Factors contributing to improved adherence rates following a clinical pharmacist intervention

Objectives: The individualized Medication Assessment and Planning (iMAP) program provided comprehensive medication therapy management to older adults in a primary care clinic. In iMAP, clinical pharmacists working collaboratively with primary care physicians performed comprehensive medication reviews during scheduled visits at baseline, 3, and 6 months, to identify and resolve medication-related problems (MRPs). One MRP, nonadherence, was assessed by the clinical pharmacist for each prescribed maintenance medication based on clinical judgment following medication review and incorporated patient self-report of adherence. The prevalence of medication nonadherence was reduced from 41% to 23% between baseline and 6 months. This study sought to identify factors that may have contributed to improved adherence. Methods: We examined patterns of nonadherence over the 6-month study through audits of medication-taking behaviors recorded by pharmacists in the study database and patients’ electronic medical records. We restricted our analysis to nonadherence problems identified at baseline and 3 months to allow us to observe subsequent changes in nonadherence. Descriptive statistics were used to characterize the findings. Results: For the 64 study patients, mean age was 75.4 years (range 65-93); 67% were white and 58% female. At baseline, patients were taking, on average, 13.9 (range 5-31) medications. Of the 64 patients, 33 (52%) were adherent to all of their medications throughout the study. The remaining 31 patients had documented nonadherence to at least one of their medications. Overall, there were 75 medications assessed as nonadherent at either baseline or 3 months. At 6 months, patients remained non-adherent to 17 of these medications (22.7%) and were now adherent to 58 (77.3%) medications. Factors potentially contributing to improved adherence include clinical pharmacist education (65.5%), medication discontinuation (12%), or therapeutic changes (12%) to decrease cost or improve ease of administration. Conclusion: Clinical pharmacist intervention, particularly providing education, may improve medication adherence rates among older adults.