Effect of Community Pharmacist Intervention on Adherence to Long-Term Medications
Condition: Medication Adherence
Study type: Interventional

Summary: 
      The 4-arm factorial design RCT tested the impact of a behavioral intervention (SBI or BI), a
      reminder device (Pillbox), and the combination of the two on adherence in adult patients who
      filled a prescription for oral medications to treat diabetes or hyperlipidemia.
    

Detailed description: 
      Patients diagnosed with chronic diseases often fail to follow their prescribed medication
      regimens, (16355071,19954264,16732693,23111664) which accounts for up to 290 billion dollars
      per year in unnecessary medical costs, largely because medication nonadherence increases
      their risk of disease progression, hospitalization, and premature death.(16355071, 23373139,
      23032359) A number of studies have investigated ways to improve medication adherence;
      (18425859, 18537843) however, few studies on interventions have demonstrated large
      improvements in adherence and few have used scientifically rigorous study methods such as
      randomized controlled trials (RCTs).(24422970) A recent systematic review identified a need
      for adherence interventions and suggested the use of factorial designs in RCTs to study
      multiple interventions and combinations within large patient populations.(24422970)

      This study used a factorial-designed, four-armed, RCT to examine the impact of three
      pharmacy-based interventions versus standard care on improving medication adherence and
      health outcomes in patients with diabetes and hyperlipidemia. The three interventions used in
      this study were a behavioral intervention, a pillbox weekly reminder, and the combination of
      the two.

      Pillboxes (PB) used in this study had compartments for each day (7X1) and for participants
      taking multiple medications, sub-compartments for each medication per day (7X4).

      The behavioral intervention, called Screening and Brief Intervention (SBI or BI), consisted
      of a short 2-5 minute conversation between the patient and the provider aimed to encourage
      modification in the patient's health behavior. While BI has primarily been used to address
      unhealthy alcohol use in patients (11), the researchers hypothesized that this
      patient-centered approach can be particularly useful for improving medication adherence in
      chronically ill patients. In this study, motivational interviewing counseling principles were
      used for motivating patients to take more active roles in self-managing their health.
      Motivational interviewing can take many forms, however, in this study, the BIs used a schema
      of motivational interviewing originally developed by the principal investigator titled
      POLAR*S™ .

      The specific aims of this research study included testing the impact of three community
      pharmacy intervention for adult patients with diabetes or hyperlipidemia on: (1) medication
      adherence; (2) biologic outcomes associated with medication adherence; (3) self-reported
      health and psychosocial status; and (4) pharmacists' impressions on how BI could be scalable
      to community pharmacy settings.
    

Intervention name(s): Screening and Brief Intervention (BI); Pill Box (PB)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Rite Aid® pharmacists screened patients at the time of the initial fill with the Adherence Estimator™ and using the screening results, provided the behavioral intervention, Brief Intervention using motivational interviewing principles based on POLAR*S (BI). BI was considered an active intervention method.; Rite Aid® pharmacists provided patients with a Pill Box (PB) and information about their medications. However, pharmacists did not use motivational interviewing principles for engaging patients in direct interventions to modify behavior. PB was considered a passive intervention method.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Keywords: medication adherence; community pharmacies; screening and brief intervention