Factors influencing the provision of adherence support by community pharmacists: A structural equation modeling approach.
BACKGROUND
Non-adherence to medication represents an important barrier to achieving optimum patient outcomes. Community pharmacists are well placed to deliver interventions to support adherence.


OBJECTIVE
To investigate community pharmacists' activities in supporting patient adherence; and identify factors influencing pharmacists' provision of adherence support.


METHODS
A random sample of 2020 Australian community pharmacies was mailed a questionnaire investigating their provision of adherence support. The self-completed, structured questionnaire consisted of eight sections, five of which were relevant to this study: strategies used to identify non-adherent patients, strategies used to support patients' adherence to medications, pharmacists' attitudes toward provision of adherence support, perceived barriers to provision of adherence support, and demographics. Structural equation modeling (SEM) was used to determine potential influencing factors.


RESULTS
A response rate of 31% was achieved (n = 627). Pharmacists reported using strategies to identify non-adherent patients for less than half (45%) of the prescriptions dispensed. A mean of 8.4 ± 14.9 (mean ± SD) strategies was used by respondents in the 7 days prior to survey completion. Dose administration aids was the most commonly used strategy (provided by 96.5% of respondents). Time pressure for patients (68%) was perceived by pharmacists as the main barrier to adherence support. SEM identified "stakeholders/skills" and "number of full time equivalent staff" as influencing provision of adherence support strategies.


CONCLUSIONS
Provision of adherence support by pharmacists was episodic and infrequent, impeded by a number of barriers. By addressing barriers, it is possible to enable pharmacists to become more proactive and effective in supporting patient adherence.
Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building, A15, Sydney, NSW 2006, Australia.
Sarab M
SM
Mansoor
Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building, A15, Sydney, NSW 2006, Australia.
Ines
I
Krass
School of Psychology, The University of Sydney, Lifehouse Building (C39Z), Sydney, NSW 2006, Australia.
Daniel S J
DS
Costa
Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building, A15, Sydney, NSW 2006, Australia. Electronic address: parisa.aslani@sydney.edu.au.
Parisa
P
Aslani
D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D003157:Community Pharmacy Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D008962:Models, Theoretical; D010595:Pharmacists / Q000458:organization & administration*; D024382:Professional Role; D013997:Time Factors
Adherence to medications; Attitudes; Australia; Barriers; Pharmacists