title: Adherence: a review of education, research, practice and policy in Spain.
abstract: OBJECTIVE
  To describe medication adherence education, practice, research and policy efforts carried out by pharmacists in Spain in the last decade.
  
  
  METHODS
  A literature review using Medline and Embase was conducted covering the last ten years. Additional pharmaceutical bibliographic sources in Spain were consulted to retrieve articles of interest from the last decade. Articles were included if a pharmacist was involved and if medication adherence was measured or there was any direct or indirect pharmacist intervention in monitoring and/or improving adherence. Articles focusing on the development of tools for adherence assessment were collected. Pre- and post-graduate pharmacy training programs were also reviewed through the Spanish Ministry of Education and Science website. Information regarding policy issues was gathered from the Spanish and Autonomous Communities of Education and Health Ministries websites.
  
  
  RESULTS
  Pharmacists receive no specific training focused on adherence. There is no specific government policies for pharmacists in Spain related to medication adherence regardless of their practice setting. A total of 24 research studies met our inclusion criteria. Of these, 10 involved pharmacist intervention in monitoring and/or improving adherence and 14 assessed only adherence. Ten studies involved hospital pharmacists working in collaboration with another healthcare professional.
  
  
  CONCLUSIONS
  At present in Spain, the investigative role of the pharmacist is not well developed in the area of medication adherence. Adherence improvement services provided to patients by pharmacists are not implemented in a systematic way. However, recent efforts to implement new initiatives in this area may provide the basis for offering new cognitive services aimed at improving patient adherence in the near future.
authors.affiliation: Pharmaceutical Care Research Group, University of Granada. Granada ( Spain ).
authors.forename: Narjis
authors.initials: N
authors.lastname: Fikri-Benbrahim
authors.affiliation: Pharmaceutical Care Research Group, University of Granada. Granada ( Spain ).
authors.forename: Victoria
authors.initials: V
authors.lastname: García-Cárdenas
authors.affiliation: Pharmaceutical Care Research Group, University of Granada. Granada ( Spain ).
authors.forename: Loreto
authors.initials: L
authors.lastname: Sáez-Benito
authors.affiliation: Pharmaceutical Care Research Group, University of Granada. Granada ( Spain ).
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Gastelurrutia
authors.affiliation: Pharmaceutical Care Research Group, University of Granada. Granada ( Spain ).
authors.forename: María P
authors.initials: MP
authors.lastname: Faus
authors.affiliation: Community Pharmacy, Dpt of ambulatory care and community medicine, University Hospital, Lausanne ( Switzerland ).
authors.forename: Marie P
authors.initials: MP
authors.lastname: Schneider
authors.affiliation: Faculty of Pharmacy, University of Sydney ( Australia ).
authors.forename: Parisa
authors.initials: P
authors.lastname: Aslani
keywords: Medication Adherence; Pharmacists; Spain