Table 3.
Studies Reporting Significant Improvement (P<0.05) in Medicine Adherence (N=11)
| Author, Year, Country | Study Design and Population | Pharmacist Intervention | Comparator, Follow-Up and Outcome Measures | Key Findings |
|---|---|---|---|---|
| Ho et al, 201423 (USA) | RCT involved 241 patients admitted with ACS and then discharged. | Multi-faceted intervention comprising medication reconciliation, patient education, collaborative care, and voice messaging. | Comparator: usual care. Follow-up: 12 months. Outcomes: Primary (refill adherence >0.8, % of adherent patients), Secondary (% of patients achieved BP and LDL-C targets). |
The intervention increased adherence to statin (93.2 vs. 71.3%) (p=<0.001) and ACEI/ARB regimens (93.1% vs. 81.7%), (p=0.03) significantly. There was no significant changes in percentage of target BP or LDL-C levels attainments. |
| Lyons et al 201627 (UK) | RCT involved 677 T2DM patients prescribed with LLT. | Two telephone-based Intervention, with medicine chart reminder. | Comparator: standard care. Follow-up: 6 months. Outcomes: Primary (self-reported nonadherence), Secondary (LDL-C levels). |
The intervention group has less percentage of nonadherence compared to control group (10.6% vs. 19.6%, p=0.010). There was no associated significant difference in the clinical outcomes. |
| Taitel et al 201216 (USA) | Retrospective cohort study included 2056 patients who were newly initiated on statin medications. | Two Face-to-face counselling session including a motivational interview | Comparator: control group. Follow-up: 12 months. Outcomes: medication adherence (MPR ≥80%). |
The statin adherence has improved in the intervention group compared to control group is (61.8% vs. 56.9%, p<0.01). There was no assessment for clinical outcomes. |
| Choudhry et al, 201822 (USA) | A Pragmatic cluster RCT involved 4078 patients’ non-adherent to their hypertension and hyperlipidemia medications. | Telephone-based behavioral interviewing, text messaging, and progress reports. | Comparator: usual care. Follow-up: 12 months. Outcomes: Primary (medication adherence, % of covered days), Secondary (LDL-C & SBP). |
The intervention showed a significant improvement of 4.7% (95% CI, 3.0–6.4%) in medication adherence. There were no significant changes in the overall assessment of clinical outcomes. |
| Hedegaard et al, 201521 (Denmark) | RCT included 532 patients prescribed with AHT and LLT. | Tailored medication review, patient interview, followed by telephone reminders. | Comparator: control group. Follow-up: 12 months. Outcomes: Primary (medication adherence, MPR ≥80%), Secondary (BP & hospital admission). |
Nonadherence was higher in the control group (30.2% vs. 20.3%, p=0.01) as compared to the intervention group. There were no significant differences in the evaluated clinical outcomes. |
| Ramanath et al, 201226 (India) | RCT involved 52 patients on AHT. | Counseling sessions using patient information leaflets and telephone reminders. | Comparator: control group. Follow-up: 1 month (twice). Outcomes: Primary (self-reported adherence, MMAS & MARS), Secondary (BP control). |
The overall adherence increased significantly in the intervention group compared to the control group. There was no significant impact on BP control. |
| Morgadoet al 201113 (Portugal) | RCT included 197 patients receiving AHT. | Counseling and educational sessions. | Comparator: usual care. Follow-up: 9 months. Outcomes: Primary (BP control), Secondary (self-reported medication adherence. |
There was a statistically significant improvement in blood pressure control (66% vs. 41.7%, p = 0.0008) and medication adherence (74.5% vs. 57.6%, p = 0.012) between intervention and control groups. |
| Benbrahim et al 201317 (Spain) | RCT included 176 patients on AHT. | Face-to-face (written and oral) tailored educational intervention. | Comparator: usual care. Follow-up: 6 months. Outcomes: medication adherence (pills count). |
The adherence was increased significantly to 95.5% (baseline 86%) in the intervention group compared to 86.5% (baseline 85.4%) in the control group (p=0.011). There was no assessment for clinical outcomes. |
| Fischer et al, 201418 (USA) | RCT included 124 131 patients with newly prescribed cardiovascular medications. | Live telephone calls with tailored educational messages | Comparator: control group. Follow-up: 30 days following index date. Outcomes: Primary medication adherence (prescription abandonment). |
The live pharmacy-based interventions decreased primary medication adherence by 4.8% (P< 0.0001) compared to control group. There was no assessment for clinical outcomes. |
| Stewart et al, 201424 (Australia) | Cluster RCT involved 395 patients who were taking at least one AHT. | Multi-faceted intervention consisted of motivational interviews, refill reminders, training on BP monitoring and medication reviews. | Comparator: control group. Follow-up: 6 months. Outcomes: Primary (self-reported adherence), Secondary (BP control) |
No significant difference in % of adherent patients between control (57.2% vs. 63.6%) and intervention (60% vs. 73.5%) groups at baseline and 6 months, respectively. Non-adherence decreased from 61.8% at baseline to 39.2% at 6 months in the intervention group (P = 0.007). There was a significant SBP reduction in the intervention group (p=0.01). |
| Svarstad et al, 201325 (USA) | Cluster RCT included 567 patients taking one or more AHT. | Team Education and Adherence Monitoring program involved tailored counselling and education using take-home toolkit, leaflets and medication box. | Comparator: control (only patient information). Follow-up: 6 and 12 months. Outcomes: adherence (refill ≥80%) and BP control. |
Participants in the intervention group had better adherence (60% vs 34%, p<0.001) and BP control (50% vs. 36%, p=0.01) compared to the control group. |
Abbreviations: ACS, acute coronary syndrome; RCT, randomized controlled trial; LLT, lipid-lowering therapy; SBP, systolic blood pressure; T2DM, type 2 diabetes mellitus; AHT, antihypertensive; LDL-C, low-density lipoprotein cholesterol.