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Elder Care News
Pharmacy Care Program Helps Elderly Patients Take
Their Medications Better
Program also results in better health for those who
take their meds
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Watch Video |
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Pharmacy Care Program Raises
Elderly Medication Adherence to Nearly 100 Percent -
Windows Media |
Quicktime
12/05/06
»2 min 05 sec |
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November 13, 2006 Diagnosing an ailment and
finding the right medicine to treat it is seldom the end of the problem
when treating the chronically ill elderly. Often, just as challenging,
is assuring they take the medicine as prescribed. A new pharmacy care
program for elderly patients was able to improve the rate of adherence
to their medication to 96.9 percent. And, there was a significant
improvement in their health.
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The study was posted online today by the Journal of
the American Medical Association. The early release coincides with its
presentation at the American Heart Association Scientific Session. It
will be published in the December 6 print issue of JAMA.
Adherence to chronic pharmacological therapies is
poor, leading to worsening disease severity and increased costs
associated with higher hospital admission rates, the authors provide as
background information.
Barriers to medication adherence are numerous, but
include the prescription of complex medication regimens, treatment of
asymptomatic conditions and convenience factors. These factors are
particularly prevalent among the elderly population, placing them at
increased risk for medication non-adherence.
Jeannie K. Lee, Pharm.D., and colleagues from
Walter Reed Army Medical Center, Washington, D.C., report the results
from the Federal Study of Adherence to Medications in the Elderly
(FAME), a multi-phase investigation that included 200 community-based
patients age 65 years or older taking at least four chronic medications.
The FAME study, which was conducted from June 2004
to August 2006 consisted of three phases. First, all 200 patients
entered a two-month run-in phase that provided a baseline for medication
adherence using pill counts, and for blood pressure (BP) and low-density
lipoprotein cholesterol (LDL-C) readings.
Of these patients, 174 then entered a six-month
intervention phase that included standardized medication education,
regular follow-up by pharmacists and all medications dispensed in
time-specified blister packs. Following the intervention phase, 159
patients were randomized to continue the pharmacy care program or return
to their usual care for an additional six months.
The average age of the study patients was 78 years.
Cardiovascular risk factors were prevalent and
included drug-treated hypertension in 184 patients (91.5 percent) and
drug-treated hyperlipidemia in 162 patients (80.6 percent).
The patients took an average of nine different
chronic daily medications. At the beginning of the first phase of the
study, the researchers found the average medication adherence was 61.2
percent.
After six months of intervention, medication
adherence increased to 96.9 percent and was associated with significant
improvements in systolic blood pressure (133.2 to 129.9 millimeters of
mercury) and LDL-C (91.7 to 86.8 milligrams per deciliter), the
researchers report.
Six months after randomization, the persistence of
medication adherence decreased to 69.1 percent among those patients
assigned to usual care, whereas it was sustained at 95.5 percent in
pharmacy care.
The pharmacy care group also had significant
reductions in systolic blood pressure compared to the usual care group,
but no significant differences between the groups in LDL-C levels or
reductions.
In this study, a comprehensive pharmacy program
composed of patient education and custom blister-packed medications was
associated with substantial and sustained improvements in medication
adherence among elderly patients receiving complex medication regimens.
The association of improved medication adherence with reduced levels of
BP and LDL-C suggests that such a program could lead to meaningful
improvements in health outcomes.
The results of the FAME study call for greater
emphasis within health care delivery systems and policy organizations on
the development and promotion of clinical programs to enhance medication
adherence particularly among the at-risk elderly population, the
authors conclude.
Editorial: Challenges for Improving
Medication Adherence
In a related editorial, Ross J. Simpson Jr., M.D.,
Ph.D., from the University of North Carolina at Chapel Hill writes for
chronic medical conditions, such as hypercholesterolemia and
hypertension, a wide and persistent separation exists between
evidence-based recommendations and the actual care patients receive.
Patient characteristics that may lead to poor
adherence include advanced age, cognitive impairment and depression as
well as attitudes and beliefs about the importance of the medication,
the disease being treated and the potential for adverse effects.
the study by Lee and colleagues adds important
information about improving medication adherence in elderly patients and
also highlights the challenges inherent in designing and conducting
high-quality research in this critically important area.
Multifaceted interventions that incorporate
structural and counseling components and include appropriately skilled
and motivated pharmacists appear useful to promote medication adherence
and persistence.
Future studies are needed to confirm that
interventions incorporating these components will result in increased
and sustained patient adherence and, better yet, will improve outcomes.
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