Effect of pharmacist-led interventions on medication adherence and inhalation technique in adult patients with asthma or COPD: A systematic review and meta-analysis

Community pharmacists on the frontline in the chronic disease management: The need for primary healthcare policy reforms in low and middle income countries

In low- and middle-income countries (LMICs), over 12 million people die yearly from chronic diseases and this number is expected to increase if concerted actions are not taken. The purpose of this paper is to highlight the roles and impact of community pharmacists in chronic disease management support and the need for policymakers in LMICs to reposition community pharmacists appropriately for this extended role. Recent findings have shown that community pharmacists are the most accessible healthcare providers to the members of the community. Published evidence have demonstrated that community pharmacists' interventions in chronic diseases significantly improve economic, clinical, and humanistic outcomes. However, they are not officially recognized as primary healthcare providers in LMICs. Therefore, there is need for policy reforms that will encourage strategic use of the clinical skills of community pharmacists as part of the primary healthcare team in LMICs.

The Role of the Pharmacist in Inhaler Selection and Education in Chronic Obstructive Pulmonary Disease

Objective: To review the role of pharmacists in educating and monitoring patients with chronic obstructive pulmonary disease (COPD) on inhalation technique. Data Sources: A PubMed search (January 2000 to May 2020) was performed using the following keywords and associated medical subject headings: adherence, chronic obstructive pulmonary disease/COPD, education, inhaler, pharmacist, and technique. Study Selection and Data Extraction: The search was conducted to identify English language articles highlighting the importance of correct inhaler technique in COPD management and benefits of pharmacist inhaler training such as improved adherence, quality of life (QoL), and disease control. Randomized controlled trials, retrospective studies, observational studies, systematic reviews, and meta-analysis reporting pharmacist training were included. Data Synthesis: This review summarizes that incorrect inhaler use negatively affects treatment outcomes, prognosis, and QoL. Pharmacists are in a unique position to educate and monitor patients with COPD on optimal inhaler technique and an individualized, multifactorial approach to COPD management involving pharmacists could provide cost-effective patient care and improve adherence and minimize inhaler misuse. Several strategies used by pharmacists can optimize patient inhaler use, such as face-to-face technique demonstrations, the "teach-back" method, telemonitoring, instructional videos, or informational leaflets. An individualized action plan involving education and regular monitoring of inhaler use further enhances optimal adherence and disease management. Conclusions: As pharmacists are easily accessible to both patients and health care providers, they are ideally placed to play an important role in the enhancement of education on, and continuous assessment of, optimal inhaler technique, thereby improving adherence, disease control, and QoL.

Chronic Obstructive Pulmonary Disease Treatment and Pharmacist-Led Medication Management

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death across the globe. Its repeated exacerbation will seriously worsen the quality of life, aggravate the patients’ symptoms, and bring a heavy burden on the patients and the society. Understanding the current status of drug therapy and the role of pharmaceutical care is essential for the management of COPD. In addition to the drugs already on the market, recent clinical trials also show that emerging novel drugs for treating COPD are being developed to prevent the symptoms, reduce the frequency of acute exacerbation, and improve the quality of life. Recent progress in new drug research should lead to novel treatment options for COPD patients in future clinical practice. The pharmaceutical care has shown significantly favourable impacts on addressing drug-related problems, supporting its vital role in the management of COPD, especially when there are a wide range of therapeutic agents. This review not only provides an overview of current treatment strategies but also further underlines the importance of new drug development and pharmaceutical care for patients with COPD.

Effect of Evidence-Based Pharmacy Care on Satisfaction and Cognition in Patients with Non-Valvular Atrial Fibrillation Taking Rivaroxaban

PURPOSE

We aimed to determine the effects of using evidence-based pharmacy care on satisfaction and cognition among patients with non-valvular atrial fibrillation (NVAF) and taking rivaroxaban.

PATIENTS AND METHODS

Between July 2018 and June 2019, 200 consecutive hospitalized patients taking oral rivaroxaban, who were diagnosed with NVAF and registered in the hospital information management system, were randomly assigned to a control group (n=100) and a study group (n=100) in a single-blind manner. The control group received pharmaceutical care based on the general pharmaceutical care model whereas the study group received care based on an evidence-based pharmaceutical care model. Patients' satisfaction and cognition were evaluated regularly using questionnaires. The follow-up time was 1 year. We compared differences in satisfaction and cognition between the two groups after pharmaceutical-related care administered by clinical pharmacists.

RESULTS

The study group had higher satisfaction scores than the control group after the EBP intervention (14.58±0.88 vs.13.81±1.01, p<0.01); cognition scores were also higher in the study group (22.58±2.19 vs 20.80±3.02, p<0.01) after the intervention. In the study group, satisfaction was increased from a score of 10.15±1.33 before the EBP intervention. Cognition also increased after the intervention in the study group, from a score of 9.88±4.09 pre-intervention. In the control group, satisfaction was 10.04±1.29 before the traditional pharmaceutical care intervention, smaller than the 13.81±1.01 after the intervention (p<0.01). Cognition in the control group was 9.83±3.51 before traditional pharmaceutical care, smaller than the 20.80±3.02 after the intervention (p<0.01).

CONCLUSION

The care model based on evidence-based pharmacy care can improve patient satisfaction and cognition, providing more comprehensive safety and efficacy of subsequent medication.

Drug compliance and the Morisky Adherence Scale: An expression of concern and a warning

WHAT IS KNOWN AND OBJECTIVE

Every prescriber knows that patients often do not take their medicines as prescribed. Hippocrates, the wise man of Kos, knew over two millennia ago. Our objective is to comment on the types of studies aimed at understanding and optimizing drug usage and to draw attention to the need to seek approval before using or citing the Morisky adherence scale.

COMMENT

The study of prescribing and how patients use their medicines is important. As part of this effort, the results of investigations of how patients adhere to drug prescriptions can be informative. However, the results are meaningful only if the methods used for doing the measurements are valid and made explicit. We were surprised when a team of our authors were threatened with legal action for citing the Morisky Adherence Scale and explaining how some authors had obtained their adherence scores. Adherence studies are but one facet of the study of prescribing aimed at improving clinical outcomes. Other aspects include investigating the quality of prescribing, and how unnecessary medicines can be deprescribed to improve the quality of care and reduce the risk of adverse effects.

WHAT IS NEW AND CONCLUSION

The study of optimal prescribing is an important endeavour and adherence studies are but one aspect. We report that using and citing the Morisky Adherence scale in any detail is a risky business. Prior approval is required unless one is prepared to pay up, retrospectively. We require all authors to certify they have no conflicts of interest with respect to the scale.

Correlation Between Patients' Medication Adherence and Their Psychological Contract with Hospital Pharmacists

OBJECTIVE

To investigate the correlation between patients' medication adherence and their psychological contract with hospital pharmacists under the background of the pharmacist-patient relationship, providing a reference for improving the pharmacist-patient relationship and the patients' medication adherence based on the patients' psychological contract with the hospital pharmacists.

MATERIALS AND METHODS

Some of the patients who received medication dispensing service at the outpatient pharmacies at the First Affiliated Hospital of Zunyi Medical University and the Second Affiliated Hospital of Zunyi Medical University were included and investigated as follows: 320 patients were included through the convenient sampling method for psychological contract and medication adherence questionnaire survey with the self-designed scales for patients' psychological contract with the hospital pharmacists and their medication adherence. SPSS 17.0 was used for reliability and validity testing, correlation analysis, and multiple linear regression analysis.

RESULTS

The average score of the psychological contract was 3.80±0.59. The average score of the patients' medication adherence was 2.93±0.70. The patients' psychological contract with the pharmacists and its dimensions (the responsibility of competence, the responsibility of service, and the responsibility of humanistic care) were positively correlated with medication adherence (P<0.05). The results of the multiple linear regression analysis showed that the effect of patients' psychological contract with the pharmacists on medication adherence was statistically significant (P<0.05).

CONCLUSION

Outpatients' psychological contract with the pharmacists is positively correlated with their medication adherence. Maintaining the patients' psychological contract with the pharmacists may be an effective way to improve medication adherence.

A cohort study of medication adherence among patients with chronic obstructive pulmonary disease in Egypt

Chronic obstructive pulmonary disease (COPD), the most common chronic respiratory disease, is expected to become the third leading cause of death worldwide in 2020. A prospective cohort study conducted in 2017 and 2018 aimed to identify factors associated with inhaler treatment adherence in patients with COPD in Cairo (Egypt). Physicians collected data regarding patient deaths, treatment-related adverse events, and patients’ social support (no support, patient, support by spouse, children, and siblings) from their patients with COPD. The reason for treatment discontinuation was categorized as per patient decision or per physician decision. Adherence was categorized as treatment continued or treatment stopped. Patients who decided to stop treatment were considered non-adherent to COPD therapy. A total of 1311 patients as well as 98 physicians and 205 pharmacists were included. Pharmacists and social support (spouse, children/siblings) were identified as key positive factors in patients’ decisions to adhere to their prescribed COPD treatment regimens. A total of 631 patients (48.1%) stopped the treatment, including 170 (27.0%) due to patient decision and 55 (8.7%) deceased. After Cox model analysis, a low number of patients (6–19) attended by the pharmacist was a significant predictive factor (hazard ratio [HR] = 1.40, 95% confidence interval [CI] = 1.03–1.91, p = 0.03) for deciding to stop treatment. A wife or husband (HR = 0.85, 95% CI = 0.72–1.02, p = 0.07) as well as children or brother/sister (HR = 0.77, 95% CI = 0.57–1.04, p = 0.08) provided a positive effect for continued treatment. Pharmacists are well positioned to play a role as an essential public health resource that can help improve adherence as well as social support that should be considered as an important component to improve adherence to long-term therapy in COPD as well as other chronic non-communicable diseases in low- and middle-income countries.