Objective:
To describe the education, research, practice, and policy related
to pharmacist interventions to improve medication adherence in
community settings in the United States.
Methods: Authors used MEDLINE and International Pharmaceutical
Abstracts (since 1990) to identify community and ambulatory pharmacy
intervention studies which aimed to improve medication adherence.
The authors also searched the primary literature using Ovid to
identify studies related to the pharmacy teaching of medication
adherence. The bibliographies of relevant studies were reviewed
in order to identify additional literature. We searched the tables
of content of three US pharmacy education journals and reviewed
the American Association of Colleges of Pharmacy website for materials
on teaching adherence principles. Policies related to medication
adherence were identified based on what was commonly known to
the authors from professional experience, attendance at professional
meetings, and pharmacy journals.
Results: Research and Practice: 29 studies were identified: 18
randomized controlled trials; 3 prospective cohort studies; 2
retrospective cohort studies; 5 case controlled studies; and one
other study. There was considerable variability in types of interventions
and use of adherence measures. Many of the interventions were
completed by pharmacists with advanced clinical backgrounds and
not typical of pharmacists in community settings. The positive
intervention effects had either decreased or not been sustained
after interventions were removed. Although not formally assessed,
in general, the average community pharmacy did not routinely assess
and/or intervene on medication adherence.
Education: National pharmacy education groups support the need
for pharmacists to learn and use adherence-related skills. Educational
efforts involving adherence have focused on students’ awareness
of adherence barriers and communication skills needed to engage
patients in behavioral change.
Policy: Several changes in pharmacy practice and national legislation
have provided pharmacists opportunities to intervene and monitor
medication adherence. Some of these changes have involved the
use of technologies and provision of specialized services to improve
adherence.
Conclusions: Researchers and practitioners need to evaluate feasible
and sustainable models for pharmacists in community settings to
consistently and efficiently help patients better use their medications
and improve their health outcomes.
