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Packaging helps elderly adhere to medication
Last Updated: 2006-11-16 14:32:12 -0400
(Reuters Health)
By Martha Kerr
CHICAGO (Reuters Health) - Blister packs of appropriately
grouped medications, along with guidance from a pharmacist, can
greatly improve treatment adherence rates of elderly patients, researchers
announced here at the American Heart Association's Scientific Sessions
2006.
The results of the Federal Study of Adherence to Medications in
the Elderly (FAME) were presented by Dr. Allen J. Taylor of Walter
Reed Army Medical Center in Washington, DC, in a late-breaking clinical
trials session. The study involved 200 patients who took four or
more medications a day. The average number of daily medications
was nine.
At the beginning of the study, data were collected for 2 months.
During this time, adherence rates were 61 percent, Taylor reported.
The patients then received individually prepared blister packs
of their medications and participated in a comprehensive pharmacy
care program.
Medication compliance rates jumped to 97.5 percent, Taylor announced.
As a result, blood pressure was significantly better controlled
and low-density lipoprotein (LDL) cholesterol ("the bad cholesterol") levels were lower than
they were at the start of the study.
For the next six months, patients were randomly assigned to continue
the pharmacy care program or to return to their usual habits of
taking medication.
In the usual-care group, "compliance rates rapidly fell" to near
pre-study levels and blood pressure levels did return to where they
were before. The compliance rates were 69 percent (vs. the original
61 percent), so there was some "carry-over" effect.
In contrast, patients in the comprehensive care group maintained
their high compliance rates. Blood pressure rates continued to fall,
as did LDL cholesterol.
Taylor noted that "physicians don't have time to follow-up" at
this level of intensity. "We don't think of the pharmacist as an
important part of patient care," but they are trained and knowledgeable,
and in a unique position to interact closely with patients. "We
should take advantage of that."
"Multiple medications are difficult for patients to manage," he
said. Despite great expenditure on drug safety and efficacy, "if
patients don't take them, they don't work."
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Pharmacy Care Program Can Increase Medication Adherence In Elderly
Main Category: Seniors / Aging News
Article Date: 18 Nov 2006 - 0:00 PST
Elderly patients will adhere more closely to their medication regimens
if they have the benefit of a comprehensive pharmacy care program
that includes patient education, specially packaged medications,
and pharmacy follow-up, according to a study published today on
the Journal of the American Medical Association's Web site (visit
http://jama.ama-assn.org/).
The "Federal Study of Adherence to Medications in the Elderly
(FAME) Study," funded by the American Society of Health-System
Pharmacists (ASHP) Research and Education Foundation, followed 200
elderly patients aged 65 or older who were taking at least four
medications for chronic conditions. The 14-month study tested the
effectiveness of a comprehensive pharmacy care program in improving
medication adherence and its associated effects on blood pressure
and low-density lipoprotein cholesterol. All patients were seen
at either Walter Reed Army Medical Center or at the Geriatric Pharmacy
Clinic in the Armed Forces Retirement Home in Washington, D.C.
"Elderly patients are at risk for medication adherence problems
because most have multiple diseases, some of which are asymptomatic,
such as high blood pressure," states principal investigator
Jeannie Kim Lee, Pharm.D., a clinical pharmacist at Walter Reed
Army Medical Center. "They also are at risk because they often
have complex medication regimens. They might stop taking medications
because they don't feel any differently or because they cannot remember
what the medications are for or when to take them. This can result
in all sorts of health problems that lead to emergency department
visits, hospitalizations, and increased health care costs."
During the FAME Study, Lee and her team spent 2 months assessing
patients for baseline medication adherence as well as LDL-cholesterol
and blood pressure measurements. Patients then began Phase 1, a
6-month period during which they saw a clinical pharmacist for disease
and medication education and were provided with blister-packed cards
that organized their medications according to their individual daily
regimens. In Phase 2, lasting an additional 6 months, patients were
divided randomly into two separate groups: one that continued the
pharmacy care program, and one that returned to the usual care situation.
The results of the study show that participation in a pharmacy
care program dramatically improves elderly patients' ability to
correctly continue their medication regimens: Before participation
in the pharmacy care program, patients' rate of medication adherence
was 61.2%. During participation in the pharmacy care program, patients
demonstrated a medication adherence rate of 96.9%.
"We were surprised by the greatly increased adherence rate,"
states Lee, who said the team had initially hoped for an improvement
rate of 85%. "We customized blister packs according to each
patient's medication regimen because some patients had so many -
a few patients had as many as 19 medications - they just had no
idea what to take when. We reviewed with patients what their medications
were, what they treated, the frequency and dose to take and the
possible side effects to expect. We also made medication charts
for them and updated them each time their medications changed."
Also encouraging were other results of the increased medication
adherence. The team measured the patients' blood pressure and cholesterol
levels at the beginning and end of Phase 1. They saw a reduction
in blood pressure, which has been associated in medical literature
with a 5% reduction in coronary deaths and an 8% reduction in stroke,
as well as a reduction in LDL-cholesterol, which is associated with
a reduction in cardiac events. "At Walter Reed, several providers
told us during this study, even before its conclusion, that they
thought our pharmacy care program should be implemented throughout
the healthcare system because they saw such positive changes in
their patients," says Lee.
While all patients showed great improvement in medication adherence
in Phase 1, rates changed dramatically for some patients in Phase
2. Six months after leaving the pharmacy care program, the group
that returned to usual care decreased in their ability to correctly
follow their medication regimens, dropping to a rate of only 69.1%
- close to the baseline measurement. The group that remained in
the pharmacy care program continued to follow their regimens, showing
a 95.5% rate of medication adherence.
"We learned that elderly patients have to stay in a pharmacy
care program long term in order for them to reach a successful medication
persistence," she says. "Our patients didn't seem to retain
their medication-taking behaviors when they returned to usual care.
So we concluded that even a 6-month pharmacy care program is not
enough for this type of high-risk patient. Pharmacy care has to
be an ongoing process."
Lee hopes to take the FAME Study pharmacy care program to a new
level within the military health care system by developing a high-risk
clinic for patients at risk for non-adherence, especially elderly
patients. "If we can identify high-risk populations and help
them sustain their medication regimens, we could become the template
for assuring medication adherence," says Lee. "It's important
to be able to provide medications to patients, but we also need
a system that helps them actually take those medications and take
them correctly. There is such a lack of education, and pharmacists
can play a key role in this problem. We are the ones who can help
with this."
Col. Allen J. Taylor, M.D., Chief of Cardiology Service at Walter
Reed Army Medical Center, agrees: "The results of FAME call
for greater emphasis within healthcare delivery systems and policy
organizations on the development and promotion of clinical programs
to enhance medication adherence, particularly among the at-risk
elderly. Success within these programs requires a team approach,
within which the clinical pharmacy expertise is an absolutely crucial
component."
The FAME Study was funded through the ASHP Foundation's 2004 Federal
Services Junior Investigator Research Grant, sponsored by Novartis.
For more information about this research grant program, visit http://www.ashpfoundation.org/research.
About the ASHP Research and Education Foundation
The ASHP Research and Education Foundation was established in 1968
by the American Society of Health-System Pharmacists as a nonprofit,
tax-exempt organization. The mission of the Foundation is to improve
the health and well-being of patients in hospitals and health systems
through appropriate, safe and effective medication use. The Foundation
provides leadership and conducts education and research activities
that foster the coordination of interdisciplinary medication management
leading to optimal patient outcomes. Emphasis is given to programs
that will have a major impact on advancing pharmacy practice in
hospitals and health systems, thereby improving public health.
American Society of Health-System Pharmacists (ASHP)
7272 Wisconsin Ave.
Bethesda, MD 20814
United States
http://www.ashp.org
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