Medication adherence and community pharmacy: a review of education, policy and research in England
Objective: The objective of this narrative review was to identify and describe the current policy, education and research related to community pharmacy and medication adherence in England.
Methods: Medline, Embase, International Pharmaceutical Abstracts and Pharmline were used to search for relevant research articles. Current policy documents were identified via the websites of the Department of Health in England, the Royal Pharmaceutical Society of Great Britain, the National Pharmacy Association, the Pharmaceutical Services Negotiating Committee and NHS Employers. All pharmacy schools in England were contacted to obtain information about the adherence-related courses they provide to undergraduate and postgraduate pharmacy students.
Results: National policies and guidelines in England are conducive to an increasing role for community pharmacists to support patients with medication adherence. Many pharmacy schools cover the issue of adherence in their undergraduate and postgraduate courses. Research in this area has tested the effectiveness of pharmacists providing adherence support in the form of compliance aids, education, involvement in discharge planning, and tailored interventions.
Conclusion: In community pharmacy in England, current policy and funding arrangements suggest there is great scope for pharmacists to support patients with medication adherence. Further research is necessary to identify the most useful, cost-effective and sustainable approach in practice.
2. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000011.
3. Horne R, Barber N, Weinman J, Elliott RA, Morgan M, Cribb A. Concordance, adherence and compliance in medicine taking: a scoping exercise. London: NHS National Co-ordinating Center for Service Delivery and Organisation, 2006.
4. Department of Health. Pharmacy in England: building on strengths – delivering the future. London: Department of Health, 2008. Available from: http://www.official-documents.gov.uk/document/cm73/7341/7341.pdf (last accessed 20th April 2010).
5. Elliott RA, Barber N, Horne R. Cost-effectiveness of adherence-enhancing interventions: a quality assessment of the evidence. Ann Pharmacother. 2005;39(3):508-515.
6. Cantrell CR, Eaddy MT, Shah MB, Regan TS, Sokol MC. Methods for evaluating patient adherence to antidepressant therapy: a real-world comparison of adherence and economic outcomes. Med Care. 2006;44(4):300-303.
7. Central Office of Information on behalf of the Department of Health. Community Pharmacy Use: Quantitative and Qualitative Research. Department of Health, 2008. Available from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_083870.pdf (last accessed 22nd April 2010).
8. Seston L Hassell K. Briefing Paper: RPSGB Register Analysis 2009. Available from http://www.rpsgb.org.uk/pdfs/rpsbreganalysis09.pdf (last accessed 29th April 2010).
9. National Pharmacy Association. Fast facts on pharmacy. Available from: http://www.npa.co.uk/Representing-you/Media-centre/Fast-facts-on-pharmacy/ (accessed 29th April 2010).
10. National Institute for Health and Clinical Excellence. Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. 2009. Available from: http://www.nice.org.uk/CG76 (accessed 20th April 2010).
11. Clifford S, Barber N, Horne R. Understanding different beliefs held by adherers, unintentional non-adherers and intentional non-adherers: the application of the necessity-concerns framework. J Psychosom Res.2008;30(1):17-23.
12. Wroe AL. Intentional and unintentional nonadherence: a study of decision making. J Behav Med. 2002;25(4):355-372.
13. Wroe AL, Thomas MG. Intentional and unintentional nonadherence in patients prescribed HAART treatment regimens. Psychol Health Med 2003;8(4):453-463.
14. Royal Pharmaceutical Society of Great Britain. NICE Clinical Guideline 76: Medicines Adherence – Quick reference sheet for pharmacists, 2009. Available from: http://www.rpsgb.org.uk/pdfs/NICEmedsadhimplementguid.pdf (accessed 29th April 2010).
15. Bellingham C. What the new contract has in store. Pharmaceutical Journal. 2004; 273: 385. Available from: http://www.pharmj.com/pdf/contract/pj_20040918_contract.pdf (accessed 14th May 2010).
16. Bradley F, Wagner AC, Elvey R, Noyce PR, Ashcroft DM. Determinants of the uptake of medicines use reviews (MURs) by community pharmacies in England: a multi-method study. Health Policy. 2008;88(2-3):258-68.
17. Latif A, Boardman H. Community pharmacists’ attitudes towards medicines use reviews and factors affecting the number performed. Pharm World Sci. 2008;30(5):536-543.
18. NPC Plus. An introduction to the Motivation for Medicines adherence service. Available from: http://www.keele.ac.uk/pharmacy/npcplus/m4m/An%20introduction%20to%20the%20Motivation%20for%20Medicines%20adherence%20service%20ELECTRONIC%20VERSION.pdf (accessed 27th May 2010).
19. Green CF, McCloskey S. UK survey of the provision of multicompartment compliance aids and medicines reminder charts on discharge from hospital. Int J Pharm Pract. 2005;13:85-89.
20. Nunney JM, Raynor DKT. How are multi-compartment compliance aids used in Primary Care? Pharm J. 2001;267:784-789.
21. Ryan-Woolley BM, Rees JA. Initializing concordance in frail elderly patients via a medicines organiser. Ann Pharmacother. 2005;39:834-839.
22. Carr A, Patel R, Jones M, Suleman A. A Pilot Study of a community pharmacist intervention to promote the effective use of emollients in childhood eczema. Pharm J. 2007;278:319-322.
23. Nazareth I, Burton A, Shulman S, Smith P, Haines A, Timberall, H. A pharmacy discharge plan for hospitalised elderly patients-a randomised controlled trial. Age Aging. 2001;30:33-40.
24. Blenkinsopp A, Phelan M, Bourne J, Dakhil N. Extended adherence support by community pharmacists for patients with hypertension: a randomised controlled trial. Int J Pharm Pract. 2000;8:165-175.
25. Raynor AK, Nicolson M, Nunney J, Petty D, Vail A, Davies L. The development and evaluation of an extended support programme by community pharmacists for elderly patients at home. Int J Pharm Pract. 2000;8:157-164.
26. Clifford S, Barber, N, Elliot R, Hartley E, Horne R. Patient-centred advice is effective in improving adherence to medicines. Pharm World Sci. 2006;28(3):165-170.
27. Elliot R, Barber N, Clifford S, Horne R, Hartley E. The cost effectiveness of a telephone-based pharmacy advisory service to improve adherence to newly prescribed medicines. Pharm World Sci. 2008:30(1):17-23.
28. NHS Employers (2010a) The community pharmacy – a guide for general practitioners and practice staff. Available from: http://www.nhsemployers.org/Aboutus/Publications/Documents/Community_Pharmacy_Guide_for_GPs.pdf (last accessed 23rd April 2010).
29. NHS Employers (2010b) The GP practice – a guide for community pharmacists and pharmacy staff. Available from: http://www.nhsemployers.org/Aboutus/Publications/Documents/Guide_to_general_practice_0410.pdf (last accessed 23rd April 2010).
30. Horne R. The nature, determinants and effects of medication beliefs in chronic illness [PhD thesis]. University of London, 1997.
31. Larson LN, MacKeigan LD. Further validation of an instrument to measure patient satisfaction with pharmacy services. J Pharm Market Manage. 1994;8:124-139.
32. MacKeigan LD, Larson LN. Development and validation of an instrument to measure patient satisfaction with pharmacy services. Med Care. 1989;27:522-136.
33. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67-74.
34. Horne R, Weinman J. Patients’ beliefs about medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res.. 1999;47(6):555-567.