Table 2.

Australian research studies implementing and/or evaluation adherence promoting strategies

Study characteristics	Intervention	Study Outcomes	Comments
Armour et al (1) Design: randomised, controlled, repeated measures; multi-site (across three states) Duration: 6 months Intervention: 26 community pharmacists, 165 patients Control: 24 community pharmacists, 186 patients	Pharmacy Asthma Care Plan: four visits involving assessment, monitoring and review, based on the Six-Step Asthma Management Plan (27) (counselling and education on asthma, triggers and medications including inhaler technique, adherence assessment and goal setting)	Improved adherence as measured by BMQ*, decrease in the proportion of patients with severe asthma, improved asthma quality of life, knowledge and perceived control, increased proportion of patients using a combination of reliever and preventer medications	Intervention delivered by trained community pharmacists. Monitoring adherence to medication was part of the overall service delivered. Pharmacists received remuneration for participation
Aslani et al (11) Design: parallel, controlled, repeated measures (Sydney metropolitan) Duration: 9 months Intervention: 19 community pharmacists, 48 patients Control: 19 community pharmacists, 49 patients	Therapeutics Outcome Monitoring Service for Hyperlipidaemia with a focus on adherence assessment, monitoring and strategy development	Significant reduction in total cholesterol levels, no change in adherence as measured with BMQ* and MARS**	Trained community pharmacists provided the intervention and received remuneration for participation
Benrimoj et al (2) Design: parallel, controlled, pre and post-intervention. Patients either randomly assigned to intervention and control groups, or non-randomly assigned to control group. Duration: 12 months retrospective data collected; 3 months post-intervention data collected 54 pharmacists in 9 study sites delivering services through 3 alternative healthcare models; metropolitan and rural settings	Patient medication management service (PMMS) and patient medication concordance service (PMCS)	Clinical (eg drug therapy changes) and economic (eg number and costs of drugs) impact data recorded by project pharmacists on study data collection forms: patients receiving PMMS showed reductions in drug related side effects (by 3.6%), improvements in symptoms (by 16.6%) and compliance (by 13.7%). PMCS resulted in significant reductions in drug related side effects (from 17.6% to 2.7%), and improvement in patient knowledge. PMMS resulted in a net medication cost saving of AUS$67.85 per patient	PMMS required referral of the patient by the general practitioner; PMCS was within the role of the pharmacist
Crockett et al (16) Design: parallel, controlled, (rural and remote NSW) Duration: 2 months Intervention: 46 patients Control: 60 patients 32 community pharmacies	Intervention focused on patients with depression, who were provided with extra advice and support by the intervention pharmacists	High adherence in both groups (self-report), significant improvement in wellbeing in both groups, no change in attitudes to drug treatment	Pharmacists trained through videoconferencing
Hughes et al. (3) Design: parallel, repeated measures (metropolitan Perth, WA) Duration: 12 months Intervention/ Control: 6 pharmacies: Control, High and Low Intervention patient groups (7 in each group)	Disease state management model for patients with hypertension, including regular blood pressure monitoring, patient education, cardiovascular risk factor management, lifestyle modification, medication management and adherence monitoring	Decrease in blood pressure in all groups, better adherence in the intervention groups (as measured through self-report and dispensing software data), high patient satisfaction with the interventions	Trained pharmacists delivered the intervention. Subjects were randomised to one of the three groups; Low Intervention group received 3 monthly follow-ups, High Intervention received monthly follow-ups
Krass et al (4) Armour et al (14) Design: parallel controlled, repeated measures (multi-site in NSW) Duration: 9 months Intervention: 9 community pharmacists, 106 patients Control: 14 community pharmacists, 82 patients	Trained pharmacists delivered a medication support service including a medication adherence assessment, adherence support and medication review to patients with type 2 diabetes; patient contact on a monthly basis	Significantly improved self-reported risk of nonadherence as measured with BMQ*, decrease in the proportion of nonadherence patients, increase in well being, decrease in A1C (glycosylated heamaglobin), decrease in the total number of medications used by both groups	Trained pharmacists delivered service and documented interventions delivered
Krass et al (5,15) Design: randomised, controlled, repeated measures (4 Australian states- multi-site) Duration: 6 months Intervention: 28 community pharmacists, 149 patients Control: 28 community pharmacists, 140 patients	Diabetes service to patients with type 2 diabetes: an on-going regular cycle of assessment, management and review focussing on blood glucose self monitoring, education, adherence assessment and support (over four visits)	Significant decrease in blood glucose and blood pressure levels, improvements in glycaemic control, improvements in quality of life; Significantly improved self-reported risk of nonadherence as measured with BMQ*	Trained pharmacists delivered intervention and documented interventions delivered.
Kritikos et al (6) Design: parallel, repeated measures (Sydney metropolitan, 2 geographically separate areas) Duration: 3 months Intervention: 2 groups, 3 and 2 community pharmacists respectively, 16 patients per group Control: 2 community pharmacists, 16 patients	Asthma Education Program delivered to small groups of patients (150 mins duration) on asthma, its management, medications, inhaler technique	Increase in knowledge, improvements in asthma severity and control, improvements in inhaler technique, improvements in adherences as measured by MARS** but not by the end of the study and compared to control, improvements in quality of life, positive subjects satisfaction	Group educational interventions delivered by trained pharmacists
Saini et al (7) Design: parallel, controlled (two distinct geographical areas in NSW) Duration: 6 months Intervention: 12 community pharmacists, 39 patients First Control: 7 community pharmacists, 20 patients Second Control: 6 community pharmacists, 28 patients	Asthma Care Model: four visits (baseline, 1, 3 and 6 months), conducting needs analysis around the Six-Step Asthma Management Plan, providing interventions and setting goals to address needs. The development of the program has been described in (12)	Improved asthma severity score, improved Peak Flow Index, decrease in daily salbutamol dose, and increases in daily salmeterol and fluticasone dose, decreased risk of non-adherence as measured by BMQ*, improved inhaler technique, improved perceived control, improved asthma knowledge, decreased monthly medication costs, positive satisfaction	Intervention delivered by trained community pharmacists. Monitoring adherence to medication was part of the overall service delivered
Saini et al (8) Design: parallel, controlled, repeated measures (two regional areas, NSW) Duration: 6 months Intervention: 12 community pharmacists, 51 patients Control: 8 community pharmacists, 39 patients	Rural Asthma Management Service based on the Six-Step Asthma Management Plan; four visits, baseline, 1, 3 and 6 months.	Significant reduction in asthma severity, reduction in risk of non-adherence (as measured using BMQ*), increase in proportion of patients having an asthma action plan	Service adapted to the regional/rural areas of Australia. Intervention delivered by trained community pharmacists. Monitoring adherence to medication was part of the overall service delivered
Smith et al (13) Design: parallel, controlled (metropolitan Sydney) Duration: 9 months Intervention: 9 community pharmacists, 35 patients Control: 11 community pharmacists, 56 patients	Asthma Self-Management Service: six visits over 9 months, conducting asthma control problem identification, goal setting and strategy development. Control group had 3 visits only	Improved asthma control in both groups, no change in adherence as measured by MARS**, improved self efficacy, anxiety and quality of life scores	Intervention delivered by trained community pharmacists. Monitoring adherence to medication was part of the overall service delivered. Intervention pharmacies had a dedicated counselling area, pharmacists received remuneration for participation

^*BMQ = Brief Medication Questionnaire (9)

^**MARS = Medication Adherence Report Scale (10)

NSW = New South Wales

WA = Western Australia