Pharmacy care and adherence to primary and secondary prevention cardiovascular medication: a systematic review of studies

Jalal, Zahraa S. and Smith, Felicity and Taylor, David and Finlay, Katherine A. and Patel, Hemant and Antoniou, Sotiris (2014) Pharmacy care and adherence to primary and secondary prevention cardiovascular medication: a systematic review of studies. European Journal of Hospital Pharmacy, 21 (4). pp. 238-244.

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Abstract

Objective To investigate the feasibility and potential impact of a pharmacy care intervention, involving motivational interviews amongst patients with acute coronary syndrome, on adherence to medication and on health outcomes. Methods This article reports a prospective, interventional, controlled feasibility/pilot study. Seventy one patients discharged from a London Heart Attack Centre following acute treatment for a coronary event were enrolled and followed up for six months. Thirty two pharmacies from 6 London Boroughs were allocated into intervention or control sites. The intervention was delivered by community pharmacists face-to-face in the pharmacy, or by telephone. Consultations were delivered as part of the New Medicine Service or a Medication Usage Review. They involved a 15-20 minute motivational interview aimed at improving protective cardiovascular medicine taking. Results At 3 months there was a statistically significant difference in adherence between the intervention group (M= 7.7, SD=0.56) and the control group (M= 7.0, SD=1.85), (P= 0.026). At 6 months the equivalent figures were for the intervention group M=7.5, SD=1.47 and for the controls M= 6.1, SD=2.09 (P=0.004). In addition, there was a statistically significant relationship between the level of adherence at 3 months and beliefs regarding medicines (P=0.028). Patients who reported better adherence expressed positive beliefs regarding the necessity of taking their medicines. However, given the small sample size, no statistically significant outcome difference in terms of recorded blood pressure and LDL-C was observed over the six months of the study. Conclusion The feasibility, acceptability and potentially positive clinical outcome of the intervention was demonstrated, long with a high level of patient acceptability. It had a significant impact on cardiovascular medicine taking adherence. But these findings must be interpreted with caution. The intervention should be tested in a larger trial to ascertain its full clinical utility.

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