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Community pharmacists and adherence

Clinical bottom line

There is no strong evidence that interventions by community pharmacists successfully improve adherence to medicines.


Background

Interventions to improve adherence to medicines is generally thought to be useful. The evidence for this is uncertain.

Reference

BLG Van Wijk et al. Effectiveness of interventions by community pharmacists to improve patient adherence to chronic medication: a systematic review. Annals of Pharmacotherapy 2005, online publication DOI 10.1345/aph.1E027.


Systematic review

Medline was searched to the end of 2003 for studies of any architecture that involved community pharmacists and adherence, and references of retrieved articles and review articles were also examined. Patients considered were those prescribed medication for a chronic disease, lasting or expected to last longer than three months. Any sort of action to improve adherence was allowed. The primary outcomes sought was patient adherence. Only English-language studies were used.

Results

Eighteen articles were included, in which 12 were randomised trials. The overall quality of all studies was poor, and there was considerable variation in intervention, duration, and methods of measuring adherence.Most studies were small. Seven randomised trials showed no effect.

Of the 12 randomised trials, five showed improved adherence at some point. In three of these five, significant changes were seen only at some of the time points measured.

Of the six observational studies, three showed an effect and three showed no effect.

The types of intervention that showed any effect were weekly or monthly appointments consisting of counselling, monitoring, and education.

Comment

This is a good systematic review of a difficult subject area. It comprehensively dissects the quality of randomised and observational studies, and found most to be lacking. It provides useful thinking on what studies should be performed, and how, and questions whether observational or randomised studies are the most useful. It describes where we are and where we need to go. The bottom line, though, is that there is little evidence to suggest that interventions by community pharmacists do much good in improving compliance.