A review of published studies of patients’ illness perceptions and medication adherence: Lessons learned and future directions

BackgroundPatients who seek medical care and who are prescribed medication may choose to either accept or not accept the prescriber’s recommendations to use the prescribed medication. The Common Sense Model (CSM) is one behavioral model that can help researchers and practitioners to identify patients’ illness perceptions that drive their decisions.ObjectiveThis article reviews published research that evaluated the impact of illness representations (as defined in CSM) with medication adherence.MethodsA narrative review of published research in illness representation and medication adherence was conducted. Articles were searched using MEDLINE, PreMEDLINE, evidence-based medicine reviews, and the International Pharmaceutical Abstracts databases and using the search terms medication adherence, compliance, illness perception, self-regulation theory, and common-sense model.ResultsEleven published studies were identified that compared illness representation (or illness perception) and medication adherence. Each illness representation factor, with the exception of illness coherence, directly or indirectly impacted medication adherence. Illness identity, where symptoms are used to label a health condition, can impact medication adherence, even with asymptomatic conditions such as hypertension. Patient age, disease condition, and culture may impact patient response to illness perceptions. Recommendations for future research are to (1) use longitudinal studies to evaluate the cause-effect relationships between illness perceptions and medication adherence, (2) study patients’ early experiences with their illness, (3) recruit patients who are nonadherent, (4) use clinical outcome measures in addition to the self-report medication adherence measures, and (5) include patient age and culture in the model.ConclusionsAlthough the CSM is a well-known patient behavior model, its use to explain medication adherence has been limited to cross-sectional studies across various health conditions. Further research is needed to elucidate the relationships between illness perceptions and patient medication adherence, which can help practitioners to better engage and communicate with patients.     

General practitioners’ perceptions of the current status and pharmacists’ contribution to primary care in Iceland

International Journal of Clinical Pharmacy - Background For the past several years pharmacists’ responsibilities have expanded globally from traditional tasks of dispensing medications to...     

Community pharmacists’ perceptions of leadership

BackgroundConcerns have been expressed regarding a “leadership crisis” in pharmacy. Previous research has identified potential barriers to pharmacists assuming leadership roles and signposted opportunities for further exploration of leadership issues in the profession related to psychological comfort with use of power.ObjectivesThis study explored community pharmacists’ perceptions of the effectiveness and impact of power leveraged by formal and informal pharmacy leaders.MethodsA theoretical framework based on Raven's 7 Sources of Power model was used to guide this research. Semi-structured interviews with community pharmacists in Ontario, Canada were undertaken, and data were coded and categorized using this framework.Findings29 pharmacists participated in this study. Participants in this study highlighted over-reliance on charismatic power, underuse of rewards and punishments, and general lack of effectiveness or impact in use of informational, expertise, positional, and relational powers amongst pharmacy leaders. Opportunities to broaden the power repertoire of pharmacy leaders, including leadership education, were identified as potentially valuable for individual leaders and the profession as a whole.ConclusionsEffectively leveraging power is important for leaders. This study has highlighted patterns of power use amongst community pharmacy leaders and identified opportunities for further research in this area and for continuing professional development for leaders.     

The impact of a community pharmacy service on patients’ medication adherence and ambulatory sensitive hospitalizations

BackgroundIn July 2012 a nationwide community pharmacy-based service was launched in New Zealand. The Long Term Conditions (LTC) service was introduced to help patients with chronic medical conditions, who have difficulties adhering to their medication regimens, improve their adherence. As part of the service pharmacists provide a variety of interventions including: patient education, medication reconciliation, medication synchronization, as well as preparing adherence support aids such as blister packs, sending reminders, and providing tailored dispensing frequencies. Seven years after its introduction scant data are available measuring the impact of the service on patients’ health outcomes.ObjectiveTo examine the impact of LTC on patients’ medication adherence and ambulatory sensitive hospitalizations.MethodsThis was a retrospective matched-cohort study using routinely collected health data. The population studied were individuals enrolled in LTC between July 2013 and December 2014 and a control group of propensity score matched individuals who never received the service. Outcomes were assessed during and after completion of the intervention. Sensitivity analysis was also undertaken whereby only those who completed the intervention and their controls were used in the analysis.ResultsThe matched cohort consisted of 51,138 individuals in the intervention and 51,138 in the control. Enrolment in LTC was associated with greater medication adherence, with individuals in the intervention group having 2.99 (95% CI: 2.79–3.20) greater odds of being adherent 12 months after the start of the study period, compared to the control group. These patients also had 1.86 (95% CI: 1.78–1.96) greater odds of having an ambulatory sensitive hospitalization 12 months after the start of the study period, compared to the control group.ConclusionThis study found that enrolment in LTC achieved one of the service's primary aims of improved medication adherence. However, enrolment in the service also appears to be associated with greater ambulatory sensitive hospitalizations, which is an unexpected finding. Further research is needed to better understand this.     

Impact of community pharmacist intervention discussing patients’ beliefs to improve medication adherence

Background Adherence to evidence based medicines in patients who have experienced a myocardial infarction remains low. Individual’s beliefs towards their medicines are a strong predictor of adherence and may influence other factors that impact on adherence. Objective To investigate if community pharmacists discussing patients’ beliefs about their medicines improved medication adherence at 12 months post myocardial infarction. Setting This study included 200 patients discharged from a public teaching hospital in Queensland, Australia, following a myocardial infarction. Patients were randomised into intervention (n = 100) and control groups (n = 100) and followed for 12 months. Method All patients were interviewed between 5 to 6 weeks, at 6 and 12 months post discharge by the researcher using the repertory grid technique. This technique was used to elicit the patient’s individualised beliefs about their medicines for their myocardial infarction. In the intervention group, patients’ beliefs about their medicines were communicated by the researcher to their community pharmacist. The pharmacist used this information to tailor their discussion with the patient about their medication beliefs at designated time points (3 and 6 months post discharge). The control group was provided with usual care. Main outcome measure The difference in non-adherence measured using a medication possession ratio between the intervention and control groups at 12 months post myocardial infarction. Results There were 137 patients remaining in the study (intervention group n = 72, control group n = 65) at 12 months. In the intervention group 29 % (n = 20) of patients were non-adherent compared to 25 % (n = 16) of patients in control group. Conclusion Discussing patients’ beliefs about their medicines for their myocardial infarction did not improve medication adherence. Further research on patients beliefs should focus on targeting non-adherent patients whose reasons for their non-adherence is driven by their medication beliefs.     

Physicians’ perceptions,expectations, and experiences of clinical pharmacists in Jordan-2017

International Journal of Clinical Pharmacy - Background A decade ago, clinical pharmacy was a new concept in hospital settings in Jordan, as evidenced in our 2006/2007 study. Changes in the...     

Pharmacy workers’ perceptions and acceptance of bar-coded medication technology in a pediatric hospital

BackgroundThe safety benefits of bar-coded medication-dispensing and administration (BCMA) technology depend on its intended users favorably perceiving, accepting, and ultimately using the technology.Objectives(1) To describe pharmacy workers’ perceptions and acceptance of a recently implemented BCMA system and (2) to model the relationship between perceptions and acceptance of BCMA.MethodsPharmacists and pharmacy technicians at a Midwest U.S. pediatric hospital were surveyed following the hospital’s implementation of a BCMA system. Twenty-nine pharmacists' and 10 technicians’ self-reported perceptions and acceptance of the BCMA system were analyzed, supplemented by qualitative observational and free-response survey data. Perception-acceptance associations were analyzed using structural models.ResultsThe BCMA system’s perceived ease of use was rated low by pharmacists and moderate by pharmacy technicians. Both pharmacists and technicians perceived that the BCMA system was not useful for improving either personal job performance or patient care. Pharmacy workers perceived that individuals important to them encouraged BMCA use. Pharmacy workers generally intended to use BCMA but reported low satisfaction with the system. Perceptions explained 72% of the variance in intention to use BCMA and 79% of variance in satisfaction with BCMA.ConclusionsTo promote their acceptance and use, BCMA and other technologies must be better designed and integrated into the clinical work system. Key steps to achieving better design and integration include measuring clinicians’ acceptance and elucidating perceptions and other factors that shape acceptance.     

The role of Sudanese community pharmacists in patients’ self-care

Objectives To describe the current and potential roles of Sudanese community pharmacists in responding to symptoms (RTS) and chronic diseases management (CDM) and identify perceived barriers. Settings Community pharmacies in Khartoum State. Method A structured, self-administered, piloted questionnaire was conducted of pharmacists in charge of 274, randomly selected, community pharmacies. Close ended questions and a 5-point Likert-type scale were used to measure responses. Main outcome measure Respondents’ demographics, their current activities, attitude and involvement in RTS and CDM and potential barriers. Response rate was 67 %. The majority of respondents (>90 %) reported that they are involved in RTS activities but have negative views regarding practice standards. They lack specific lists of minor conditions and their treatment (87.4 %), recorded counseling procedure (84.7 %), and referral forms (85.8 %). Almost all community pharmacists see an important role for them in CDM (4.54 ± 0.74, 95.3 %) and accept team work with other health care providers (4.46 ± 0.74, 87.5 %). Lack of proper knowledge and training, time, space, patients’ acceptance and official recognition of pharmacists’ new role, were some of the identified barriers. Conclusion Sudanese community pharmacists provide RTS and CDM services; however, clinical knowledge and training and well defined national practice standards needs were identified. The current product-focused activities need to be refined to include more patient-focused services. For Improved patients’ self-care services, a number of obstacles identified by surveyed pharmacists need to resolved. This requires collaboration of different parties including academics, governmental bodies and professional organizations.     

The effect of partial patients’ adherence to antihypertensive drugs: scope for pharmacists’ role in hypertension care

In many individuals, blood pressure varies between clinic visits conducted days, weeks, or months apart. This visit-to-visit variability (VVV) of blood pressure has been recently related with an increased risk of coronary heart disease, stroke, and mortality, independently of mean blood pressure. As for other chronical diseases, patients’ adherence to hypertensive therapies remains low and partial adherence to antihypertensive treatment may constitute a source of VVV, as suggested by recent studies. This data should lead to a new clinical approach for hypertension care, based on patients’ real adherence to treatment. Therapeutic strategies should include patients’ adherence. In this context, the role of community pharmacists for patients’ follow-up of hypertension should be reinforced, as they represent efficient and easily accessible health professionals.

     

Sildenafil citrate use in Addis Ababa: characteristics of users and pharmacists’ dispensing practices

International Journal of Clinical Pharmacy - Background Studies have reported misuse of sildenafil citrate for recreational purpose, not least by healthy young men. This is becoming a major...     

Pharmacists’ perceptions of the pharmacists’ patient care process and performance in a simulated patient interaction

ObjectivesTo (1) evaluate the use of the pharmacists’ patient care process (PPCP) by licensed pharmacists through a simulated patient activity and (2) describe pharmacists’ awareness and perceptions of the PPCP in the state of Arizona.DesignInterviews were conducted to elicit pharmacists’ perceptions and awareness of the PPCP. A simulated patient activity involved a role-play pharmacist-patient interaction in a community pharmacy setting. The PPCP was employed as the evaluative framework to assess pharmacist behavior.Setting and participantsPharmacists licensed in the state of Arizona practicing in various pharmacy settings were recruited through e-mail list serves and snowball recruitment. Data were collected in person, by telephone, and via video chat.Outcome measuresEmergent qualitative themes from interviews were used to describe pharmacists’ awareness and perceptions of the PPCP. The presence or absence of PPCP elements were assessed during the simulations.ResultsA total of 17 pharmacists were interviewed; 16 participated in the simulated activity. Of these, 7 (41.2%) participants recalled specific details regarding the PPCP process. Participants felt that the PPCP accurately reflected their daily workflow. Accordingly, a mean of 15.8 of the 19 PPCP elements was observed in simulated pharmacist-patient interactions, still allowing room for improvement in pharmacist-led care planning. Participants indicated perceived value in a shared patient care process that facilitates collaboration with myriad health professionals and as an aid to leverage pharmacists’ role on health care teams.ConclusionIn this study, pharmacists practicing in Arizona in various settings expressed an awareness of the PPCP, felt it accurately reflected the work they do, and expressed that the tool potentially added value to their work.     

Community chain pharmacists’ perceptions of increased technicians’ involvement in the immunization process

BackgroundOver the past 2 decades, pharmacists have positioned immunization services as an important aspect of their expanding role in patient care.ObjectivesTo examine how community chain pharmacists view time spent on immunization, available in-store resources and barriers, and pharmacy technician involvement in the context of their views about the achievement of key National Vaccine Advisory Committee (NVAC) Standards of Adult Immunization Practice in their workplace.MethodsA representative, nationwide survey was administered electronically to chain community pharmacists over a 4-week period. Community pharmacists offering year-round immunization in retail chain, supermarket, and mass-merchant settings, randomly sampled from a database maintained by the American Pharmacists Association. We examined several sets of interrelated relationships regarding pharmacists’ perceived achievement of 3 key NVAC standards (assessment, recommendation and administration), time spent on the overall immunization process, the effectiveness of available in-store resources, immunization impediments, and the endorsement of increased technician involvement in community pharmacy-based immunization service (PBIS) delivery.ResultsA sample of 590 survey responses was obtained from 9717 e-mails delivered, with 489 deemed eligible (5% response rate). Sizeable numbers of pharmacists acknowledged that several activities integral to achieving optimal immunization levels were not being addressed. Although pharmacists accepted that appropriately trained pharmacy technicians should be able to ask (77%) and assess (66%) patients, only 24% agreed that technicians should be able to administer vaccine doses. Pharmacists satisfied with in-store immunization resources and technicians’ involvement were more likely to report achieving the 3 key NVAC standards. Paradoxically, how pharmacists viewed their immunization time expenditures was unrelated to whether they agreed that pharmacy technicians should have an expanded role in asking, assessing, or administering vaccines to their patients.ConclusionOverall, community pharmacies would likely better meet national immunization goals by achieving all 3 key NVAC standards and incorporating expanded roles for appropriately trained and supervised technicians in PBIS.     

Importance of balancing follow-up time and impact of oral-anticoagulant users’ selection when evaluating medication adherence in atrial fibrillation patients treated with rivaroxaban and apixaban

Objective: Studies comparing medications adherence have become common yet they often do not account for differences in relative follow-up. Patient selection criteria may impact validity and comparability of these studies as well.

Methods: Adults with non-valvular atrial fibrillation, ≥1 rivaroxaban or apixaban dispensing (index date), and ≥1 year of pre-index eligibility were selected from IMS Health Real World Data Adjudicated Claims (IMS RWD Adjudicated Claims) and Truven Health MarketScan Research (Truven MarketScan) databases. Adherence was evaluated using proportion of days covered (PDC)?≥?0.8 for treatment cohorts: (1) unmatched, with different follow-up, (2) propensity-score matched with similar follow-up, (3) matched, with similar follow-up and ≥2 rivaroxaban or apixaban dispensings, and (4) matched, with similar follow-up and chronic medication users only. Robustness was verified with PDC ≥0.9.

Results: In the IMS RWD Adjudicated Claims database, rivaroxaban users had a longer mean follow-up than apixaban users (408 versus 254 days, respectively; p?p?p?p?>?.05), and reversed after (3) excluding non-chronic medication users (5.0 pp; p?Conclusion: Medication adherence comparisons need to account for differences in follow-up. Selection of chronic medication users may impact comparative adherence advantage between medications.