Support from pharmacists improves adherence to complex drug regimens

Persuading people to stick to their prescribed drug treatment can be difficult, especially if they need a handful of pills several times a day for asymptomatic conditions such as hypertension. Intensive education and follow-up by pharmacists, coupled with tailor-made blister packs dispensing the right combination of pills at the right time, worked well in a recent trial, but patients soon fell behind again when the intervention stopped.

The trial included 200 independent elderly men and women who needed at least four different drugs each day. Most had both hypertension and hyperlipidaemia. Before the intervention began, they took 61% of their prescribed pills. This percentage rose to 96.9% after six months of education, follow-up, and special packaging. Better adherence was accompanied by significant improvements in systolic blood pressure (from a mean of 133 mm Hg to 130 mm Hg, P=0.02), and serum concentrations of low density lipoprotein cholesterol (from 2.38 mmol/l to 2.25 mmol/l, P=0.001). But in the randomised phase of the study which followed, participants who reverted to usual care slipped back to an adherence rate of 65%, compared with 95% among those who continued to get the extra support.

Even though this intervention seemed to work, the authors acknowledge that it would be too expensive and time consuming for most pharmacies. Not least because the complex blister packs must be prepared by hand.