Pharmacists up adherence
November 26, 2013
A new study published online
in JAMA Internal Medicine has
confirmed the positive impact on
medication adherence of having a
pharmacist-led program in place.
However despite the improved
adherence there was no significant
improvement in the proportion
of patients who achieved blood
pressure and cholesterol goals.
In a 12 month post-hospitalisation
follow-up trial involving 253
patients in four centres in the USA,
adherence to cardioprotective
medications were evaluated in two
groups - one with the “multifaceted
intervention” led by the hospital
pharmacist and the other group as
a control with no intervention.
The intervention group scored
89.3% on adherence, versus 73.9%
in the control group.
According to MJA Insight, Andrew
Matthews, Pharmacy Guild national
director for quality assurance and
standards, said that as medicines
experts, pharmacists considered
improving medicine adherence as a
key role of their profession.
He said the study results were
consistent with other research
showing improvement in patient
outcomes associated with higher
levels of adherence.
“The Guild sees this as further
evidence supporting the expansion
of pharmacists’ primary health care
role”, he said.
However the findings were
hailed by Dr Evan Ackermann, chair
of the Royal Australian College of
General Practitioners’ National
Standing Committee for Quality
Care, who said “the ongoing bid
by pharmacists to expand their
primary health care role has been
struck a blow.”
In the MJA InSight report
Ackermann said that given the
study demonstrated “no positive
health impacts” from the improved
adherence, there was “no
evidence to support medication
interventions in primary care, or
for medication reconciliation by a
pharmacist at hospital admission or
discharge.”
Ackermann called for further
research into medication safety
interventions in diseases where
medication was an important part
of care, and where patients were
prone to high hospital admission
rates, the use of drugs associated
with a high risk of adverse events,
and high-risk settings such as aged
care facilities and transfer of care.
He said that evidence about the
factors contributing to adverse drug
events should be used to develop
strategies that improve early
detection and prevention.
“I believe this can only occur
within the confines of a general
practice, using pharmacy funding
schemes that do not rely on the
sale of medications,” he said.
MJA Insight noted a JAMA Internal
Medicine editorial suggesting that
if the studied intervention was
applied to every patient with Acute
Coronary Syndrome in the USA “it
would add $1 billion annually to
health care costs” and that before
spending this money “it would
be prudent to know that patient
outcomes will actually improve”.
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