title: Process- and patient-reported outcomes of a multifaceted medication adherence intervention for hypertensive patients in secondary care.
abstract: BACKGROUND
  Adherence to antihypertensive medications is suboptimal. Hospital pharmacist interventions including motivational interviewing (MI) might assist in improving adherence in patients with hypertension. For an intervention to be useful, it is important to have tools that can easily identify potential adherence problems.
  
  
  OBJECTIVE
  To evaluate process outcomes and patient- and pharmacist-reported outcomes of a pharmacist adherence intervention for hypertensive patients treated in hospital outpatient clinics. Secondly, to determine the agreement between two different adherence metrics: an adherence questionnaire used in the intervention and a prescription-based measure.
  
  
  METHODS
  The development of the intervention was based on adherence and behavioral theories and evidence of effective interventions. This included a focused medication review, a patient interview, and follow-up telephone calls. Two tools were used to identify adherence problems: The Drug Adherence Work-up (DRAW) tool and an adherence questionnaire. Process data included drug-related problems (DRPs) with recommendations to the physicians, medication- and lifestyle problems identified at the patient interview, actions taken and time spent on the intervention.
  
  
  RESULTS
  In total, 91 DRPs in 8 categories generated recommendations to the physicians; 56 recommendations were generated at the medication review and 35 at the patient interview. At the interview, 421 problems were identified, of which 60% were medication-related and 40% lifestyle-related. In connection with the interview, 528 actions were taken within 8 different categories. MI was a central technique applicable for most problems and was employed in nearly all patients (94%). About half of the patients reported increased focus on lifestyle change, and 21-39% reported increased knowledge, confidence and skills in relation to their medication as well as better quality of life. The pharmacists found that the intervention elements were meaningful pharmacist tasks, and that the DRAW tool was easy to use and helped them focus on addressing reasons for non-adherence. The mean total time spent by the pharmacist per patient was 2 h 14 min (SD 40 min).
  
  
  CONCLUSIONS
  A pharmacist-led, multifaceted, tailored adherence intervention was feasible for identifying and addressing a wide range of potential adherence and lifestyle problems. Among the intervention procedures, MI was a central technique, applicable in most types of problems. The questionnaire showed relatively little value for identifying non-adherence. The intervention was well accepted both by the pharmacists and the patients, thereby increasing the likeliness of successful implementation in routine practice.
authors.affiliation: Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 19.2, DK-5000 Odense C, Denmark; Hospital Pharmacy of Funen, Clinical Pharmacy Department, Odense University Hospital, J.B. Winsløws Vej 13, DK-5000 Odense C, Denmark. Electronic address: uhedegaard@health.sdu.dk.
authors.forename: Ulla
authors.initials: U
authors.lastname: Hedegaard
authors.affiliation: Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 19.2, DK-5000 Odense C, Denmark; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Kløvervænget 29, DK-5000, Odense C, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Hallas
authors.affiliation: Hospital Pharmacy of Funen, Clinical Pharmacy Department, Odense University Hospital, J.B. Winsløws Vej 13, DK-5000 Odense C, Denmark.
authors.forename: Lene Vestergaard
authors.initials: LV
authors.lastname: Ravn-Nielsen
authors.affiliation: The Danish Research Unit for Hospital Pharmacy, Amgros I/S, Dampfærgevej 22, DK-2100 Copenhagen Ø, Denmark.
authors.forename: Lene Juel
authors.initials: LJ
authors.lastname: Kjeldsen
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008019:Life Style; D008297:Male; D055118:Medication Adherence; D059065:Medication Reconciliation; D008875:Middle Aged; D062405:Motivational Interviewing; D010044:Outpatient Clinics, Hospital; D063868:Patient Outcome Assessment; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D063127:Secondary Health Care; D011795:Surveys and Questionnaires
chemical_list: D000959:Antihypertensive Agents
keywords: Hospital; Hypertension; Medication adherence; Motivational interviewing; Pharmacy services