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International Journal of Clinical Pharmacy

, Volume 38, Issue 2, pp 296–302 | Cite as

Pharmacists’ perspectives on monitoring adherence to treatment in Cystic Fibrosis

  • Karen Mooney
  • Cristín Ryan
  • Damian G. Downey
Research Article
First Online:
Received:
Accepted:

Abstract

Background Cystic Fibrosis (CF) management requires complex treatment regimens but adherence to treatment is poor and has negative health implications. There are various methods of measuring adherence, but little is known regarding the extent of adherence measurement in CF centres throughout the UK and Ireland. Objective To determine the adherence monitoring practices in CF centres throughout the UK and Ireland, and to establish CF pharmacists’ views on these practices. Setting UK and Ireland Cystic Fibrosis Pharmacists’ Group’s annual meeting (2014). Methods A questionnaire was designed, piloted and distributed to pharmacists attending the UK and Ireland Cystic Fibrosis Pharmacists’ Group’s annual meeting (2014). The main outcome measures were the methods of inhaled/nebulised antibiotic supply and the methods used to measure treatment adherence in CF centres. The questionnaire also ascertained the demographic information of participating pharmacists. Closed question responses were analysed using descriptive statistics. Open questions were analysed using content analysis. Results Twenty-one respondents (84 % response) were included in the analysis and were mostly from English centres (66.7 %). Detailed records of patients receiving their inhaled/nebulised antibiotics were lacking. Adherence was most commonly described to be measured at ‘every clinic visit’ (28.6 %) and ‘occasionally’ (28.6 %). Patient self-reported adherence was the most commonly used method of measuring adherence in practice (90.5 %). The availability of electronic adherence monitoring in CF centres did not guarantee its use. Pharmacists attributed an equal professional responsibility for adherence monitoring in CF to Consultants, Nurses and Pharmacists. Seventy-six percent of pharmacists felt that the current adherence monitoring practices within their own unit were inadequate and associated with the absence of sufficient specialist CF pharmacist involvement. Many suggested that greater specialist pharmacist involvement could facilitate improved adherence monitoring. Conclusion Current adherence knowledge is largely based on self-report. Further work is required to establish the most appropriate method of adherence monitoring in CF centres, to improve the recording of adherence and to understand the impact of increased specialist pharmacist involvement on that adherence.

Keywords

Cystic Fibrosis Ireland Medication adherence Treatment monitoring United Kingdom 
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Notes

Acknowledgments

We thank members of the Cystic Fibrosis Pharmacists’ Group for their participation in this work.

Funding

This work was funded by the Gilead Fellowship programme. However, they did not have a direct role in the data collection and analysis, nor did they have any editorial input into this paper.

Conflicts of interest

The authors (Karen Mooney, Cristín Ryan and Damian G Downey) have no conflicts of interest to declare.

Supplementary material

11096_2015_239_MOESM1_ESM.pdf (434 kb)
Supplementary material 1 (PDF 434 kb)

References

  1. 1.
    Jain M, McColley SA. Breathing in America: Diseases, progress and hope [Internet]. United States: American Thoracic Society; 2010 [cited 21 Sept 2015]. 8p. Available from: http://www.ukmi.nhs.uk/filestore/ukmianp/2014PrescribingOutlook-NewMedicines2014-FINAL.pdf.
  2. 2.
    Sawicki Gregory S, Sellers Deborah E, Robinson Walter M. High treatment burden in adults with cystic fibrosis: challenges to disease self-management. J Cyst Fibros. 2009;8(2):91–6.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    World Health Organisation. Adherence to long-term therapies: Evidence for action [Internet]. 2003 [cited 21 Sept 2015]. Available from: http://www.who.int/chp/knowledge/publications/adherence_report/en/.
  4. 4.
    Eakin MN, Bilderback A, Boyle MP, Mogayzel PJ, Riekert KA. Longitudinal association between medication adherence and lung health in people with cystic fibrosis. J Cyst Fibros. 2011;10(4):258–64.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Quittner AL, Zhang J, Marynchenko M, Chopra PA, Signorovitch J, Yushkina Y, et al. Pulmonary medication adherence and health-care use in cystic fibrosis. Chest. 2014;146(1):142–51.CrossRefPubMedGoogle Scholar
  6. 6.
    Modi AC, Lim CS, Yu N, Geller D, Wagner MH, Quittner AL. A multi-method assessment of treatment adherence for children with cystic fibrosis. J Cyst Fibros. 2006;5(3):177–85.CrossRefPubMedGoogle Scholar
  7. 7.
    Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther. 1999;21(6):1074–90.CrossRefPubMedGoogle Scholar
  8. 8.
    Quittner AL, Modi AC, Lemanek KL, Ievers-Landis CE, Rapoff MA. Evidence-based assessment of adherence to medical treatments in pediatric psychology. J Pediatr Psychol. 2008;33(9):916–36.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Daniels T. Accurate assessment of adherence: self-report and clinician report vs electronic monitoring of nebulizers. Chest. 2011;140(2):425–32.CrossRefPubMedGoogle Scholar
  10. 10.
    Riekert KA, Rand CS. Electronic monitoring of medication adherence: When is high-tech best? J Clin Psychol Med Settings. 2002;9(1):25–34.CrossRefGoogle Scholar
  11. 11.
    Denyer J. Adherence monitoring in drug delivery. Expert Opin Drug Deliv. 2010;7(10):1127–31.CrossRefPubMedGoogle Scholar
  12. 12.
    Quittner AL, Espelage DL, Levers-Landis C, Drotar D. Measuring adherence to medical treatments in childhood chronic illness: considering multiple methods and sources of information. J Clin Psychol Med Settings. 2000;7(1):41–54.CrossRefGoogle Scholar
  13. 13.
    Geller DE, Madge S. Technological and behavioral strategies to reduce treatment burden and improve adherence to inhaled antibiotics in cystic fibrosis. Resp Med. 2011;105(Supplement 2):S24–31.CrossRefGoogle Scholar
  14. 14.
    Lehmann A, Aslani P, Ahmed R, Celio J, Gauchet A, Bedouch P, et al. Assessing medication adherence: options to consider. Int J Clin Pharm. 2014;36(1):55–69.CrossRefPubMedGoogle Scholar
  15. 15.
    Davies J, Wainwright C, Canny G, Chilvers MA, Howenstine MS, Munck A, et al. Efficacy and safety of ivacaftor in patients aged 6 to 11 years with cystic fibrosis with a G551D mutation. Am J Respir Crit Care Med. 2013;187(11):1219–25.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    NHS Health Research Authority. Does my project require review by a Research Ethics Committee? [Internet]. 2013 [cited 24 Nov 2015]. Available from: http://www.hra.nhs.uk/documents/2013/09/does-my-project-require-rec-review.pdf.
  17. 17.
    McColl E, Jacoby A, Thomas L, Soutter J, Bamford C, Steen N, et al. Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients. Health Technol Assess. 2001;5(31):1–250.CrossRefPubMedGoogle Scholar
  18. 18.
    Hsieh H, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRefPubMedGoogle Scholar
  19. 19.
    Rand CS, Sevick MA. Ethics in adherence promotion and monitoring. Control Clin Trials. 2000;21(5 Supplement 1):S241–7.CrossRefGoogle Scholar
  20. 20.
    Wildman MJ, Hoo ZH. Moving cystic fibrosis care from rescue to prevention by embedding adherence measurement in routine care. Paediatr Respir Rev. 2014;15(Supplement 1):16–8.PubMedGoogle Scholar
  21. 21.
    Iles R, Legh-Smith J, Drummond M, Prevost A, Vowler S. Economic evaluation of tobramycin nebuliser solution in cystic fibrosis. J Cyst Fibros. 2003;2(3):120–8.CrossRefPubMedGoogle Scholar
  22. 22.
    UK Medicines Information. Prescribing Outlook: New Medicines [Internet]. Sept 2014 [cited 21 Sept 2015]. Available from: http://www.ukmi.nhs.uk/filestore/ukmianp/2014PrescribingOutlook-NewMedicines2014-FINAL.pdf.
  23. 23.
    Whiting P, Al M, Burgers L, Westwood M, Ryder S, Hoogendoorn M, et al. Ivacaftor for the treatment of patients with cystic fibrosis and the G551D mutation: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2014;18(18):1–106.CrossRefGoogle Scholar
  24. 24.
    Tommelein E, Mehuys E, Van Hees T, Adriaens E, Van Bortel L, Christiaens T, et al. Effectiveness of pharmaceutical care for patients with chronic obstructive pulmonary disease (PHARMACOP): a randomized controlled trial. Br J Clin Pharmacol. 2014;77(5):756–66.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kjeldsen LJ, Bjerrum L, Dam P, Larsen BO, Rossing C, Søndergaard B, et al. Safe and effective use of medicines for patients with type 2 diabetes—a randomized controlled trial of two interventions delivered by local pharmacies. Res Social Adm Pharm. 2015;11(1):47–62.CrossRefPubMedGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Karen Mooney
    • 1
    • 2
    • 4
  • Cristín Ryan
    • 3
  • Damian G. Downey
    • 1
  1. 1.Centre for Infection and ImmunityQueen’s University BelfastBelfastUK
  2. 2.Northern Ireland Adult Cystic Fibrosis Centre, Belfast City HospitalBelfast Health and Social Care TrustBelfastUK
  3. 3.School of PharmacyRoyal College of Surgeons in IrelandDublin, D2Ireland, UK
  4. 4.CF and Airways Microbiology Research GroupQueen’s University BelfastBelfastUK

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