Impact of drugs counselling by an undergraduate pharmacist on cardiac surgical patient’s compliance to medicines.

  • Natalie Zerafa
  • Maurice Zarb Adami
  • Joseph Galea


Open heart surgery is a procedure which warrants patient education about the complexity of drug regimens and lifestyle modifications.  Patient nonadherence is likely to have a considerable negative impact on the patients’ quality of life post-cardiac surgery.

Objective: To evaluate the impact of pharmacist intervention on patients’ adherence to medication and lifestyle changes.

Method: This case-controlled study was conducted at the Cardiac Surgical Ward and Outpatients Clinic of Mater Dei Hospital, Malta.  Eighty consecutive patients who underwent coronary artery bypass or heart valve surgery were interviewed on their day of discharge using the ‘Past Medical History Questionnaire’. The patients were then randomized to receive pharmacist intervention or usual care. Those who received intervention (40 patients) were given a chart with pictorial explanation of the time of day together with a colorful photograph of each tablet prescribed.  This group of patients was also counselled to comply to oral analgesia and exercise and also on the avoidance of alcohol and smoking during the recovery period. The control patients received usual care without the pharmacist intervention.  All patients were re-interviewed eight weeks after discharge using the ‘Assessing Patient Compliance Questionnaire’. Any differences between the control and experimental groups were analysed using Chi-square, Three-Way Cross tabulation One-Way ANOVA and Two-Way ANOVA tests using the SPSS software version 17.0.

Results: A statistically significant difference between the two groups in the mean percentage compliance was registered following pharmacist intervention (p<0.05). Patients in the experimental group had a higher mean percentage compliance score (88%) than patients in the control group (66%).

Conclusion: The statistically significant difference in the mean percentage compliance between the two groups following pharmacist intervention shows conclusive evidence of the advantage patients gain when offered this intervention.  The pharmacist intervention provides patients with sufficient information to help them achieve optimal benefit from the medication prescribed.


Keywords: Pharmacists. Medication Adherence. Cardiac Surgical Procedures. Malta.


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1. Operating Theatre Activity for 2009. Operating Theatre database, Mater Dei Hospital, 2010.

2. Cebeci F, Celik SS. Discharge training and couselling increase self-care ability and reduce post discharge problems in CABG patients. J Clin Nurs. 2008;17(3):412-420.

3. Theobald K, McMurray A. Coronary artery bypass graft surgery: discharge planning for successful recovery. J Adv Nurs. 2004;47(5):483-491.

4. Meyer K, Laederach-Hofmann K. Effects of a comprehensive rehabilitation program on quality of life in patients with chronic heart failure. Prog Cardiovasc Nurs. 2003;18(4):169-176.

5. Insull W. The problem of compliance to cholesterol altering therapy. J Intern Med. 1997;241(4):317-325.

6. Krueger KP, Felkey BG, Berger BA. Improving adherence and persistence: a review and assessment of interventions and description of steps toward a national adherence initiative. J Am Pharm Assoc. 2003;43(6):668-678.

7. LaRosa JH, LaRosa JC. Enhancing drug compliance with lipid-lowering treatment. Arch Fam Med. 2000;9(10):1169-1175.

8. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;(2):CD000011.

9. Masoudi FA, Baillie CA, Wang Y, Bradford WD, Steiner JF, Havranek EP, Foody JM, Krumholz HM. The complexity and cost of drug regimens of older patients hospitalized with heart failure in th United States, 1998-2001. Arch Intern Med. 2005;165(18):2069-2076.

10. Fredericks S, Ibrahim S, Puri R. Coronary artery bypass graft surgery patient education: A systematic review. Prog Cardiovasc Nurs. 2009;24(4):162-168.

11. Suls J, Wan CK. Effects of sensory and procedural information on coping with stressful medical procedure and pain: a meta-analysis. J Consult Clin Psychol. 1989;57(3):372-379.

12. Al-Rashed SA, Wright DJ, Roebuck N, Sunter W, Chrystyn H. The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol. 2002;54(6):657-664.

13. Gabriel M, Gagnon JP, Bryan C. Improved patient compliance through use of a daily drug reminder chart. Am J Public Health. 1977;67(10):968-969.

14. Katz MG, Kripalani S, Weiss BD. Use of pictorial aids in medication instructions: A review of the literature. Am J Health Syst Pharm. 2006;63(23):2391-2397.

15. George J, Elliott RA, Stewart DC. A systematic review of interventions to improve medication taking in elderly patients prescribed multiple medications. Drugs Aging. 2008;25(4):307-324.
How to Cite
Zerafa N, Zarb Adami M, Galea J. Impact of drugs counselling by an undergraduate pharmacist on cardiac surgical patient’s compliance to medicines. Pharm Pract (Granada) [Internet]. 2011Sep.14 [cited 2019Jul.23];9(3):156-61. Available from:
Original Research