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International Journal of Clinical Pharmacy

, Volume 36, Issue 1, pp 98–104 | Cite as

Assessing the impact of multi-compartment compliance aids on clinical outcomes in the elderly: a pilot study

  • Carolina Mosca
  • Margarida M. Castel-Branco
  • Ana C. Ribeiro-Rama
  • Margarida M. Caramona
  • Fernando Fernandez-Llimos
  • Isabel V. Figueiredo
Research Article

Abstract

Background Medication non-adherence is a major problem for elderly people. Multicompartment compliance aids (MCAs) have been advocated as a solution for this problem. Objective To assess the impact of using MCAs in self-reported adherence and clinical biomarkers of elderly patients followed in a community pharmacy. Setting One community pharmacy at Sabugal (Portugal). Methods A four-month prospective, non-randomised, controlled study was performed. Autonomous patients aged 65 or more using 3 or more medicines and under follow-up in the pharmacy were invited to participate. All patients were offered to receive their medication in MCAs prepared in the pharmacy. Patients refusing the MCA were used as control. The intervention consisted of providing 4 weekly MCAs during the monthly visit. All patients received regular pharmacy counselling. Blood pressure (BP), lipid profile and glycaemia were assessed at baseline and monthly for all the patients. Morisky self-reported scale was applied at baseline and at the end of the study. Bivariate analysis and generalized estimation equations (GEE) were used. Main Outcome Measure: Self-reported medication adherence, clinical biomarkers: BP, lipid profile, glycaemia. Results 54 patients between 65 and 90 years were under follow-up. 44 patients accepted the MCA, constituting the intervention group. No difference in the baseline biomarkers between both groups was found. The bivariate pre-post analysis yielded significant improvements in the intervention groups, but not in the control, for glycaemia (p < 0.001), HDL-c (p = 0.018), and systolic (p < 0.001) and diastolic (p = 0.012) BP. However, when introducing the ‘time in follow-up’ in the GEE model, all the differences became non-significant, except systolic BP, but the time remained significant for all the biomarkers. Conclusion MCAs apparently improve several clinical biomarkers in a cohort of patients under pharmacist’s follow-up. When including the time in pharmacist’s followup in a GEE, the effect of the MCA disappeared, remaining only the time as a significant variable. Not considering the time in follow-up may be overestimating the effect of MCAs.

Keywords

Aged Community pharmacy Elderly Medication adherence Pharmaceutical services Portugal 

Notes

Funding

None.

Conflicts of interest

The authors declare not having any conflict of interest regarding this study.

Supplementary material

11096_2013_9852_MOESM1_ESM.doc (181 kb)
Supplementary material 1 (DOC 181 kb)
11096_2013_9852_MOESM2_ESM.docx (64 kb)
Supplementary material 2 (DOCX 63 kb)

References

  1. 1.
    World Health Organization. Active ageing: a policy framework. Geneva: WHO; 2002. Available: http://whqlibdoc.who.int/hq/2002/who_nmh_nph_02.8.pdf. Accessed 30 July 2013.
  2. 2.
    Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, Meinow B, Fratiglioni L. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Nobili A, Licata G, Salerno F, Pasina L, Tettamanti M, Franchi C, De Vittorio L, Marengoni A, Corrao S, Iorio A, Marcucci M, Mannucci PM. Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study. Eur J Clin Pharmacol. 2011;67(5):507–19.PubMedCrossRefGoogle Scholar
  4. 4.
    Hanlon JT, Lindblad CI, Hajjar ER, McCarthy TC. Update on drug-related problems in the elderly. Am J Geriatr Pharmacother. 2003;1(1):38–43.PubMedCrossRefGoogle Scholar
  5. 5.
    Stephenson BJ, Rowe BH, Haynes RB, Macharia WM, Leon G. Is this patient taking the treatment as prescribed? JAMA. 1993;269(21):2779–81.PubMedCrossRefGoogle Scholar
  6. 6.
    Fraser S. Concordance, compliance, preference or adherence. Patient Prefer Adherence. 2010;4:95–6.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2002;288(22):2868–79.PubMedCrossRefGoogle Scholar
  8. 8.
    DeMaria AN. Adherence, compliance, concordance, or the lack thereof. J Am Coll Cardiol. 2012;59(12):1120–1.PubMedCrossRefGoogle Scholar
  9. 9.
    World Health Organization. Adherence to longterm therapies. Evidence for action. Geneva: WHO; 2003. Available: http://whqlibdoc.who.int/publications/2003/9241545992.pdf. Accessed 30 July 2013.
  10. 10.
    Barat I, Andreasen F, Damsgaard EM. Drug therapy in the elderly: what doctors believe and patients actually do. Br J Clin Pharmacol. 2001;51(6):615–22.PubMedCrossRefGoogle Scholar
  11. 11.
    Van Wijk BL, Klungel OH, Heerdink ER, de Boer A. Effectiveness of interventions by community pharmacists to improve patient adherence to chronic medication: a systematic review. Ann Pharmacother. 2005;39(2):319–28.PubMedCrossRefGoogle Scholar
  12. 12.
    Saez-Benito L, Fernandez-Llimos F, Feletto E, Gastelurrutia MA, Martinez-Martinez F, Benrimoj SI. Evidence of the clinical effectiveness of cognitive pharmaceutical services for aged patients. Age Ageing. 2013;42(4):442–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Nunney JM, Raynor DK. How are multi-compartment compliance aids used in primary care? Pharm J. 2001;48(5):784–9.Google Scholar
  14. 14.
    Mahtani KR, Heneghan CJ, Glasziou PP, Perera R. Reminder packaging for improving adherence to self-administered long-term medications. Cochrane Database Syst Rev. 2011;7(9):CD005025.Google Scholar
  15. 15.
    Zedler BK, Kakad P, Colilla S, Murrelle L, Shah NR. Does packaging with a calendar feature improve adherence to self-administered medication for long-term use? A systematic review. Clin Ther. 2011;33(1):62–73.PubMedCrossRefGoogle Scholar
  16. 16.
    Raynor DK, Nunney JM. Medicine compliance aids are partial solution, not panacea. BMJ. 2002;324(7349):1338.PubMedCrossRefGoogle Scholar
  17. 17.
    National Institute for Health and Clinical Excellence. Medicines adherence: Involving patients in decisions about prescribed medicines and supporting adherence. Manchester: NICE; 2009. Available: http://www.nice.org.uk/nicemedia/pdf/CG76FullGuideline.pdf. Accessed 30 July 2013.
  18. 18.
    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560–72.PubMedCrossRefGoogle Scholar
  19. 19.
    Expert Panel on Detection E, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486–97.CrossRefGoogle Scholar
  20. 20.
    American Diabetes Association. Standards of medical care in diabetes-2011. Diabetes Care. 2011;34(Suppl 1):S11–61.CrossRefGoogle Scholar
  21. 21.
    Portuguese General Health Directorate. Guidelines on diabetes mellitus diagnose and classification (002/2011). Lisbon; 2011. Available: http://www.dgs.pt/ms/7/paginaRegisto.aspx?back=1&id=19925. Accessed 30 July 2013.
  22. 22.
    Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.PubMedCrossRefGoogle Scholar
  23. 23.
    Fitzmaurice G, Laird N, Ware J. Applied longitudinal analysis. Hoboken: Wiley; 2004. ISBN 0-471-21487-6.Google Scholar
  24. 24.
    Pepe MS, Anderson GL. A cautionary note on inference for marginal regression models with longitudinal data and general correlated response data. Commun Stat Simul Comput. 1994;23(4):939–51.CrossRefGoogle Scholar
  25. 25.
    Lecouturier J, Cunningham B, Campbell D, Copeland R. Medication compliance aids: a qualitative study of users’ views. Br J Gen Pract. 2011;61(583):93–100.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Nunney J, Raynor DK, Knapp P, Closs SJ. How do the attitudes and beliefs of older people and healthcare professionals impact on the use of multi-compartment compliance aids? A qualitative study using grounded theory. Drugs Aging. 2011;28(5):403–14.PubMedCrossRefGoogle Scholar
  27. 27.
    DiIorio C, Yeager K, Shafer PO, Letz R, Henry T, Schomer DL, McCarty F. The epilepsy medication and treatment complexity index: reliability and validity testing. J Neurosci Nurs. 2003;35(3):155–62.PubMedCrossRefGoogle Scholar
  28. 28.
    Guillausseau PJ. Impact of compliance with oral antihyperglycemic agents on health outcomes in type 2 diabetes mellitus: a focus on frequency of administration. Treat Endocrinol. 2005;4(3):167–75.PubMedCrossRefGoogle Scholar
  29. 29.
    McDonald MV, Peng TR, Sridharan S, Foust JB, Kogan P, Pezzin LE, Feldman PH. Automating the medication regimen complexity index. J Am Med Inform Assoc. 2013;20(3):499–505.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    George J, Phun YT, Bailey MJ, Kong DC, Stewart K. Development and validation of the medication regimen complexity index. Ann Pharmacother. 2004;38(9):1369–76.PubMedCrossRefGoogle Scholar
  31. 31.
    Melchiors AC, Correr CJ, Fernandez-Llimos F. Translation and validation into Portuguese language of the medication regimen complexity index. Arq Bras Cardiol. 2007;89(4):210–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Stange D, Kriston L, Langebrake C, Cameron LK, Wollacott JD, Baehr M, Dartsch DC. Development and psychometric evaluation of the German version of the Medication Regimen Complexity Index (MRCI-D). J Eval Clin Pract. 2012;18(3):515–22.PubMedCrossRefGoogle Scholar
  33. 33.
    Landsberger HA. Interaction process analysis of the mediation of labor-management disputes. J Abnorm Psychol. 1955;51(3):552–8.PubMedGoogle Scholar
  34. 34.
    Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part II: systematic review and meta-analysis in hypertension management. Ann Pharmacother. 2007;41(11):1770–81.PubMedCrossRefGoogle Scholar
  35. 35.
    Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part I: systematic review and meta-analysis in diabetes management. Ann Pharmacother. 2007;41(10):1569–82.PubMedCrossRefGoogle Scholar
  36. 36.
    Ellis SL, Billups SJ, Malone DC, Carter BL, Covey D, Mason B, Jue S, Carmichael J, Guthrie K, Sintek CD, Dombrowski R, Geraets DR, Amato M. Types of interventions made by clinical pharmacists in the IMPROVE study. Impact of managed pharmaceutical care on resource utilization and outcomes in veterans affairs medical centers. Pharmacotherapy. 2000;20(4):429–35.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Carolina Mosca
    • 1
  • Margarida M. Castel-Branco
    • 1
  • Ana C. Ribeiro-Rama
    • 1
  • Margarida M. Caramona
    • 1
  • Fernando Fernandez-Llimos
    • 2
  • Isabel V. Figueiredo
    • 1
  1. 1.Group of Pharmacology and Pharmaceutical Care, Center for Pharmaceutical Studies (CEF), Faculty of PharmacyUniversity of CoimbraCoimbraPortugal
  2. 2.Research Institute for Medicines and Pharmaceutical Sciences (iMed.UL), Department of Social Pharmacy, Faculty of PharmacyUniversity of LisbonLisbonPortugal

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