Pharmacy care boosted medication adherence at army hospital

Adherence is poor among elderly patients who may take nine different medications a day.

CHICAGO — Interventional pharmacy care, including custom-packaged medications and follow-up with a pharmacist, is associated with an increased rate of medication adherence among elderly patients, according to Allen J. Taylor, MD, of Walter Reed Army Medical Center.

Patients who were eventually randomized to receive usual care during a later phase of the trial did not adhere to their medication regimens as well as patients who continued to receive the interventional pharmacy care.

“It was the assignment to usual care that represented the greatest decline in adherence,” Taylor said.

Taylor presented data from the Federal Study of Adherence to Medications in the Elderly (FAME) trial at the American Heart Association Scientific Sessions 2006.

Three key components

The comprehensive interventional pharmacy care program was composed of three components: individualized education for the patient by the pharmacist, custom-packaged medications in a time-specific blister pack, and regular follow-up with the pharmacist every two months. The blister packs could contain up to nine pills per blister.

Taylor and colleagues enrolled 200 patients aged 65 or older who received at least four medications daily. The average age of the patients was 78. Taylor said the average number of medications patients older than 65 take per day is nine.

Courtesy of Walter Reed Army Medical Center

The researchers collected baseline data during the run-in phase, which lasted two months. The intervention occurred during phase 1, which occurred from month two to month eight. From month eight to month 14 of the study, Taylor and colleagues randomized the patients to continue receiving the interventional pharmacy care or usual treatment.

They measured the patients’ pill adherence at months one, two, eight and 14. They also measured the patients’ BP and LDL at baseline and months two, eight and 14 of the study.

After phase 1, medication adherence improved from 61.2% ± 13.5% to 96.9% ± 5.2%. Systolic BP decreased from 133.2 mm Hg ± 14.9 mm Hg to 129.9 mm Hg ± 16.0 mm Hg. LDL cholesterol decreased 91.7 mg/dL ± 26.1 mg/dL to 86.8 mg/dL ± 23.4 mg/dL, according to Taylor.

The researchers found continued adherence in the pharmacy care group after the second phase (95.5% ± 7.7%); however, adherence fell among patients who returned to usual care (69.1% ± 16.4%). The pharmacy care group also experienced significant reductions in systolic BP (95% CI, –10.7 mm Hg to –3.1 mm Hg) compared with the usual care group (95% CI, –5.9 mm Hg to –3.9 mm Hg).

Taylor stressed the importance of the education component of the program.

“One would never disconnect education from an adherence program,” he said.

Harlan M. Krumholz, MD, Harold H. Hines, Jr. Professor of Medicine and Epidemiology and Public Health at Yale University School of Medicine, discussed the FAME trial results. Benefits to the trial included the noted increase in adherence to medications from 61.2% to 96.9% after enrollment in the program.

However, one point to consider is that the study was small, according to Krumholz. It was also a single-center trial that occurred in a military hospital where patients may be more likely to comply.

The study is the first of its kind to study adherence in elderly patients.

“This ought to be the beginning of more work like this,” Krumholz said. – by Lauren Riley

For more information:

• Taylor AJ. FAME (The Federal Study of Adherence to Medications in the Elderly): a randomized controlled trial on the impact of a medication adherence program on control of blood pressure and LDL cholesterol. Presented at: American Heart Association’s Scientific Sessions 2006; Nov. 12-15, 2006; Chicago.
• Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol. JAMA. 2006;296:doi:10.1001/jama.296.21.joc60162.