Developing a generic, individualised adherence programme for chronic medication users

Main Article Content

Hanne Herborg
Lotte S. Haugbølle
Lene Sørensen
Charlotte Rossing
Pernille Dam

Keywords

Patient Compliance, Counseling, Self Efficacy, Denmark

Abstract

Objective: The scope of this article is to describe the background for and content of an adherence counselling programme with a specific focus on an individualised, multi-dimensional adherence model for patients with a potential adherence problem (a so-called ‘individualised systems model’).

Methods: An intervention programme based on WHO’s systems model for adherence was developed for implementation in primary health care and tested in a development project in Danish pharmacies in 2004-2005 in three pharmacies and 4 GP practices by 27 patients. Data were collected from the participants by registration forms, questionnaires, and focus groups. Since the programme was to support patients in the self-management process regarding choice and implementation of medication treatment, various strategies were used and different theoretical assumptions and choices made prior to setting up the study. These strategies include distinguishing between different types of non-adherence, a model for stages of change, self-efficacy, narratives, motivating interviewing strategies and coaching techniques. These strategic and theoretical choices are described in the article.

Results: The strategies and theoretical reflections formed the platform for the creation of a counselling programme, which was tested in two forms, a basic and an extended version - provided by either a pharmaconomist or a pharmacist. The result section also describes a toolbox of instruments to enable pharmacy staff and GPs to tailor a counselling programme for patients individually called ‘Safe and effective use of medicines’. Besides, the results include a description of how the WHO-model is transformed into an individualised counselling model.

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References

1. WHO. Adherence to long-term therapies - evidence for action. Noncommunicable diseases and mental health adherence to long term therapies project. Report. Geneva: World Health Organisation; 2003.

2. Haynes RB. Determinants of compliance: The disease and the mechanics of treatment. Baltimor (MD): Johns Hopkins University Press; 1979.

3. Rand CS. Measuring adherence with therapy for chronic diseases: implications for the treatment of hetrozygous familial hypercholesterolemia. Am J Cardiol 1993; 72:68D-74D.

4. Marinker M, Blekinsopp A, Bond C, Britten N, Feely M, George C. From compliance to concordance: achieving shared goals in medicines taking. London: Royal Society of Great Britain; 1997.

5. Hepler CD, Grainger-Rousseau TJ. Pharmaceutical care versus traditional drug treatment. Is there a difference? Drugs 1995;49(1):1-10.

6. Carter BL, Barnette DJ, Chrischilles E, Mazotti GJ, Asali ZJ. Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting. Pharmacotherapy 1997;17:1274-1285.

7. Park JJ, Kelly P, Carter BL, Burgess PP. Comprehensive pharmaceutical care in a chain setting. J Am Pharm Assoc. 1996;NS36:443-451.

8. Ringer J, Keys P, Wagenknacht LD, Miller DE, Slaughter RL.The Michigan Pharmacists´ Association Patient Persistency Project. J Managed Care Pharm. 2001;7(1):50-55.

9. Munroe WP, Kunz K, Dalmady-Israel C, Potter L, Schonfeld WH. Economic evaluation of pharmacist involvement in disease management in community pharmacy setting. Clin Ther. 1997;19:113-123.

10. Søndergaard B, Thorleifsson S, Herborg H, Frøkjær B, Hepler CD, Ersbøll BK. Kvalitetssikring af astmapatienters lægemiddelbehandling. Sundhedsøkonomisk analyse. Ugeskr Læger. 2000;162:480-486.

11. Herborg H, Soendergaard B, Groekjaer B, Fonnesbaek L, Jorgensen T, Hepler CD, Grainger-Rousseau TJ, Ersboell BK. Improving drug therapy for patients with asthma - Part I: Patient outcomes. J Am Pharm Assoc. 2001;41:539-550.

12. Stason WB. Compliance, quality of life and cost effectiveness. Curr Hypertens Rep. 1999;1:471-474.

13. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions. JAMA. 2002;288:2868-2879.

14. Haynes RB, McKibbon KA, Kanani R. Systematic review of randomised trials of interventions to assist patients to follow prescriptions for medication. Lancet. 1996;348(10):383-386.

15. Schroeder K, Fahey T, Ebrahim S. How can we improve adherence to blood pressure-lowering medication in ambulatory care? Systematic review of randomized controlled trials. Arch Intern Med. 2004;164:722-732.

16. Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Patient adherence in the treatment of depression. Br J Psychiatry 2002;180:104-109.

17. DiMatteo MR. Variations in patients´ adherence to medical recommendations – a quantitative review of 50 years of research. Med Care 2004 Mar;42(3):200-209.

18. Weingarten SR, Henning JM, Badamgarav E, Knught K, Hasselblad V, Gano Jr A, Ofman JJ. Interventions used in disease management programmes for patients with chronic illness – which ones work? Meta-analysis of published reports. Br Med J 2002 Oct;325:925.

19. Hepler CD, Segal R. Preventing medication errors and improving drug therapy outcomes: a managemetn systems approach. Boca Raton, 2003.

20. Charon R. Narrative medicine – a model for empaty, reflection, profession and trust. JAMA 2001;286(15):1897-1902.

21. Greenhalgh T, Hurwitz B, editors. Narrative based medicine: dialogue and discourse in clinical practice. London: BMJ Books; 1998.

22. Kleinman A. The illness narratives: suffering, healing and the human conditions. New York (NY): Basic Books; 1988.

23. Tomm K. Interviewet som intervention – er hensigten at stille lineære, cirkulære, strategiske eller refleksive spørgsmål? Forum 1992;4: 3-13.

24. Miller WG, Rollnick S. Motivational interviewing preparing people to change addictive behaviour. New York: Guilford; 1991.

25. Prochaska JO, DiClimente CC, Norcross JC. In search of how people change. Am Psychol 1992;47:1102-1104.

26. Ficke DL, Farris KB. Use of the transtheoretical model in the medication use process. Ann Pharmacother. 2005;39:1325-1330.

27. Prochaska JO, Redding CA, Evers KE. The transtheoretical model and stages of change. In: Glanz K, Rimer BK, Lewis, editors. Health behavior and health education: theory, research, and practice, 3rd ed. San Fransisco: Jossey Bass; 2002. p. 99-116.

28. Bandura A. Self-efficacy: towards a unifying theory of behavioral change. Psychol Rev. 1977;84:191-215.

29. Barlow JH, Cullen LA, Rowe IF. Educational preferences, psychological well-being and sef-efficary among people with reumatoid arthritis. Patient Educ Couns. 2002;46:11-19.

30. Vermeien E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001; 26:331-342.

31. Barber N. Should we consider non-compliance a medical error? Qual Saf Health Care. 2002;11:81-84.

32. Waeber B, Brunner HR, Métry JM. Compliance with antihypertensive treatment: implications for practice. Blood Press. 1997;6:326-331.

33. Marinker M, Shaw J. Not to be taken as directed. Putting concordance for taking medicines into practice. BMJ. 2003;326:348-349.

34. Benson J, Britten N. Patients’ decisions about whether or not to take antihypertensive drugs: a qualitative study. BMJ. 2002;325:873-878.

35. Pharmakon. Udviklingsrapport “Sikker og effektiv medicinbrug” for brugere af blodtryksmedicin – version 1.1; 2007.

36. Haynes R, Yao X, Degani A, Kripalani S, Garg A, McDonald H. Interventions to enhance medication adherence. Cochrane Database Syst Rev. 2005. 2005:1-96.

37. Burke LE, Dunbar-Jacob-JM, Hill MN. Compliance with cardiovascular disease prevention strategies: a review of the research. Ann Behav Med. 1997;19:239-263.

38. van Dulmen S, Sluijs E, van Dijk L, de Ridder D, Heerdink R, Bensing J. Patient adherence to medical treatment: a review of reviews. BMC Health Serv Res. 2007;7:1-13.

39. Sluijs E, van Dulmen S, van Dijk L, de Ridder D, Heerdink R, Bensing J. Patient adherence to medical treatment: a meta review. 2006. Report by NIVEL. Available from: http://www.nivel.nl/

40. Vrijens B, Tousset E, Gaillard P-A, Métry J-M, Urquhart J. Major Features of Dose Omissions in 87 Ambulatory Drug Trials. Clinl Pharmacol Ther. 2005;77(2): P99, abstract LB.6.

41. Vrijens B, Urquhart J. Impact of diverse temporal patterns of dosing on drug actions. Leiden/Amsterdam Center for Drug Research, Vrije Universiteit Amsterdam. Homepage available from http://www.lacdr.nl/index.php3?c=92 (Viewed on March 14, 2008).

42. Burnier M, Schneider MP, Chiolero A, Stubi CL and Brunner HR. Electronic compliance monitoring in resistant hypertension: the basis for rational therapeutic decisions. J Hypertens. 2001; 19: 335-341.

43. Vrijens B and Goetghebeur E (2004) Electronic monitoring of variation in drug intakes can reduce bias and improve precision in pharmacokinetic/pharmacodynamic population studies. Stat Med. 23:531-544.

44. Vergouwen AC, Bakker A, Katon WJ, Verhaij TJ, Koerselman F. Improving adherence to antidepressants: a systematic review of interventions. J Clin Psychiatry. 2003;64:1415-1420.