Pharmacy Daily | Pharmacists up adherence

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”. CLICK HERE to read the full paper.

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