Pharmacist intervention improves medication adherence, leads to risk factor improvement

Pharmacist-directed education combined with prepackaging of medications increases compliance with medication schedules, leading to improvements in blood pressure and cholesterol levels among elderly patients, according to a study headed by Allen J. Taylor, MD.

The Federal Study of Adherence to Medications in the Elderly (FAME) tested the effect of a comprehensive pharmacy program on medication adherence in 200 patients older than 65 (mean age: 78 years) who were taking 4 or more medicines daily. Baseline data were collected during a 2-month run-in phase, which was followed by an intervention phase during months 2 to 8, and then a randomized phase of continued pharmacy care versus return to usual care during months 8 to 14.

The pharmacy care program consisted of standardized medication education, regular follow-up by pharmacists, and all medications dispensed in time-specified blister packs.

After the intervention phase, medication adherence increased from 61.2% to 96.9%, systolic blood pressure declined from 133.2 mmHg to 129.9 mmHg (P=.019), and low-density lipoprotein (LDL) cholesterol decreased from 91.7 mg/dL to 86.8 mg/dL (P =.001).

After the randomized phase, there was sustained medication adherence in the continued pharmacy group (95.5%), whereas medication adherence fell to 69.1% in the group that reverted to usual care. "There was no durable effect of the program after having it withdrawn," said Dr. Taylor, chief of cardiology at Walter Reed Army Medical Center in Washington, D.C. The improved persistence in the intervention group resulted in significant reductions in blood pressure compared with the usual care group (10.7 mmHg vs. 3.1 mmHg; P =.04), although the LDL cholesterol reduction during the intervention phase was sustained in patients later randomized to usual care.

The patients in this study received their medications through the military health system and thus did not have the financial concerns than many elderly patients do, Dr. Taylor said.

The medication prepackaging cost 14 cents per month, he said, with the major expense of the program being the pharmacist's time, which may limit the widespread use of the system. Nevertheless, Dr. Taylor said that a program to improve medication compliance may be warranted, considering the amount of money third-party payors and the Medicare system spend on the drugs themselves.