title: The (cost-)effectiveness of a patient-tailored intervention programme to enhance adherence to antihypertensive medication in community pharmacies: study protocol of a randomised controlled trial.
abstract: Medication non-adherence is a complex health care problem. Due to non-adherence, substantial numbers of cardiovascular patients benefit from their medication to only a limited extent. In order to improve adherence, a variety of pharmacist-led interventions have been developed. However, even the most effective interventions achieved only a modest positive effect. To be effective, interventions should be targeted at underlying barriers to adherence, developed in a systematic manner and tailored to specific features of a target group and setting. The current paper describes the design of the Cardiovascular medication non-Adherence Tailored Intervention (CATI) study aimed to evaluate the (cost-)effectiveness of a patient-tailored intervention programme in patients using antihypertensive medication.
  
  
  
  The CATI study is a randomised controlled trial that will be performed in 13 community pharmacies. Patients aged 45-75 years using antihypertensive medication and considered non-adherent according to pharmacy dispensing data, as well according to a self-report questionnaire, are eligible to participate. Patients in the intervention condition will receive a patient-tailored, pharmacist-led intervention programme. This programme consists of a structured interview at the pharmacy to identify patients' barriers to adherence and to counsel patients in order to overcome these barriers. The primary outcome is self-reported medication adherence measured with the MARS-5 questionnaire. Secondary outcome measures are blood pressure, illness perceptions, quality of life and societal costs. A cost-effectiveness analysis and process evaluation will also be performed.
  
  
  
  This study will provide insight into the (cost-)effectiveness of a patient-tailored, pharmacist-led intervention programme in non-adherent patients using antihypertensive medication. This intervention programme allows community pharmacists to support their patients in overcoming barriers to adherence and improving medication adherence in a structured and patient-tailored manner. An effective intervention will not only enhance medication adherence, but may also improve health outcomes and decrease health care utilisation and costs.
  
  
  
  Netherlands Trial Register (identifier: NTR5017), registered on 2 February 2015.
authors.affiliation: Department of Clinical Pharmacology and Pharmacy and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands. d.vanderlaan1@vumc.nl.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: van der Laan
authors.affiliation: Department of General Practice and Elderly Care Medicine and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Petra J M
authors.initials: PJ
authors.lastname: Elders
authors.affiliation: Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Christel C L M
authors.initials: CC
authors.lastname: Boons
authors.affiliation: Department of Health Sciences and the Amsterdam Public Health Research Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Bosmans
authors.affiliation: Department of General Practice and Elderly Care Medicine and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Giel
authors.initials: G
authors.lastname: Nijpels
authors.affiliation: Department of Clinical Pharmacology and Pharmacy and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jacqueline G
authors.initials: JG
authors.lastname: Hugtenburg
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003157:Community Pharmacy Services / Q000191:economics*; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D016527:Drug Costs; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009426:Netherlands; D010595:Pharmacists / Q000191:economics*; D024382:Professional Role; D012107:Research Design; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: Antihypertensive medication; Medication non-adherence; Patient-tailored intervention; Randomised controlled trial