Effectiveness of a Patient-Tailored, Pharmacist-Led Intervention Program to Enhance Adherence to Antihypertensive Medication: The CATI Study

Abstract

Introduction: Non-adherence to medication is a complex health care problem. In spite of substantial efforts, up till now little progress has been made to effectively tackle the problem with adherence-enhancing interventions. The aim of this study was to investigate the effectiveness of a patient-tailored, pharmacist-led and theory-driven intervention program aimed to enhance self-reported adherence to antihypertensive medication.Materials and Methods: A parallel-group randomized controlled trial in 20 community pharmacies with nine months follow-up was conducted. Patients (45–75 years) using antihypertensive medication and considered non-adherent based on both pharmacy dispensing data and a self-report questionnaire were eligible to participate. The intervention program consisted of two consultations with the pharmacist to identify participants’ barriers to adhere to medication and to counsel participants in overcoming these barriers. The primary outcome was self-reported medication adherence. Secondary outcomes were beliefs about medicines, illness perceptions, quality of life and blood pressure. Mixed-model and generalized estimating equation (GEE) analyses were used to assess overall effects of the intervention program and effects per time point.Results: 170 patients were included. No significant differences between intervention and control groups were found in self-reported adherence, quality of life, illness perceptions, beliefs about medicines (concern scale), and blood pressure. After nine months, intervention participants had significantly stronger beliefs about the necessity of using their medicines as compared to control participants (mean difference 1.25 [95% CI: 0.27 to 2.24], p = 0.012).Discussion: We do not recommend to implement the intervention program in the current form for this study population. Future studies should focus on how to select eligible patient groups with appropriate measures in order to effectively target adherence-enhancing interventions.Trial Register: NTR5017 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5017.

Impact of a Multifaceted Pharmacist-Led Intervention on Antimicrobial Stewardship in a Gastroenterology Ward: A Segmented Regression Analysis

“…The intensity of antibiotic consumption (IAC) was defined as the cumulative number of defined daily doses (DDDs) of antibiotics in hospitalized patients per 100 patient days in the same period (DDDs/100pd). According to the WHO Collaborative Centre for Drug Statistics Methodology (WHO, 2003), the DDDs equivalence was defined as the usage amount multiplied the pack size divided by the defined daily dose (DDD), a measurement developed by the WHO to compare drug consumption, DDDs = (usage amount × pack size/DDD) (Tang et al, 2018).…”

“…Since the establishment of the system of clinical pharmacists in China in 2002, clinical pharmacists have been increasingly involved in ASPs in hospitals (Xiao and Li, 2013;Li et al, 2017;Zhang et al, 2017). Pharmacist-led interventions have yielded excellent results in many areas (Kooij et al, 2016;van Eikenhorst et al, 2017;Ravn-Nielsen et al, 2018;van der Laan et al, 2018). However, the studies that have been performed on ASPs for hospital inpatients led by pharmacists have received insufficient attention in developing countries (Davey et al, 2017;Sakeena et al, 2018).…”

The Cost-Effectiveness of an Intervention Program to Enhance Adherence to Antihypertensive Medication in Comparison With Usual Care in Community Pharmacies

“…We have previously shown that the CATI intervention program did not influence self-reported medication adherence, quality of life, illness perceptions or blood pressure. However, participants in the intervention group had stronger beliefs in the necessity of using their medicines after 9 months as compared to the control group ( van der Laan et al, 2018 ). The aim of the present study was to evaluate the cost-effectiveness of the CATI intervention program in comparison with usual care in patients using antihypertensive medication from a societal perspective.…”

Implementation fidelity of an intervention programme to enhance adherence to antihypertensive medication in Dutch community pharmacies

“…This care consists of reviewing and dispensing of the prescribed medication, providing instructions on its use as well as information about intended effects and possible side effects during first and second dispensing. The CATI study showed no significant effects on self-reported medication adherence or other secondary outcomes [16]. The process evaluation of the CATI study might clarify whether the ineffectiveness of the intervention was due to poor implementation or inadequacies in the design of the intervention.…”