International Journal of Clinical Pharmacy

, Volume 33, Issue 4, pp 642–649 | Cite as

Effect of a 36-month pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients

  • Paulo Roque Obreli-Neto
  • Camilo Molino Guidoni
  • André de Oliveira Baldoni
  • Diogo Pilger
  • Joice Mara Cruciol-Souza
  • Walderez Penteado Gaeti-Franco
  • Roberto Kenji Nakamura CumanEmail author
Research Article


Objective: The primary objective of this study was to evaluate the effect of a pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients. The clinical outcomes of this pharmacotherapy adherence approach were the secondary objective of the study. Setting: Public Primary Health Care Unit in a municipality in the Brazilian State of Sao Paulo. Method: A 36-month randomized, controlled, prospective clinical trial was carried out with 200 patients divided into two groups: control (n = 100) and intervention (n = 100). The control group received the usual care offered by the Primary Health Care Unit (medical and nurse consultancies). The patients randomized into the intervention group received pharmaceutical care intervention besides the usual care offered. Main outcome measure: Pharmacotherapy adherence (Morisky-Green test translated into Portuguese and computerized dispensed medication history) and clinical measurements (blood pressure, fasting glucose, A1C hemoglobin, triglycerides and total cholesterol) were evaluated at the baseline and up to 36 months. A P value <0.05 was considered statistically significant. Results: A total of 97 patients from the intervention group and 97 patients from the control group completed the study (n = 194). Significant improvements in the pharmacotherapy adherence were verified for the intervention group according to the Morisky-Green test (50.5% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001) and the computerized dispensed medication history (52.6% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001); no significant changes were verified in the control group. Significant improvements in the number of patients reaching adequate values for their blood pressure (26.8% at baseline vs. 86.6% after 36-months; P < 0.001), fasting glucose (29.9% at baseline vs. 70.1% after 36 months; P < 0.001), A1C hemoglobin (3.3% at baseline vs. 63.3% after 36 months; P < 0.001), triglycerides (47.4% at baseline vs. 74.2% after 36 months; P < 0.001) and total cholesterol (59.8% at baseline vs. 80.4% after 36 months; P = 0.002) were verified in the intervention group, but remained unchanged in the control group. Conclusion: These results indicated the effectiveness of pharmaceutical care in improving pharmacotherapy adherence, with positive effects in the clinical outcomes of the patients studied.


Brazil Clinical trial Diabetes Elderly Hypertension Medication adherence Pharmaceutical care Public health 



The authors would like to thank the pharmacists and researchers for their assistance during the research.



Conflicts of interest

The authors have no conflicts of interest to declare.


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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Paulo Roque Obreli-Neto
    • 1
  • Camilo Molino Guidoni
    • 2
  • André de Oliveira Baldoni
    • 2
  • Diogo Pilger
    • 3
  • Joice Mara Cruciol-Souza
    • 4
  • Walderez Penteado Gaeti-Franco
    • 1
  • Roberto Kenji Nakamura Cuman
    • 1
    Email author
  1. 1.Department of Pharmacology and TherapeuticsState University of MaringáMaringáBrazil
  2. 2.Department of Pharmaceutical ScienceUniversity of Sao PauloRibeirão PretoBrazil
  3. 3.Faculty of PharmacyDepartamento do Medicamento, Federal University of BahiaSalvadorBrazil
  4. 4.Department of Pharmaceutical SciencesState University of LondrinaLondrinaBrazil

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