Process- and patient-reported outcomes of a multifaceted medication adherence intervention for hypertensive patients in secondary care

Ulla Hedegaard, Jesper Hallas, Lene Vestergaard Ravn-Nielsen, Lene Juel Kjeldsen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: Adherence to antihypertensive medications is suboptimal. Hospital pharmacist interventions including motivational interviewing (MI) might assist in improving adherence in patients with hypertension. For an intervention to be useful, it is important to have tools that can easily identify potential adherence problems.

OBJECTIVES: To evaluate process outcomes and patient- and pharmacist-reported outcomes of a pharmacist adherence intervention for hypertensive patients treated in hospital outpatient clinics. Secondly, to determine the agreement between two different adherence metrics: an adherence questionnaire used in the intervention and a prescription-based measure.

METHODS: The development of the intervention was based on adherence and behavioral theories and evidence of effective interventions. This included a focused medication review, a patient interview, and follow-up telephone calls. Two tools were used to identify adherence problems: The Drug Adherence Work-up (DRAW) tool and an adherence questionnaire. Process data included drug-related problems (DRPs) with recommendations to the physicians, medication- and lifestyle problems identified at the patient interview, actions taken and time spent on the intervention.

RESULTS: In total, 91 DRPs in 8 categories generated recommendations to the physicians; 56 recommendations were generated at the medication review and 35 at the patient interview. At the interview, 421 problems were identified, of which 60% were medication-related and 40% lifestyle-related. In connection with the interview, 528 actions were taken within 8 different categories. MI was a central technique applicable for most problems and was employed in nearly all patients (94%). About half of the patients reported increased focus on lifestyle change, and 21-39% reported increased knowledge, confidence and skills in relation to their medication as well as better quality of life. The pharmacists found that the intervention elements were meaningful pharmacist tasks, and that the DRAW tool was easy to use and helped them focus on addressing reasons for non-adherence. The mean total time spent by the pharmacist per patient was 2 h 14 min (SD 40 min).

CONCLUSIONS: A pharmacist-led, multifaceted, tailored adherence intervention was feasible for identifying and addressing a wide range of potential adherence and lifestyle problems. Among the intervention procedures, MI was a central technique, applicable in most types of problems. The questionnaire showed relatively little value for identifying non-adherence. The intervention was well accepted both by the pharmacists and the patients, thereby increasing the likeliness of successful implementation in routine practice.

Original languageEnglish
JournalResearch in Social and Administrative Pharmacy
Volume2016; 12
Issue number2
Pages (from-to)302–318
ISSN1551-7411
DOIs
Publication statusPublished - 2016

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Medication Adherence
Pharmacists
Motivational Interviewing
Interviews
Pharmaceutical Preparations
Hospital Outpatient Clinics
Physicians
Prescriptions
Quality of Life

Cite this

@article{e84c325b24ec433da4072e3d86f126ad,
title = "Process- and patient-reported outcomes of a multifaceted medication adherence intervention for hypertensive patients in secondary care",
abstract = "BACKGROUND: Adherence to antihypertensive medications is suboptimal. Hospital pharmacist interventions including motivational interviewing (MI) might assist in improving adherence in patients with hypertension. For an intervention to be useful, it is important to have tools that can easily identify potential adherence problems.OBJECTIVES: To evaluate process outcomes and patient- and pharmacist-reported outcomes of a pharmacist adherence intervention for hypertensive patients treated in hospital outpatient clinics. Secondly, to determine the agreement between two different adherence metrics: an adherence questionnaire used in the intervention and a prescription-based measure.METHODS: The development of the intervention was based on adherence and behavioral theories and evidence of effective interventions. This included a focused medication review, a patient interview, and follow-up telephone calls. Two tools were used to identify adherence problems: The Drug Adherence Work-up (DRAW) tool and an adherence questionnaire. Process data included drug-related problems (DRPs) with recommendations to the physicians, medication- and lifestyle problems identified at the patient interview, actions taken and time spent on the intervention.RESULTS: In total, 91 DRPs in 8 categories generated recommendations to the physicians; 56 recommendations were generated at the medication review and 35 at the patient interview. At the interview, 421 problems were identified, of which 60{\%} were medication-related and 40{\%} lifestyle-related. In connection with the interview, 528 actions were taken within 8 different categories. MI was a central technique applicable for most problems and was employed in nearly all patients (94{\%}). About half of the patients reported increased focus on lifestyle change, and 21-39{\%} reported increased knowledge, confidence and skills in relation to their medication as well as better quality of life. The pharmacists found that the intervention elements were meaningful pharmacist tasks, and that the DRAW tool was easy to use and helped them focus on addressing reasons for non-adherence. The mean total time spent by the pharmacist per patient was 2 h 14 min (SD 40 min).CONCLUSIONS: A pharmacist-led, multifaceted, tailored adherence intervention was feasible for identifying and addressing a wide range of potential adherence and lifestyle problems. Among the intervention procedures, MI was a central technique, applicable in most types of problems. The questionnaire showed relatively little value for identifying non-adherence. The intervention was well accepted both by the pharmacists and the patients, thereby increasing the likeliness of successful implementation in routine practice.",
author = "Ulla Hedegaard and Jesper Hallas and Ravn-Nielsen, {Lene Vestergaard} and Kjeldsen, {Lene Juel}",
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year = "2016",
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Process- and patient-reported outcomes of a multifaceted medication adherence intervention for hypertensive patients in secondary care. / Hedegaard, Ulla; Hallas, Jesper; Ravn-Nielsen, Lene Vestergaard; Kjeldsen, Lene Juel.

In: Research in Social and Administrative Pharmacy, Vol. 2016; 12, No. 2, 2016, p. 302–318.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Process- and patient-reported outcomes of a multifaceted medication adherence intervention for hypertensive patients in secondary care

AU - Hedegaard, Ulla

AU - Hallas, Jesper

AU - Ravn-Nielsen, Lene Vestergaard

AU - Kjeldsen, Lene Juel

N1 - Copyright © 2015 Elsevier Inc. All rights reserved.

PY - 2016

Y1 - 2016

N2 - BACKGROUND: Adherence to antihypertensive medications is suboptimal. Hospital pharmacist interventions including motivational interviewing (MI) might assist in improving adherence in patients with hypertension. For an intervention to be useful, it is important to have tools that can easily identify potential adherence problems.OBJECTIVES: To evaluate process outcomes and patient- and pharmacist-reported outcomes of a pharmacist adherence intervention for hypertensive patients treated in hospital outpatient clinics. Secondly, to determine the agreement between two different adherence metrics: an adherence questionnaire used in the intervention and a prescription-based measure.METHODS: The development of the intervention was based on adherence and behavioral theories and evidence of effective interventions. This included a focused medication review, a patient interview, and follow-up telephone calls. Two tools were used to identify adherence problems: The Drug Adherence Work-up (DRAW) tool and an adherence questionnaire. Process data included drug-related problems (DRPs) with recommendations to the physicians, medication- and lifestyle problems identified at the patient interview, actions taken and time spent on the intervention.RESULTS: In total, 91 DRPs in 8 categories generated recommendations to the physicians; 56 recommendations were generated at the medication review and 35 at the patient interview. At the interview, 421 problems were identified, of which 60% were medication-related and 40% lifestyle-related. In connection with the interview, 528 actions were taken within 8 different categories. MI was a central technique applicable for most problems and was employed in nearly all patients (94%). About half of the patients reported increased focus on lifestyle change, and 21-39% reported increased knowledge, confidence and skills in relation to their medication as well as better quality of life. The pharmacists found that the intervention elements were meaningful pharmacist tasks, and that the DRAW tool was easy to use and helped them focus on addressing reasons for non-adherence. The mean total time spent by the pharmacist per patient was 2 h 14 min (SD 40 min).CONCLUSIONS: A pharmacist-led, multifaceted, tailored adherence intervention was feasible for identifying and addressing a wide range of potential adherence and lifestyle problems. Among the intervention procedures, MI was a central technique, applicable in most types of problems. The questionnaire showed relatively little value for identifying non-adherence. The intervention was well accepted both by the pharmacists and the patients, thereby increasing the likeliness of successful implementation in routine practice.

AB - BACKGROUND: Adherence to antihypertensive medications is suboptimal. Hospital pharmacist interventions including motivational interviewing (MI) might assist in improving adherence in patients with hypertension. For an intervention to be useful, it is important to have tools that can easily identify potential adherence problems.OBJECTIVES: To evaluate process outcomes and patient- and pharmacist-reported outcomes of a pharmacist adherence intervention for hypertensive patients treated in hospital outpatient clinics. Secondly, to determine the agreement between two different adherence metrics: an adherence questionnaire used in the intervention and a prescription-based measure.METHODS: The development of the intervention was based on adherence and behavioral theories and evidence of effective interventions. This included a focused medication review, a patient interview, and follow-up telephone calls. Two tools were used to identify adherence problems: The Drug Adherence Work-up (DRAW) tool and an adherence questionnaire. Process data included drug-related problems (DRPs) with recommendations to the physicians, medication- and lifestyle problems identified at the patient interview, actions taken and time spent on the intervention.RESULTS: In total, 91 DRPs in 8 categories generated recommendations to the physicians; 56 recommendations were generated at the medication review and 35 at the patient interview. At the interview, 421 problems were identified, of which 60% were medication-related and 40% lifestyle-related. In connection with the interview, 528 actions were taken within 8 different categories. MI was a central technique applicable for most problems and was employed in nearly all patients (94%). About half of the patients reported increased focus on lifestyle change, and 21-39% reported increased knowledge, confidence and skills in relation to their medication as well as better quality of life. The pharmacists found that the intervention elements were meaningful pharmacist tasks, and that the DRAW tool was easy to use and helped them focus on addressing reasons for non-adherence. The mean total time spent by the pharmacist per patient was 2 h 14 min (SD 40 min).CONCLUSIONS: A pharmacist-led, multifaceted, tailored adherence intervention was feasible for identifying and addressing a wide range of potential adherence and lifestyle problems. Among the intervention procedures, MI was a central technique, applicable in most types of problems. The questionnaire showed relatively little value for identifying non-adherence. The intervention was well accepted both by the pharmacists and the patients, thereby increasing the likeliness of successful implementation in routine practice.

U2 - 10.1016/j.sapharm.2015.05.006

DO - 10.1016/j.sapharm.2015.05.006

M3 - Journal article

C2 - 26088274

VL - 2016; 12

SP - 302

EP - 318

JO - Research in Social and Administrative Pharmacy

JF - Research in Social and Administrative Pharmacy

SN - 1551-7411

IS - 2

ER -