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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pharmacol. | doi: 10.3389/fphar.2018.01057

Effectiveness of a Patient-tailored, Pharmacist-led Intervention Program to Enhance Adherence to Antihypertensive Medication: the CATI Study

  • 1VU University Medical Center, Netherlands
  • 2Netherlands Institute for Health Services Research, Netherlands

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 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.

Keywords: Medication adherence (MeSH), patient-tailored, Community pharmacies, randomized controlled trial, Antihypertensive medication

Received: 10 Jul 2018; Accepted: 03 Sep 2018.

Edited by:

Brian Godman, Karolinska Institutet (KI), Sweden

Reviewed by:

Johanna C. Meyer, Sefako Makgatho Health Sciences University, South Africa
Amanj Kurdi, University of Strathclyde, United Kingdom  

Copyright: © 2018 Van Der Laan, Elders, Boons, Nijpels, Van Dijk and Hugtenburg. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Ms. Danielle M. Van Der Laan, VU University Medical Center, Amsterdam, Netherlands, d.vanderlaan1@vumc.nl