient receiving a first-time antidepressant prescription and hesitant to begin treatment; 2) patient perceiving lack of treatment efficacy for antidepressant after starting treatment for 2 weeks; and 3) patient wanting to discontinue antidepressant treatment after 3 months due to perceived symptom improvement. The interactions were recorded and analyzed to evaluate the content of consultations in terms of information gathering, information provision including key educational messages, and treatment recommendations.
There was variability among community pharmacists in terms of the extent and content of information gathered and provided. In scenario 1, while some key educational messages such as possible side effects and expected benefits from antidepressants were mentioned frequently, others such as the recommended length of treatment and adherence-related messages were rarely addressed. In all scenarios, about two thirds of pharmacists explored patients' concerns about antidepressant treatment. In scenarios 2 and 3, only half of all pharmacists' consultations involved questions to assess the patient's medication use. The pharmacists' main recommendation in response to the patient query was to refer the patient back to the prescribing physician.
The majority of pharmacists provided information about the risks and benefits of antidepressant treatment. However, there remains scope for improvement in community pharmacists' counseling practice for patients on antidepressant treatment, particularly in providing key educational messages including adherence-related messages, exploring patients' concerns, and monitoring medication adherence.
Patient Preference and Adherence 01/2013; 7:813-25. · 1.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: PURPOSE: Non-adherence to antidepressant medications is a significant barrier to the successful treatment of depression. The purpose of this study was to explore the perspectives of health care providers on antidepressant medication non-adherence in clinical practice. METHODS: Individual semi-structured interviews were conducted with a purposive sample of 31 health care providers from a range of disciplines and settings in the state of New South Wales, Australia. Interviews focused on medication adherence issues in depression and participants' strategies in addressing them. Interviews were audio recorded, transcribed verbatim and thematically content analyzed using a constant comparison approach. RESULTS: Participants acknowledged medication non-adherence to be a complex problem in depression, and attributed this problem to patient, medication and environmental-specific issues. Five approaches in addressing non-adherence were reported: patient education, building partnerships with patients, pharmacological management, developing behavioural skills and building supportive networks. Challenges to the management of non-adherence were lack of time and skills, assessment of medication adherence, transition period immediately post-discharge and conflicts in views between providers. CONCLUSION: Participants were able to identify issues and strategies in addressing antidepressant non-adherence; however, barriers were also identified that could impact on providers' ability to address this issue effectively. More research is needed to develop effective multidisciplinary strategies that take into account providers' perspectives in improving adherence to antidepressant medications.
[show abstract][hide abstract] ABSTRACT: OBJECTIVES: To explore participants' opinions and preferences on tailored written medicines information. METHODS: Forty-five participants were recruited to eight focus groups, run concurrently in Australia (23 participants in four groups) and the UK (22 participants in four groups). Participants were provided with exemplar leaflets for a cardiovascular medicine based on the angiotensin-converting enzyme (ACE) inhibitor ramipril, which was tailored for a man aged 55 with hypertension. Reference to other indications of the medicine, children's doses, pregnancy and breast-feeding information were removed. A topic guide directed the discussion and explored preferences and opinions on tailored leaflets. Focus group discussions were recorded, transcribed verbatim and content analysed using adapted cross-case study analysis. KEY FINDINGS: Participants welcomed the concept of tailored information, desiring shorter and more relevant information. Information tailored to their condition or disease was most sought-after, followed by tailoring by age or gender. However, some participants voiced concerns about the potential for the wrong information being given to patients who would be unable to recognise that it was incorrect. Other concerns included how tailoring might impact upon the quality of information available and the feasibility of delivery, especially regarding the legal implications (Australia) and the cost (UK). A key finding was the participants' desire for a truly individualised approach to tailoring medicines information, as opposed to the generalised tailored information provided in the study. Participants said they would value having spoken communication with a healthcare professional at the same time as they received tailored leaflets. CONCLUSIONS: Most participants welcomed tailored leaflets but overall valued a more personalised approach than the generalised tailored information we provided. Despite concerns about quality and delivery, many felt tailoring written medicines information could improve the relevance of the information to the individual and potentially encourage them to value it.
The International journal of pharmacy practice. 11/2012;
[show abstract][hide abstract] ABSTRACT: OBJECTIVES: To explore consumers' beliefs and preferences for benefit information in medicine leaflets and examine their understanding and reaction to treatment benefits. METHODS: Forty-five participants were recruited to eight focus groups, run concurrently in Australia (23 participants in four groups) and the UK (22 participants in four groups). Participants were provided with amended leaflets based on the medicine clopidogrel, containing textual and numerical benefit information presented using numbers needed to treat (NNT). A topic guide which explored use of leaflets, preferences and opinions was used to direct discussion. Focus group discussions were recorded, transcribed verbatim and content analysed using adapted cross-case study analysis. KEY FINDINGS: The consensus was that the inclusion of benefit information was a positive factor. Many participants felt that textual benefit information offered an incentive to take a medicine, although some Australian participants had concerns that included benefit information could create anxiety. The presentation of numerical benefit information provoked strong feelings of disbelief and shock. Participants were surprised that so few people would benefit. Some participants struggled to understand and interpret the NNT and others found it difficult to comprehend the magnitude of the benefit information, instead operating on initial and often crude assumptions of what the data meant. In both countries the provision of numerical benefit information appeared to shake participants' faith in drug treatments. Participants were concerned about how this might affect the 'less-informed' patient. However, in the UK, participants stated that their adherence to treatment was also reinforced by their doctor's advice. CONCLUSIONS: Participants wanted to receive information about the benefits of their medicines. However, they may misinterpret the numerical information provided.
The International journal of pharmacy practice. 11/2012;
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Poor adherence to medications is a significant health care issue, particularly among cardiovascular patients. A variety of interventions have been tested by researchers in an effort to identify the most effective approach to improving adherence. Interventions delivered by multiple health care professionals (HCPs) may have an impact on improving adherence to medications in patients with chronic conditions, although the evidence to support this is still limited. OBJECTIVE: To investigate the impact of interventions delivered by HCPs within a multiprofessional team to improve patients' adherence to cardiovascular disease medications in community settings. Search strategy: The search strategy involved the use of the following data bases: Google scholar, PubMed, Medline, Cinahl, Embase, IPA, and Cochrane Library, from 1994 to 2010. Search was restricted to articles published in English. Selection criteria: Cluster randomized trials, controlled randomized clinical trials, prospective randomized trials, and nonrandomized studies were included. We considered any intervention designed to enhance adherence to medication directed by more than 1 HCP. RESULTS: We included 17 studies testing 3 different types of interventions directed by more than 1 HCP. The HCPs received a variety of training via educational lectures or interactive workshops. Informational, behavioral, and combined interventions were delivered to cardiovascular patients. The majority of studies using only informational interventions or a combination of behavioral and informational interventions showed improvements in clinical outcomes (ie, blood pressure and total cholesterol lowering). However, only 2 studies measured improvements in adherence but the results were not significant. In contrast, all interventions based on the behavior change strategies improved both clinical outcomes and adherence to medication. CONCLUSIONS: Behavioral interventions delivered by a multiprofessional team appear to offer the best opportunity to improve clinical outcomes through improvements in adherence. However, whether interventions delivered by a multiprofessional team are more clinically effective than those delivered by a single HCP remain to be tested.
Journal of Cardiovascular Pharmacology and Therapeutics 04/2012; · 2.38 Impact Factor