The role of the pharmacist in improving adherence
A.J.M. (Ton) Hoek. General Secretary. International Pharmaceutical Federation (FIP)
Medicines are an integral part of most courses of therapy, and their safe and appropriate use is an important aspect of optimizing health care outcomes. Medicines can be used effectively to prevent disease or the negative consequences of long-term chronic illness, but more needs to be done to improve the overall quality of their use. Pharmacists have a key role to play by providing assistance, information and advice to the public about medicines, as well as by monitoring treatment and identifying problems in close cooperation with other health care providers and the patients.
Pharmacists are well-positioned to play a primary role in improving adherence to long-term therapy because they are the most accessible health care professionals and they have extensive training in pharmaceuticals. Part of the professional responsibility of pharmacists is to provide sound, unbiased advice and a comprehensive pharmacy service that includes activities both to secure good health and quality of life, and to avoid ill-health.
Pharmaceutical care is a relatively new philosophy of practice, the goal of which is to optimize the patient's health-related quality of life and to achieve positive clinical outcomes.
Pharmaceutical care includes:
- educating the patient or the person caring for the patient about their medications and the conditions for which they are prescribed to ensure maximum therapeutic benefit and safety;
- reviewing the patient's medication history;
- continuous monitoring of the patient's therapy;
- screening for potential adverse effects; and
- monitoring the patient's ability to take his or her medications correctly and to adhere to the prescribed therapies.
Pharmacists, through the practice of pharmaceutical care, can prevent or stop interactions, monitor and prevent or minimize adverse drug reactions and monitor the cost and effectiveness of drug therapy as well as provide lifestyle counselling to optimize the therapeutic effects of a medication regimen. The concept of pharmaceutical care is particularly relevant to special groups of patients such as the elderly and chronically ill.
Intervention by the pharmacist and pharmaceutical care are effective approaches to improving adherence to long-term therapies. Adherence to immunosuppressive medications in renal transplant patients ranges from 50 to 95% and nonadherence can result in organ rejection1. Intervention by pharmacists has been demonstrated to improve average monthly compliance by more than 100% over a 12-month period2. Advice, information and referral by community pharmacists have been demonstrated to significantly improve adherence to antihypertensive medications and improve blood-pressure control3. Similar results have been demonstrated in patients with asthma4,5.
1 Greenstein S, Siegal B. Compliance and noncompliance in patients with a functioning renal transplant: a multicenter study. Transplantation, 1998, 66: 1718 - 1726.
2 Chisholm MA et al. Impact of clinical pharmacy services on renal transplant patients' compliance with immunosuppressive medications. Clinical Transplantation, 2001, 15: 330 - 336.
3 Blenkinsopp A et al. Extended adherence support by community pharmacists for patients with hypertension: A randomised controlled trial. International Journal of Pharmacy Practice, 2000, 8: 165 - 175.
4 Cordina M, McElnay JC, Hughes CM. Assessment of a community pharmacy-based program for patients with asthma. Pharmacotherapy, 2001, 21: 1196 - 1203.
5 Schulz M et al. Pharmaceutical care services for asthma patients: a controlled intervention study. Journal of Clinical Pharmacology, 2001,41: 668 - 676.
These are only examples of many indications where improved compliance and outcomes have been clearly demonstrated to result from pharmacists' interventions. Many studies on this subject have been published, especially during the last 10 - 15 years.
Pharmacists are an important resource for improving adherence to long-term therapy.