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CURATOR
A pinboard by
Elyssa Wiecek

PhD Candidate, University of Technology Sydney

PINBOARD SUMMARY

Pharmacists play an important role in motivating patients to take their medications correctly.

Remember the last time you took a medication. Were you adherent? Meaning you took every dose at the correct time, every day just like the doctor told you. Since I started my PhD a year ago, I have been lucky enough to have been prescribed antibiotics twice. I thought “this is easy— two pills a day for a week." Guess how many I actually took correctly? Barely half. I was terrible at it. I thought I was the worst patient and the worst PhD student. I couldn’t practice what I preached. But from my failure I learned empathy. I gained an understanding that adherence is not a simple problem with a simple fix. I couldn’t give myself a pill box or alarm and magically be adherent. Medication adherence is complex because human behavior is complex. Why is this important? Non-adherence is costing billions of dollars to our health care systems. It’s causing 125,000 preventable deaths per year. But there’s good news. This topic is incredibly well studied. In fact, there are over 1,000 studies trying to find interventions to fix this problem. I would know because I had so much fun reading all of them. What works? This is where it gets tricky. There is no common solution. There is no “one-size-fits-all” answer. There’s evidence that complex, multi-component interventions have the best results but these are neither feasible nor realistic in our health care settings. However, one common thread in these interventions always has a positive effect. Interaction with patients. It’s not a perfect theory but there’s evidence to show a simple, two-minute conversation with a patient can have just as big of an impact. Who would be good for this? Pharmacists, of course. They are a major point of contact for patients. For my thesis, I’m proposing we train our pharmacists to ask the right questions. To see patients as individuals with individual medication difficulties. That we give our pharmacists the right tools and knowledge to recommend the right solutions. I want to prove that an empathetic and sincere short conversation -- and that just by being a listener, supporter, and motivator each time a patient steps in a pharmacy – we can have just as big of an impact on medication adherence.

4 ITEMS PINNED

Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis.

Abstract: Excellent medication adherence contributes to decreases in morbidity, mortality, and health care costs. Although researchers have tested many interventions to increase adherence, results are sometimes conflicting and often unclear. This systematic review applied meta-analytic procedures to integrate primary research that tested medication adherence interventions. Comprehensive searching completed in 2015 located 771 published and unpublished intervention studies with adherence behavior outcomes. Random-effects model analysis calculated standardized mean difference effect sizes. Meta-analytic moderator analyses examined the association between adherence effect sizes and sample, design, and intervention characteristics. Analyses were conducted in 2016. A standardized mean difference effect size of 0.290 comparing treatment and control groups was calculated. Moderator analyses revealed larger effect sizes for habit-based and behavioral-targeted (vs. cognitive-focused) interventions. The most effective interventions were delivered face-to-face, by pharmacists, and administered directly to patients. Effect sizes were smaller in studies with older and homeless participants. Risks of bias were common; effect sizes were significantly lower among studies with masked data collectors and intention-to-treat analyses. The largest effect sizes were reported by studies using medication electronic event monitoring and pill count medication adherence measures. Publication bias was present. This most comprehensive review to date documented that, although interventions can increase adherence, much room remains for improvement. Findings suggest health care providers should focus intervention content on behavioral strategies, especially habit-based interventions, more so than cognitive strategies designed to change knowledge and beliefs.

Pub.: 21 Mar '17, Pinned: 27 Jul '17

Effect of pharmacist intervention on improving antidepressant medication adherence and depression symptomology: A systematic review and meta-analysis.

Abstract: Depression is a widespread disease with effective pharmacological treatments, but low medication adherence. Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients.The aim of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders.A systematic review of controlled trials (both randomized and non-randomized) was conducted. Studies were obtained through a search of PubMed, Academic Search Premier, and Cochrane Library databases. Studies which included a pharmacist intervention to improve medication adherence in outpatients age 17 and above with a depressive disorder diagnosis and antidepressant treatment were included. Twelve publications met inclusion criteria, representing a total of 15,087 subjects: 1379 (9%) intervention and 13,708 (91%) control.The interventions in each selected publication included some level of in-person counseling and education to promote antidepressant adherence. The pooled odds ratio for medication adherence at 6 months was 2.50 (95% CI 1.62 to 3.86). There were no significant differences noted in subgroup meta-analyses except study location (US, Middle East or Europe) and setting. Only one of the identified studies reported statistically significant impacts of the pharmacist intervention on patient depression symptoms.The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms. Additional longitudinal research is recommended to investigate the multidimensional relationships between pharmacist interventions, patient adherence, and clinical outcomes.Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients. The purpose of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders. A systematic review of randomized and non-randomized controlled trials was conducted of the twelve studies which met inclusion criteria. The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms.

Pub.: 18 Jun '17, Pinned: 27 Jul '17

Effect of pharmacist care on medication adherence and cardiovascular outcomes among patients post-acute coronary syndrome: A systematic review.

Abstract: The impact of collaborative and multidisciplinary health care on the outcomes of care in patients with acute coronary syndromes (ACS) is well-established in the literature. However, there is lack of high quality evidence on the role of pharmacist care in this setting.This systematic review aimed to evaluate the impact of pharmacist care on patient outcomes (readmission, mortality, emergency visits, and medication adherence) in patients with ACS at or post-discharge.The following electronic databases and search engines were searched from their inception to September 2016: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science, Scopus, Campbell Library, Database of Abstracts of Reviews of Effects (DARE), Health System Evidence, Global Health Database, Joanna Briggs Institute Evidence-Based Practice Database, Academic Search Complete, ProQuest, PROSPERO, and Google Scholar. Studies were included if they evaluated the impact of pharmacist's care (compared with no pharmacist's care or usual care) on the outcomes of rehospitalization, mortality, and medication adherence in patients post-ACS discharge. Comparison of the outcomes with relevant statistics was summarized and reported.A total of 17 studies [13 randomized controlled trials (RCTs) and four non-randomized clinical studies] involving 8391 patients were included in the review. The studies were of variable quality (poor to good quality) or risk of bias (moderate to critical risk). The nature and intensity of pharmacist interventions varied among the studies including medication reconciliation, medication therapy management, discharge medication counseling, motivational interviewing, and post-discharge face-to-face or telephone follow-up. Pharmacist-delivered interventions significantly improved medication adherence in four out of 12 studies. However, these did not translate to significant improvements in the rates of readmissions, hospitalizations, emergency visits, and mortality among ACS patients.Pharmacist care of patients discharged after ACS admission was not associated with significant improvement in medication adherence or reductions in readmissions, emergency visits, and mortality. Future studies should use well-designed RCTs to assess the short- and long-terms effects of pharmacist interventions in ACS patients.

Pub.: 24 Jun '17, Pinned: 27 Jul '17