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Pharmacist-Delivered Interventions Affect Target and Nontarget Chronic Medication Adherence

Published Online: September 04, 2014
Michael S. Taitel, PhD; Robert J. Sanchez, PhD; Leonard E. Fensterheim, MPH; Jack Mardekian, PhD; Adam E. Cannon, MPH; Thomas B. Rough, RPh; and Melissa A. Farley, PharmD

Objective: To determine the impact of a focused pharmacistdelivered counseling program on patient adherence to target and nontarget chronic medications.


Study Design: A post hoc analysis of a randomized retail pharmacy pilot that enrolled patients who filled a prescription for brand-name atorvastatin, pregabalin, or tolterodine extended release (target medications) between October 2008 and March 2009. 

Methods: Patients in the intervention group received focused, pharmacist-delivered counseling on target medications that included adherence education, coaching, and reminder aids; control patients received usual care. One-year adherence rates for target and other chronic (nontarget) medications were assessed based on proportion of days covered (PDC).


Results: For target medications, patients receiving the intervention (n = 3329) had a significantly higher mean PDC than control patients (n = 2313): 33.8% higher for atorvastatin (47.9% vs 35.8%; <.001), 36.2% higher for pregabalin (33.1% vs 24.3%; <.001), and 29.2% higher for tolterodine extended release (39.8% vs 30.8%; P <.001). For nontarget medications, mean PDC was 17.5% higher for atorvastatin (45.6% vs 38.8%; P <.001), 10.5% higher for pregabalin (37.8% vs 34.2%; P <.001), and 8.3% higher for tolterodine extended release (41.8% vs 38.6%; P = .078) in 
intervention and control patients, respectively. Overall, the intervention improved adherence by 36.8% (P <.001) for target medications and 14.7% (P <.001) for nontarget medications.


Conclusions: Patients participating in a focused pharmacistdelivered counseling program demonstrated improved adherence to target medications. Furthermore, patients generalized their improved adherence behavior to nontarget chronic medications that were not directly addressed by the intervention.


Am J Pharm Benefits. 2014;6(4):e115-e124

In the United States, nearly 1 out of every 2 adults has at least 1 chronic medical condition.1 Each year, 7 out of 10 deaths are attributed to chronic conditions, with heart disease, cancer, and stroke accounting for more than 50% of all deaths.2 Adhering to medication treatment regimens is crucial for chronic disease patients to ensure proper management of their disease.3 However, previous studies suggest that medication adherence rates are relatively low among patients with chronic diseases. For example, a recent study conducted in a California Medicaid population found that nonadherence among patients with chronic conditions ranged from 41% for patients with diabetes to 69% for patients with hypertension.4



Nonadherence to medication is associated with increased hospitalization, progression of disease, and higher mortality, ultimately translating into increased healthcare costs.5-7 In the United States, nonadherence has been demonstrated to result in $100 billion each year in excess hospitalizations alone.8 In 2009, the total avoidable healthcare cost related to poor adherence was estimated to be $290 billion.9 Thus, improving patient adherence to chronic medication regimens is animportant public health and clinical goal that could reduce healthcare costs.



Approximately 1 in 4 Americans has multiple chronic conditions (MCCs), defined as 2 or more chronic conditions that simultaneously affect the patient. MCC patients account for 66% of total healthcare expenditure in the United States.10 For this population, increasing medication adherence for all of their maintenance medications is crucial to reduce morbidity, mortality, and healthcare costs.



Factors associated with nonadherence include cost of medication, complexity of medication regimen, number and severity of side effects, long duration or chronic usage of a medication, increasing medication dosage, poor prescriber communication or follow-up, use of multiple pharmacies, patient forgetfulness, access to medication, and lower health literacy.5-7,11 Although activities such as increasing a patient’s knowledge of the disease, communicating the benefits of medication, and maintaining a patient’s trust in the physician are associated with medication adherence, a physician’s ability to identify nonadherent patients is limited.5,8,11



To address the problem of medication nonadherence, community pharmacists are well positioned to proactively counsel patients on the importance of taking medications as prescribed. Pharmacists can successfully perform medication management for patients by having access to medication profiles, potential prescription errors, drug interactions, and gaps in evidence-based therapies.12



Research on medication adherence suggests that the act of counseling patients on a specific target medication improves patient adherence to that medication.12,13 Building upon that literature, Walgreens collaborated with a pharmaceutical company on a pilot study to test the impact of a 6-month pharmacist-delivered counseling program on adherence among new users of 3 preselected brand name pharmaceutical products: Lipitor (atorvastatin), Lyrica (pregabalin), and Detrol (tolterodine extended release). The aim of the pilot study was to determine whether medication adherence differed between those assigned to an intervention group who received additional counseling versus those who received usual care.



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