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.
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."