Effect of a pharmacist-led intervention on adherence among patients with a first-time prescription for a cardiovascular medicine: a randomized controlled trial in Norwegian pharmacies.

OBJECTIVE: To examine whether a pharmacist-led intervention improves medication adherence among patients who have filled a first-time prescription for a cardiovascular medicine. METHODS: Design: Unblinded randomized controlled trial. SETTING: 67 Norwegian pharmacies, October 2014-June 2015. PARTICIPANTS: 1480 adults with a first-time prescription for a cardiovascular medicine. INTERVENTION: Participants in the intervention group received two consultations with a pharmacist 1-2 and 3-5 weeks after filling the prescription. Participants in the control group received care according to usual practice. MAIN OUTCOME MEASURE: The primary outcome was self-reported adherence as measured by the 8-item Morisky Medication Adherence Scale (MMAS-8), at 7 and 18 weeks after filling the prescription. Adherence from baseline to week 52 was estimated using data from the Norwegian Prescription Database (NPD). KEY FINDINGS: Data from MMAS-8 showed that 91.3% of the patients in the intervention group were adherent after 7 weeks versus 86.8% in the control group (4.5% difference, 95% CI 0.8-8.2, P = 0.017). The corresponding proportions were 88.7% versus 83.7% after 18 weeks (5.0% difference, 95% CI 0.8-9.2, P = 0.021). NPD data (n = 1294) showed no significant difference in adherence after 52 weeks (95% CI -2.0 to 7.8, P = 0.24). However, adherence among statin users (n = 182) was 66.5% in the intervention group versus 57.4% among new statin users in the general population (n = 1500) (difference 9.1%, 95% CI 1.5-16.0, P = 0.019). CONCLUSION: The main outcome measure indicates that a short, structured pharmacist-led intervention may increase medication adherence for patients starting on chronic cardiovascular medication. However, these findings could not be confirmed by the NPD data analysis.

Evaluation of a structured pharmacist-led inhalation technique assessment service for patients with asthma and COPD in Norwegian pharmacies.

OBJECTIVE: To investigate whether the inhalation technique improved among patients with asthma and chronic obstructive pulmonary disease after an Inhalation Technique Assessment Service (ITAS), and to assess the patients' and pharmacists' perceptions of ITAS. METHODS: This uncontrolled, pre-post study included 405 patients recruited from 42 Norwegian pharmacies. Inhalation technique was assessed by trained pharmacists before ITAS (baseline), directly after (follow-up 1) and three months after ITAS (follow-up 2), and analyzed statistically using SPSS. Perceptions of ITAS were assessed using a questionnaire. RESULTS: 488 ITAS were performed. At baseline, 8% of the inhalation technique demonstrations were rated as optimal and 31% as acceptable. Following ITAS, this increased to 72% (optimal) and 86% (acceptable). At follow-up 2 inhalation technique remained significantly higher than baseline (optimal: 52%, acceptable: 75%). The median rate of wrong steps decreased from 25% (baseline) to 0% (follow-ups). The usefulness of ITAS was rated 4 on a 5-point Likert scale. CONCLUSION: Inhalation technique improved significantly after ITAS for both new and experienced users and all assessed devices. The technique remained significantly improved at follow-up 2. ITAS was well accepted by pharmacists and patients. PRACTICE IMPLICATIONS: ITAS can contribute to significant improvements in inhalation technique among patients using inhaler devices.