Adherence: a review of education, research, practice and policy in Spain

Main Article Content

Narjis Fikri-Benbrahim
Victoria Garcia-Cardenas
Loreto Saez-Benito
Miguel A. Gastelurrutia
Maria J. Faus

Keywords

Medication Adherence, Pharmacists, Spain

Abstract

Aims: To describe medication adherence education, practice, research and policy efforts carried out by pharmacists in Spain in the last decade.


Methods: A literature review using Medline and Embase was conducted covering the last ten years. Additional pharmaceutical bibliographic sources in Spain were consulted to retrieve articles of interest from the last decade. Articles were included if a pharmacist was involved and if medication adherence was measured or there was any direct or indirect pharmacist intervention in monitoring and/or improving adherence. Articles focusing on the development of tools for adherence assessment were collected. Pre- and post-graduate pharmacy training programs were also reviewed through the Spanish Ministry of Education and Science website. Information regarding policy issues was gathered from the Spanish and Autonomous Communities of Education and Health Ministries websites.


Results: Pharmacists receive no specific training focused on adherence. There is no specific government policies for pharmacists in Spain related to medication adherence regardless of their practice setting. A total of 24 research studies met our inclusion criteria. Of these, 10 involved pharmacist intervention in monitoring and/or improving adherence and 14 assessed only adherence. Ten studies involved hospital pharmacists working in collaboration with another healthcare professional.


Conclusions: At present in Spain, the investigative role of the pharmacist is not well developed in the area of medication adherence. Adherence improvement services provided to patients by pharmacists are not implemented in a systematic way. However, recent efforts to implement new initiatives in this area may provide the basis for offering new cognitive services aimed at improving patient adherence in the near future.

Abstract 1488 | PDF Downloads 852

References

1. WHO. Adherence to long-term therapies. Evidence for actions. Geneve: World health Organization;2004.http://www.who.int/chp/knowledge/publications/adherence_report/en/index.html (accessed 1-7-2009)

2. López Cabezas C, Falces Salvador C, Cubí Quadrada D, Arnau Bartés A, Ylla Boré M, Muro Perea N, et al. Randomized clinical trial of a postdischarge pharmaceutical care program vs. regular follow-up in patients with heart failure. Farm Hosp 2006;30:328-342.

3. García MD, Orozco D, Gil V, Carratala C. Relación entre cumplimiento farmacológico y grado de control en pacientes con hipertensión, diabetes o dislipemia. Med Clin 2001;116(Supl.2):141-146.

4. Rodríguez-Marín J. Cumplimiento de regímenes terapéuticos y calidad asistencial. Rev Calidad Asistencial. 2006;21(5):255-263.

5. Gascón Cánovas JJ, Saturno Hernández PJ, Llor Esteban B; Grupo de Investigación del Proyecto EMCA sobre Evaluación y Mejora de la Adhesión Terapéutica en la Hipertensión. [Evaluation and improvement of therapy adherence of hypertensive patients]. Aten Primaria. 2001;28(9):615-619.

6. Márquez Contreras E, de la Figuera von Wichmann M, Roig Ponsa L, Naval Chamosa J. [Compliance with hypertension therapy in Spain, according to the views of family doctors. Complex project]. Aten Primaria. 2007;39(8):417-423.

7. Márquez Contreras E, Gil Guillén V, Casado Martínez JJ, Martel Claros N, De la Figuera von Wichmann M, Martín de Pablos JL, Atienza Martín F, Gros García T, Espinosa García J. [Analysis of studies published on hypertension treatment non-compliance in Spain between 1984 and 2005]. Aten Primaria. 2006;38:325-332.

8. Márquez Contreras E. Evaluación del incumplimiento en la práctica clínica. Hipertensión (Madr.) 2008;25(5):205-213.

9. Wiederholt JB, Wiederholt PA. The patient: our teacher and friend. Am J Pharm Educ. 1997; 61; 415-423.

10. Murphy J, Coster G. Issues in patient compliance. Drugs. 1997;54:797-800.

11. Rigueira García AI. [Treatment compliance: what do we know about Spain?]. Aten Primaria. 2001;27(8):559-568.

12. Machuca M, Espejo J, Gutiérrez L, Machuca MP, Herrera J. La Información escrita del farmacéutico mejora el cumplimiento de la antibioterapia. Ars Pharm. 2003;44(2):141-157.

13. Grupo de Consenso. Documento de Consenso en Atención Farmacéutica. Ars Pharm. 2001;42: 223-243.

14. Herrera Carranza J. [Objectives of pharmaceutical care]. Aten Primaria. 2002;30(3):183-187.

15. Pharmaceutical Care Forum, Expert panel. Consensus Document, January 2008. Consejo General de Colegios Oficiales de Farmacéuticos, Madrid. ISBN 978-84-613-1219-1.

16. Pharmaceutical Care Research Group, University of Granada (Spain). Pharmacotherapy follow-up: The Dader method (3rd revision: 2005). Pharm Pract. 2006;4(1):44-53.

17. Sabater D, Silva-Castro MM, Faus MJ. Metodo Dader: Guia de Seguimiento Farmacoterapeutico. Granada: Universidad de Granada; 2007.

18. Gobierno de España. Ministerio de Educación. Oferta de Titulaciones. Tipo de Estudio: Grado 1º y 2º ciclo. Rama: Ciencias de la salud. Enseñanza: Grado en Farmacia. https://www.educacion.es/ructweb/jsp/busquedaDo.do?opcionMenu=BusquedaSimple&codTipoUniversidad=T&nomTipoUniversidad=Todas&codUniversidad=T&nomUniversidad=Todas&nomTitula=Grado%20en%20Farmacia&codRama=431005&nomRama=Ciencias%20de%20la%20Salud&codAut=00&codProv=00&tipoEnsenanza=CICLO (accessed 1-7-2009).

19. Ministerio de Educación. Oferta de titulaciones: https//www.educacion.es/ructweb/jsp/compBdDo.do (accessed 1-7-2009).

20. Agencia Nacional de Evaluación de la Calidad y Acreditación. Libro blanco. Título de Grado en Farmacia. 2005. http://www.aneca.es/media/150368/libroblanco_farmacia_def.pdf (accessed 1-7-2009).

21. Marino EL, Alvarez-Rubio L, Miro S, Modamio P, Banos F, Lastra CF, Alberdi-Leniz A. Pharmacist intervention in treatment of patients with genotype 1 chronic hepatitis C. J Manag Care Pharm. 2009 Mar; 15(2):147-150.

22. López C, Falces C, Cubí D, Arnau A, Ylla M, Muro N, Homs E. Ensayo clínico aleatorizado de un programa de atención farmacéutica al alta frente al seguimiento habitual en pacientes con insuficiencia cardiaca. Farm Hosp. 2006; 30:328-342.

23. Ventura JM, Alós M. Programa de Atención farmacéutica a pacientes con VIH con tratamiento antirretroviral: metodología y documentación. Farm Hosp. 2004;28(1):72-79.

24. Arias JL, Santamaría-López JM. Mejora de los resultados de la farmacoterapia de pacientes hipertensos en una farmacia comunitaria. Ars Pharm. 2008;49(1):13-24.

25. García-Jiménez E, Amariles P, Machuca M, Parras-Martín M, Espejo-Guerrero J, Faus MJ. Incumplimiento, problemas relacionados con los medicamentos y resultados negativos asociados a la medicación: causas y resultados en el seguimiento farmacoterapéutico. Ars Pharm. 2008;49(2):145-157.

26. Andrés NF, Fornos JA, Andrés JC. Valoración del conocimiento/cumplimiento en un programa de SFT en diabéticos tipo 2 en farmacia comunitaria: estudios aleatorizado. Pharm Care Esp 2007;9(1):2-9.

27. Rodríguez MA, Rodríguez A, García E. incumplimiento terapéutico en pacientes en seguimiento farmacoterapéutico mediante el método Dáder en dos farmacias rurales. Pharm Care Esp 2006;8(2):62-68.

28. Juan G, Lloret T, Perez C, Lopez P, Navarro R, Ramón M, Cortijo J, Morcillo EJ. Directly observed treatment for tuberculosis in pharmacies compared with self-administered therapy in Spain. Int J Tuberc Lung Dis. 2006;10(2):215-221.

29. Bofill C, Valenti MJ, Palmer JL, Rovira M, Nogareda F, Cimadevilla D, et al. Intervención sobre uso racional del medicamento: experiencia piloto en centros de atención primaria y las farmacias de su entorno. Pharm Care Esp. 2006; 8(5):209-217.

30. Bueno Gómez M, Barrionuevo Sancho MD, Fikri Benbrahim N, García-Jiménez E. [Causes of non-compliance of patients who attend a community pharmacy in Granada]. Aten Primaria. 2008;40(2):101-106.

31. Martín MT, del Cacho E, López E, Codina C, Tuset M, de Lazzari E, Miró JM, Gatell JM, Ribas J. [Adverse side effects of antiretroviral therapy: relationship between patients' perception and adherence]. Med Clin (Barc). 2007;129(4):127-133.

32. Morillo Verdugo R, Abdel-Kader Martín L, Márquez Saavedra E, Martínez Alonso I, Artacho Criado S, Almeida González c, Miguel del Corral M. Análisis de las causas de suspensión del régimen antirretroviral simplificado abacavir, lamivudina y zidovudina. Farm Hosp. 2005;29(3):164-170.

33. Baena MI, Fajardo P, Martínez-Olmos J, Martínez- Martínez F, Moreno P, Calleja MA, Luque FM, Sierra F, Parras M, Romero JM, Vargas J, López E, Fernández-Llimós F, Faus MJ. Cumplimiento, conocimiento y automedicación como factores asociados a los resultados clínicos negativos de la farmacoterapia. Ars Pharm. 2005; 46 (4): 365-381.

34. Méndez Lora M, del Valle Gómez MO, López González ML, López González I. Descripción del cumplimiento farmacológico antihipertensivo y sus determinantes psicosociales. Pharm Care Esp. 2006, 8(5): 199-252.

35. Ventura-Cerdá JM, Mínguez-Gallego C, Fernández-Villalba EM, Alós-Almiñana, Andrés-Soler J. Escala simplificada para detectar problemas de adherencia (ESPA) al tratamiento antirretroviral. Farm Hosp. 2006; 30(3): 171-176.

36. Martín-Sánchez V, Ortega-Valín L, Pérez-Simón MR, Mostaza-Fernández JL, Ortiz de Urbina-González JJ, Rodríguez-María MM, Carro-Fernández JA, Cuevas-González MJ, Alcoba-Leza M, y Grupo de Trabajo sobre Adhesión a TARGA. [Factors predicting lack of adherence to highly active antiretroviral treatment]. Enferm Infecc Microbiol Clin. 2002; 20(10):491-497.

37. Martín J, Escobar I, Rubio R, Sabugal G, Cascón J, Pulido F. Study of the validity of a questionnaire to assess the adherence to therapy in patients infected by HIV. HIV Clinical Trials. 2001; 2(1):31-37.

38. Alcoba M, Cuevas MJ, Perez-Simon MR, Mostaza JL, Ortega L, Ortiz de Urbina J, Carro JA, Raya C, Abad M, Martin V; HAART Adherence Working Group for the Province of Leon, Spain. Assessment of adherence to triple antiretroviral treatment including indinavir: role of the determination of plasma levels of indinavir. J Acquir Immune Defic Syndr. 2003; 33(2):253-258.

39. García de Olalla P, Knobel H, Carmona A, Guelar A, López-Colomés JL, Caylà JA. Impact of adherence and highly active antiretroviral therapy on survival in HIV-infected patients. J Acquir Immune Defic Syndr. 2002;30(1):105-110.

40. Girón-González JA, López-Sánchez A, Elvira J, Perez E, Fernández-Gutiérrez C. Effect of patient adherence to antiretroviral therapy on CD4+ cell count, HIV-1 RNA, and serum concentrations of tumor necrosis factor and its soluble receptors. Eur J Clin Microbiol Infect Dis. 2000;19(11):852-858.

41. Codina C, Martínez M, Tuseta M, Cacho E, Martín MT, Miró JM, Mallolas J, Lazzari E, García F, Martínez E, Gatell JM y Ribas J. Comparison of three methods to calculate adherence in patients receiving antiretroviral treatment. Enferm Infecc Microbiol Clin 2002;20(10):484-490.

42. Cuevas González MJ, Valín LO, Pérez-Simón MD, Mostaza Fernández JL, Alcoba Leza M, Sánchez VM; the HAART Adherence Working Group of the Province of Léon, Spain. A Prospective Study of Adherence and Virologic Failure in HIV-Infected Patients: Role of a Single Determination of Plasma Levels of Antiretroviral Medications. J Int Assoc Physicians AIDS Care 2007; 6(4):245-250.

43. Escobar I, Campo M, Martín J, Fernández-Shaw, Pulido F, Rubio. Factors affecting patient adherence to highly active antiretroviral therapy. Ann Pharmacother 2003;37:775-781.

44. Segura MM, Llaves E, Baena MI, García E, Lamenca AG, López B. Educación Sanitaria y Medipack en el cumplimiento posológico de pacientes con hipertensión arterial y dislipemias. Seguim Farmacoter 2004;2(supl 1):35.

45. Ibarra O, Ortega V, Grupo VIH de la SEFH. Encuesta de la Atención Farmacéutica en el paciente con VIH en España. Farm Hosp 2008;32(3):170-177.

46. Gastelurrutia MA, Faus MJ, Fernández-Llimós F. Providing Patient Care in Community Pharmacies in Spain. Ann Pharmacother 2005;39:2105-2110.

47. Banegas JR, Jovell A, Abarca B, Aguilar Diosdado M, Aguilera L, Aranda P, Bertoméu V, Capilla P, Conthe P, De Alvaro F, Fernández-Pro A, Formiguera X, Frías J, Guerrero L, Llisterri JL, Lobos JM, Macías JF, Martín De Francisco AL, Millán J, Morales JC, Palomo V, Roca-Cusachs A, Román J, Sanchis C, Sarriá A, Segura J, De La Sierra A, Verde L, Zarco J, Ruilope LM. [Hypertension and health policy in Spain]. Med Clin (Barc) 2009;132(6):222–229.

48. Gastelurrutia MA. Spanish Consensus on Pharmaceutical Care. Pharmaceutical Care Forum. In: Conference Abstracts: Abstracts of the PCNE 7th Working Conference.2009. PP.18.

49. Plan Estratégico de Política Farmacéutica para el Sistema Nacional de Salud Español. Ministerio de Sanidad y Consumo. 2004. http://bscw.iesalbasit.es/pub/bscw.cgi/d102154/PLAN%20ESTRATICO%20DE%20SANIDAD.pdf (accessed 1-7-2009).

50. Gastelurrutia MA, Larrañaga B, Garay A, Echeveste FA. Program to improve the use of medication by users of the Municipal Domiciliary Care Service in Gipuzkoa. In: Conference Abstracts: Abstracts of the PCNE 7th Working Conference. 2009. PP.17

51. [Ministerio de Sanidad y Política Social - Gabinete de Prensa - Notas de Prensa]: http://www.msps.es/gabinetePrensa/notaPrensa/ desarrolloNotaPrensa.jsp?id=1443 (accessed 1-7-2009).

52. Schneider MP, Krummenacher I, Figueiredo H, Marquis J, Bugnon O. Adherence: a review of education, research, practice and policy in Switzerland. Pharm Pract. 2009;7(2):63-73.

53. Aslani P, Krass I. Adherence: a review of education, research, practice and policy in Australia. Pharm Pract. 2009;7(1):1-10.

54. Södergård B. Adherence to treatment: what is done in Sweden? Practice, education and research. Pharm Pract. 2008;6(4):171-177

55. Haynes RB, Yao X, Degani A, Kripalani S, Garg A, McDonald HP. Interventions to enhance medication adherence. Cochrane Database Syst Rev. 2008;(2):CD000011.

56. Comité de Consenso. Tercer Consenso de Granada sobre Problemas Relacionados con los Medicamentos (PRM) y Resultados Negativos asociados a la Medicación. Ars Pharm. 2007;48(1):5-17.

57. Baena MI, Calleja MA, Romero JM, Vargas J, Jiménez J, Faus MJ. The validation of a questionnaire for the identification of problems arising from the use of medicines by patients at a hospital emergency ward. Ars Pharm. 2001; 42:147-171.

58. Gao X, Nau DP. Congruence of three self-report measures of medication adherence among HIV patients. Ann Pharmacother. 2000;34(10):1117-1122.

Most read articles by the same author(s)