AUTHOR=Kooij Marcel J. , Heerdink Eibert R. , van Dijk Liset , van Geffen Erica C. G. , Belitser Svetlana V. , Bouvy Marcel L. 

TITLE=Effects of Telephone Counseling Intervention by Pharmacists (TelCIP) on Medication Adherence; Results of a Cluster Randomized Trial

JOURNAL=Frontiers in Pharmacology

VOLUME=7

YEAR=2016

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2016.00269

DOI=10.3389/fphar.2016.00269

ISSN=1663-9812

ABSTRACT=<p><bold>Objectives:</bold> To assess the effect of a pharmacist telephone counseling intervention on patients' medication adherence.</p><p><bold>Design:</bold> Pragmatic cluster randomized controlled trial.</p><p><bold>Setting:</bold> 53 Community pharmacies in The Netherlands.</p><p><bold>Participants:</bold> Patients ≥18 years initiating treatment with antidepressants, bisphosphonates, Renin-Angiotensin System (RAS)-inhibitors, or statins (lipid lowering drugs). Pharmacies in arm A provided the intervention for antidepressants and bisphosphonates and usual care for RAS-inhibitors and statins. Pharmacies in arm B provided the intervention for RAS-inhibitors and statins and usual care for antidepressants and bisphosphonates.</p><p><bold>Intervention:</bold> Intervention consisted of a telephone counseling intervention 7–21 days after the start of therapy. Counseling included assessment of practical and perceptual barriers and provision of information and motivation.</p><p><bold>Main outcome measure:</bold> Primary outcome was refill adherence measured over 1 year expressed as continuous outcome and dichotomous (refill rate≥80%). Secondary outcome was discontinuation within 1 year.</p><p><bold>Results:</bold> In the control arms 3627 patients were eligible and in the intervention arms 3094 patients. Of the latter, 1054 patients (34%) received the intervention. Intention to treat analysis showed no difference in adherence rates between the intervention and the usual care arm (74.7%, SD 37.5 respectively 74.5%, 37.9). More patients starting with RAS-inhibitors had a refill ratio ≥80% in the intervention arm compared to usual care (81.4 vs. 74.9% with odds ratio (OR) 1.43, 95%CI 1.11–1.99). Comparing patients with counseling to patients with usual care (per protocol analysis), adherence was statistically significant higher for patients starting with RAS-inhibitors, statins and bisphosphonates. Patients initiating antidepressants did not benefit from the intervention.</p><p><bold>Conclusions:</bold> Telephone counseling at start of therapy improved adherence in patients initiating RAS-inhibitors. The per protocol analysis indicated an improvement for lipid lowering drugs and bisphosphonates. No effect for on adherence in patients initiating antidepressants was found.</p><p>The trial was registered at <ext-link ext-link-type="uri" xlink:href="http://www.trialregister.nl" xmlns:xlink="http://www.w3.org/1999/xlink">www.trialregister.nl</ext-link> under the identifier NTR3237.</p>