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This study was recently released, as reported by Medscape: Federal Study of Adherence to Medications (FAME -- Presented at AHA 2006)
Posted 12/22/2006
Quote:
Description: The goal of the trial was to evaluate the effect of a pharmacy intervention program compared with usual care on medication adherence among elderly patients treated with ≥4 chronic medications.
Drugs/Procedures Used: Following a 2-month run-in phase, all patients were entered a 6-month intervention phase that included medication education, pharmacist follow-up, and medications dispensed in time-specific packets (observation phase). After the 6 months, patients were randomized to either continuation of the intervention (n = 83) or usual care (n = 76) for an additional 6 months (randomization phase). The trial was conducted at the Walter Reed Army Medical Center.
Principal Findings: Mean number of chronic medications taken at baseline was 8.7. Medications included treatment for hypertension (91.5%) and hyperlipidemia (80.6%). Mean medication adherence at baseline was 61.2%. Medications included statins (80%), angiotensin-converting enzyme inhibitors (50.2%), beta-blockers (47.3%), calcium channel blockers (36.8%), and thiazide diuretic (25.9%). Following the observation intervention phase, the primary endpoint of medication adherence increased significantly from baseline (96.9%, p < 0.001). An adherence rate of taking 80% of all medications increased from 5.0% at baseline to 98.7% after intervention (p < 0.001). Among patients with treated hypertension, systolic blood pressure (SBP) was reduced from 133.2 mm Hg at baseline to 129.9 mm Hg at 6 months (p = 0.02). Low-density lipoprotein cholesterol (LDL-C) was also reduced from baseline (91.7 mg/dl to 86.8 mg/dl, p = 0.001) among patients with treated hyperlipidemia. During the randomization phase, medication adherence decreased to 69.1% in the usual care group but was maintained at 95.5% in the intervention group (p < 0.001). Adherence rate of at least 80% of all medications was higher in the intervention group compared with the usual care group (97.4% vs. 21.7%, p < 0.001). The reduction in SBP among treated hypertensives was greater in the intervention group compared with the usual care group (-6.9 mm Hg vs. -1.0 mm Hg, p = 0.04). Among treated hyperlipidemics, reduction in LDL-C did not differ between the intervention and usual care group (-2.8 mg/dl vs. -5.8 mg/dl, p = 0.85).
Interpretation: Among patients age ≥65 years treated with multiple chronic medications, use of a pharmacy intervention program was associated with better medication use adherence compared with usual care. In addition to demonstrating an association between the intervention program and medication compliance, the trial also demonstrated clinical effects on blood pressure, with a reduction in SBP in treated hypertensive patients in the intervention group compared with the usual care group. Patients taking multiple chronic medications are at high risk for medication nonadherence. The risk can be even higher for asymptomatic conditions, including hypertension and hyperlipidemia. Nonadherence can lead to worsening health problems, increased hospitalizations, and subsequently higher overall health costs. While the present trial showed the intervention program was effective, the time necessary for pharmacists to provide patient education may be a barrier to widespread use of the program.
Federal Study of Adherence to Medications - FAME
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