Delivery of patient adherence support: a systematic review of the role of pharmacists and doctors
Malin Andersson,1,2 Sara Garfield,1,2 Lina Eliasson,3,4 Christina Jackson,3 David K Raynor5
1The Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, 2UCL School of Pharmacy, London, 3Atlantis Healthcare, London, 4Centre for Haematology, Imperial College London, Hammersmith Hospital, London, 5School of Healthcare, University of Leeds, Leeds, UK
Abstract: We conducted a systematic review of adherence support programs involving doctors and pharmacists. We searched MEDLINE®, Embase, International Pharmaceutical Abstracts, PsycINFO®, and CINAHL using the keywords "pharmacist" or "doctor" and "adhere*" or "compli*" and "randomized controlled trials". We found 89 studies involving pharmacists; in contrast, only 14 studies involved doctors. The roles of pharmacists and doctors ranged from providing education and counseling to adjusting treatment. Most interventions that specified a patient group were carried out with patients with chronic conditions (n=79) and only six included short-term treatments. The majority of interventions improved adherence and clinical outcomes to some extent, although the size of effect size was sometimes small. Resource utilization (eg, hospitalization rates, visits to doctors) did not change in the majority of studies that reported it. Few studies included cost analyses. All but one study had high risk of performance bias due to the nature of the interventions, which made it impossible to blind the participants. The majority of studies did not report tailoring the interventions to patient needs and the vast majority of papers did not report taking a concordant patient-centered approach or considering patients' own views and experiences when providing adherence support. In addition, the majority of studies did not describe training for the health care professionals involved in providing adherence support. Providing training for doctors and pharmacists to take a more patient-centered concordant approach would be expected to increase the effectiveness of adherence support further.
Keywords: interventions, patient views, patient experiences, patient-centered approach, resource utilization
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