Main Article Content
Medication Adherence, Pharmacists, Australia
Community pharmacists are well placed to deliver adherence support services as well as other pharmaceutical services to patients. They are often the last point of contact with patients collecting medicines in the healthcare chain, and they tend to be visited by patients on a regular basis to collect prescription medicines. They have the opportunity to reinforce information already received from other health practitioners, provide further information and monitor adherence to therapy.
The past decade has seen an increase in focus on the importance of adherence to therapy, not only in the higher education sector, but also in government policy and community pharmacy practice. Adherence monitoring and promotion has not only become the foundation of courses taught in pharmacy schools, but has become an essential component of disease management and pharmaceutical services delivered by community pharmacists.
Aims: This article aims to describe the education, research, practice and policy in the area of adherence to therapy in Australia with a focus on community pharmacists.
Methods: A search of MEDLINE and International Pharmaceutical Abstracts as well as hand searches of the bibliographies of retrieved articles was conducted for the period 2000-2008. All pharmacy schools in Australia were also contacted to obtain information on the patient adherence to therapy content of their courses.
Results: Ten studies met the inclusion criteria. Only one study had a specific adherence focus, with the remainder including adherence support and monitoring as part of the overall interventions delivered by the community pharmacists. In the majority of cases the interventions resulted in an improvement in patients’ adherence to therapy. The research was supported by government and pharmacy professional organisation initiatives in the area of cognitive pharmaceutical services. All universities which responded delivered specific patient adherence courses.
Conclusions: Australian pharmacy schools are educating cohorts of students who will have the skills to monitor and support patient medication adherence in the context of contemporary pharmacy practice. This is supported by research evidence, government policy and fits well into the move to expand community pharmacy services to include chronic disease state management and primary health care.
2. Benrimoj S, Peacocke G, Whitehead P, Kopecny E, Ward P, Emerson L. Cognitive pharmaceutical services in emerging healthcare systems- new patient medication management and concordance services in community pharmacy. J Soc Admin Pharm. 2003;20(1):2-11.
3. Hughes J, Keen N, Dillon M, Maricic T. Hypertension: improving patient compliance and clinical outcomes through community pharmacist managed care. 2003. URL: http://www.guild.org.au/uploadedfiles/Research_and_Development_Grants_Program/Projects/2001-055_fr.pdf. (accessed 12 Dec. 08).
4. Krass I, Taylor S, Smith C, Armour C. Impact on medication use and adherence of Australian pharmacists' diabetes care services. J Am Pharm Assoc. 2005;45(1):33-40.
5. Krass I, Armour C, Taylor S, Hughes J, Peterson G, Stewart K, et al. The Pharmacy Diabetes Care Program. Final report to The Commonwealth Department of Health and Ageing as part of the Third Community Pharmacy Research and Development Grants Program. April 2005. URL: http://www.guild.org.au/uploadedfiles/Research_and_Development_Grants_Program/Projects/2002-518_fr.pdf (accessed 12 Dec. 08).
6. Kritikos V, Armour C, Bosnic-Anticevich S. Interactive small-group asthma education in the community pharmacy setting: a pilot study. J Asthma. 2007;44(1):57-64.
7. Saini B, Krass I, Armour C. Development, implementation and evaluation of a community pharmacy-based asthma care model. Ann Pharmacother. 2004;38(11):1954-1960.
8. Saini B, Filipovska J, Bosnic-Anticevich S, Taylor S, Krass I, Armour C. An evaluation of a community pharmacy-based rural asthma management service. Aust J Rural Health. 2008;16(2):100-108.
9. Svarstad B, Chewning B, Sleath B, Claesson C. The brief medication questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Counselling. 1999;37(2):113-124.
10. Horne R. The medication adherence report scale. Brighton, UK: University of Brighton; 2003.
11. Aslani P, Krass I, Chen T, Whitehead P, Rose G, editors. A community pharmacist delivered therapeutics outcome monitoring service for hyperlipidaemia. Sydney: The University of Sydney; 2006. URL: http://www.guild.org.au/uploadedfiles/Research_and_Development_Grants_Program/Projects/2002-024%20Final%20version.pdf (accessed 30 January 2009).
12. Saini B, Smith L, Armour C, Krass I. An educational intervention to train community pharmacists in providing specialized asthma care. Am J Pharm Educ. 2006;70(5):118.
13. Smith L, Bosnic-Anticevich S, Mitchell B, Saini B, Krass I, Armour C. Treating asthma with a self-managment model of illness behaviour in an Australian community pharmacy setting. Soc Sci Med. 2007;64(7):1501-1511.
14. Armour C, Taylor S, Hourihan F, Smith C, Krass I. Implementation and evaluation of Australian pharmacists' diabetes care services. J Am Pharm Assoc. 2004;44(4):455-466.
15. Krass I, Armour CL, Mitchell B, Brillant M, Dienaar R, Hughes J, Lau P, Peterson G, Stewart K, Taylor S, Wilkinson J. The Pharmacy Diabetes Care Program: assessment the impact of a diabetes service model delivered by community pharmacists in Australia. Diabet Med. 2007;24(6):677-683.
16. Crockett J, Taylor S, Grabham A, Stanford P. Patient outcomes following an intervention involving community pharmacists in the management of depression. Aust J Rural Health. 2006 Dec;14(6):263-269.
17. Commonwealth Department of Health and Aged Care. National Medicines Policy. Canberra, ACT; 1999.
18. Commonwealth Department of Health and Ageing. The National Strategy for Quality Use of Medicines - Executive Summary. Canberra, ACT; 2002.
19. Pharmaceutical Society of Australia. Framework Document endorsed by all stakeholders in February 2001. URL: http://www.psa.org.au/site.php?id=1090 (accessed 15 July 2008).
20. Pharmacy Guild of Australia. Medication Management Review program. URL: http://www.guild.org.au/mmr/ (accessed 15 July 2008).
21. Pharmacy Guild of Australia, 2009. URL: http://www.guild.org.au/mmr/content.asp?id=2030 (accessed 2 February 2009).
22. Medicare Australia Statistics, Item Reports 2009. URL: https://www.medicareaustralia.gov.au/cgi-bin/broker.exe?_PROGRAM=sas.mbs_item_standard_report.sas&_SERVICE=default&DRILL=ag&_DEBUG=0&group=900&VAR=services&STAT=count&RPT_FMT=by+state&PTYPE=finyear&START_DT=199807&END_DT=200812 (accessed 2 February 2009).
23. Pharmacy Guild of Australia. Dose Administration Aids URL: http://www.guild.org.au/pps/content.asp?id=1425 (accessed 15 July 2008).
24. Pharmacy Guild of Australia. Operations Manual: Dose Administration Aids Program. URL: http://www.guild.org.au/uploadedfiles/Professional_Pharmacy_Services/PPS_Programs/Dose_Administration_Aids/2_operations_manual.pdf (accessed 15 July 2008).
25. Pharmacy Guild of Australia. Operations Manual: Patient Medication Profile Program. URL: http://www.guild.org.au/uploadedfiles/Professional_Pharmacy_Services/PPS_Programs/Medication_Profiling/pmp_operations_manual_020408.pdf (accessed 15 July 2008).
26. MedsIndex: A medicine compliance indicator. URL: http://www.medsindex.com.au/index.php/Content/what-is-medsindex.html (accessed 15 July 08).
27. National Asthma Council Australia. The asthma management handbook. Melbourne: National Asthma Council Australia; 2002.