Pharmacy Care Program Helps Elderly Patients Take All Their Medications
Prescription Medication Adherence
A pharmacy care program for elderly patients increases medication adherence, which results in improved health outcomes, according to a study in the December 6 issue of JAMA. The study was posted online November 13 to coincide with its presentation at the American Heart Association Scientific Session.
"Adherence to chronic pharmacological therapies is poor, leading to worsening disease severity and increased costs associated with higher hospital admission rates," the authors provide as background information. "Barriers to medication adherence are numerous, but include the prescription of complex medication regimens, treatment of asymptomatic conditions and convenience factors. These factors are particularly prevalent among the elderly population, placing them at increased risk for medication nonadherence."
Jeannie K. Lee, Pharm.D., and colleagues from Walter Reed Army Medical Center, Washington, D.C., report the results from the Federal Study of Adherence to Medications in the Elderly (FAME), a multi-phase investigation that included 200 community-based patients age 65 years or older taking at least four chronic medications. The FAME study, which was conducted from June 2004 to August 2006 consisted of three phases. First, all 200 patients entered a two-month run-in phase that provided a baseline for medication adherence using pill counts, and for blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) readings. Of these patients, 174 then entered a six-month intervention phase that included standardized medication education, regular follow-up by pharmacists and all medications dispensed in time-specified blister packs. Following the intervention phase, 159 patients were randomized to continue the pharmacy care program or return to their usual care for an additional six months.
The average age of the study patients was 78 years. Cardiovascular risk factors were prevalent and included drug-treated hypertension in 184 patients (91.5 percent) and drug-treated hyperlipidemia in 162 patients (80.6 percent). The patients took an average of nine different chronic daily medications. At the beginning of the first phase of the study, the researchers found the average medication adherence was 61.2 percent. "After six months of intervention, medication adherence increased to 96.9 percent and was associated with significant improvements in systolic blood pressure (133.2 to 129.9 millimeters of mercury) and LDL-C (91.7 to 86.8 milligrams per deciliter)," the researchers report. "Six months after randomization, the persistence of medication adherence decreased to 69.1 percent among those patients assigned to usual care, whereas it was sustained at 95.5 percent in pharmacy care." The pharmacy care group also had significant reductions in systolic blood pressure compared to the usual care group, but no significant differences between the groups in LDL-C levels or reductions.
"In this study, a comprehensive pharmacy program composed of patient education and custom blister-packed medications was associated with substantial and sustained improvements in medication adherence among elderly patients receiving complex medication regimens. The association of improved medication adherence with reduced levels of BP and LDL-C suggests that such a program could lead to meaningful improvements in health outcomes. The results of the FAME study call for greater emphasis within health care delivery systems and policy organizations on the development and promotion of clinical programs to enhance medication adherence particularly among the at-risk elderly population," the authors conclude.
CHALLENGES FOR IMPROVING MEDICATION ADHERENCE
In a related editorial, Ross J. Simpson Jr., M.D., Ph.D., from the University of North Carolina at Chapel Hill writes "for chronic medical conditions, such as hypercholesterolemia and hypertension, a wide and persistent separation exists between evidence-based recommendations and the actual care patients receive."
"Patient characteristics that may lead to poor adherence include advanced age, cognitive impairment and depression as well as attitudes and beliefs about the importance of the medication, the disease being treated and the potential for adverse effects."
"...the study by Lee and colleagues adds important information about improving medication adherence in elderly patients and also highlights the challenges inherent in designing and conducting high-quality research in this critically important area. Multifaceted interventions that incorporate structural and counseling components and include appropriately skilled and motivated pharmacists appear useful to promote medication adherence and persistence. Future studies are needed to confirm that interventions incorporating these components will result in increased and sustained patient adherence and, better yet, will improve outcomes." (JAMA. 2006:296:2614-2616)