title: Medication adherence program: adherence challenges and interventions in type 2 diabetes.
abstract: OBJECTIVE
  To describe medication adherence problems for adults with type 2 diabetes and to assess the nature and frequency of pharmacist activities in addressing them and proximate outcomes.
  
  
  METHODS
  Pre-post analysis.
  
  
  METHODS
  Four community chain pharmacies located in Seattle, WA, from April 2008 to October 2009.
  
  
  METHODS
  120 patients (mean age >60 years) with type 2 diabetes taking oral diabetes medications and who were 6 or more days late for refills.
  
  
  METHODS
  Pharmacist telephone-initiated adherence support.
  
  
  METHODS
  Nature and frequency of adherence-related problems and intervention activities and impact on reduction in refill gaps.
  
  
  RESULTS
  The primary adherence challenge was difficulty taking medications (27.1%). Failure to remember doses and forgetting refills were reported by 24.6% and 26.3% of patients at baseline, respectively. Pharmacists provided support through some form of patient education (35.6% of encounters) or other adherence support (40.7%). Pharmacist time averaged slightly greater than 5 minutes per intervention and 12.6 ± 10.7 minutes (mean ± SD) over 12 months, with 3.4 ± 2.4 interventions per patient. Patient-specific education and adherence support by pharmacists and total intervention time were positively correlated, with a modest but significant reduction in refill gaps during 12 months of follow-up.
  
  
  CONCLUSIONS
  Not remembering to refill medications was the most commonly reported problem. Patient encounters averaged 4 to 6 minutes for the first visit and 12 to 13 minutes over 12 months. Phone calls by pharmacists to adults who were late for oral diabetes medication refills were effective in identifying adherence-related problems and developing support strategies to promote medication self-management in busy urban community chain pharmacy settings.
authors.affiliation: School of Pharmacy, University of Washington, Box 357630, 1959 NE Pacific St., Seattle, WA 98195, USA. podegard@u.washington.edu
authors.forename: Peggy Soule
authors.initials: PS
authors.lastname: Odegard
authors.forename: Gina
authors.initials: G
authors.lastname: Carpinito
authors.forename: Dale B
authors.initials: DB
authors.lastname: Christensen
mesh_terms: D000284:Administration, Oral; D003157:Community Pharmacy Services / Q000458:organization & administration*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D010595:Pharmacists / Q000458:organization & administration; D024382:Professional Role; D012648:Self Care / Q000379:methods; D013689:Telephone; D013997:Time Factors; D014861:Washington
chemical_list: D007004:Hypoglycemic Agents