ORIGINAL PAPERS The development and evaluation of an extended adherence support programme by community pharmacists for elderly patients at home D. K. RAYNOR, M. NICOLSON, J. NUNNEY, D. PETTY, A. VAIL and L. DAVIES Objective -To devise, implement and evaluate a medication adherence support service by community pharmacists for elderly patients living at home and at risk of non-adherence. Method - Six community pharmacists identified patients who were 65 years of age and older, prescribed four or more regular medicines and living alone. A random sample of patients was visited at home and assessed for adherence- related problems using a structured interview. The pharmacist then drew up an action plan in conjunction with the patient and general practitioner (GP), and returned for a second home visit, where the revised regime was delivered and explained. A self-reported adherence questionnaire was also administered. After two months an independent researcher visited the patients at home to assess progress. Setting - Six community pharmacies in the city of Leeds, UK, and patients' homes. Key findings - A total of 143 patients were recruited and 441 medicine-related problems were identified. Of these, 241 (55 per cent) required the provision of information and advice, 106 (24 per cent) required consultation with the GP and 86 (20 per cent) required changes in the presentation of the medicines. The median number of regular prescribed medicines fell from six to five (P<O.OOl). Overall, there was a reduction in the number of patients with one or more problems from 94 per cent to 58 per cent (P<O.OOl). The proportion of patients who reported non-adherence fell from 38 per cent to 14 per cent (PeO.001). Conclusion -This study shows that community pharmacists can target patients at risk of medication non-adherence and, using a structured approach, identify problems and implement solutions. The pharmacy patient medication record is an underutilised tool for identifying patients with adherence problems. The software needs enhancing to enable pharmacists to maxiniise their use of these records in adherence support. An adherence support programme needs to take more account of intentional non-adherence and should be closely linked with the rest of the primary health care team. THREE trends in UK health care support the de- velopment of pharmacist-led domiciliary adher- ence support programmes. These are the shift towards patients being treated in their own home, the persistence of high levels of non-ad- herence with medication, and the promotion of an extended role for community pharmacists in medicines management. The elderly form 16 per cent of the general population but consume 44 per cent of pre- scribed medicines.' The majority of medicines have always been consumed in the domiciliary setting, and this has been increased by the devel- oping emphasis in the UK health system on treat- ing patients at home rather than in the hospital setting2 No evidence has been convincingly pre- sented to challenge the widely quoted estimate, first given in 1979, that 50 per cent of patients do not take their medicines as prescribed.3 All patients are at risk of non-adherence and here is little evidence that individual older peo- ple are likely to be more or less adherent than younger people. However, significant risk factors linked with non-adherence are more common in elderly patients4 high numbers of medicines, high dose frequencies, confusion, poor memory, Division of Academic Pharmacy Practice, University of Leeds, 10 Clarendon Road, Leeds, England LS2 9NN D. K. The0 Raynor, PhD, MRPharmS, head of division Margaret Nicolson, BSc, MRPharmS, honorary research fellow Jacky Nunney, DipClinPharm, MRPharmS, visiting research associate Duncan Petty, BPharm, MRPharmS, research pharmacist School of Medicine, University of Leeds Andy Vail, MSc, medical statistician Centre for Health Economics, University of York Linda Davies, MSc, senior research fellow Correspondence: Dr Raynor D.K.Raynor@leeds. ac.uk lnt J Pharrn Pract 2000:8:157-64 SEPTEMBER 2000, THE INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 157 Downloaded from https://academic.oup.com/ijpp/article/8/3/157/6138977 by guest on 05 June 2022