Identification of psychosocial factors which influence patient adherence with antihypertensive medication

□ It is estimated that only 50 per cent of hypertensive patients adhere to medication regimens □ In this study evaluation of self‐efficacy and the theory of planned behaviour was used to identify psychosocial factors which impact on patient adherence to antihypertensives □ High self‐efficacy, intentions to comply with the medication regimen, possessing a positive attitude towards taking medication, perceiving pressure from significant others to take medication as prescribed, and perceiving control over taking medication were determinants of good adherence □ The successful identification of factors which influence adherence will allow health‐care providers to implement interventions, aimed at enhancing adherence with antihypertensive medication.     

Headache experiences and medication use in primary care

□ A survey was used to examine headache experiences and medication use in an adult population sample □ Seventy per cent had experienced headaches in the previous three months □ Sixty per cent had taken medication for headache in the past three months □ Most headache sufferers self‐treated their headaches □ Only a few respondents had taken medication before headache pain started or had found their medication ineffective, but combination therapy was common.     

Preliminary investigation of the problems associated with supply of palliative care medicines in primary care

□ Fax‐back was a cost effective method for administration of a self‐completion questionnaire which produced a high (76 per cent) response rate □ Problems with supply of palliative care medicines were reported by 58.5 per cent of health authorities responding to the survey □ Supply of medicines out of hours was the most common problem reported (93 per cent), with stock levels held in pharmacies and problems with specialist medicines also causing problems in over 50 per cent of respondents □ Some health authorities reported that protocols for supply of palliative medicines, or the existence of designated community pharmacies for their provision, reduced the problems reported □ Further research into effectiveness of protocols and designated palliative care pharmacies is indicated, and our study has identified those health authorities where such research could be targeted     

The development and evaluation of an extended adherence support programme by community pharmacists for elderly patients at home

Objective —To devise, implement and evaluate a medication adherence support service by community pharmacists for elderly patients living at home and at risk of non‐adherence. Method — Six community pharmacists identified patients who were 65 years of age and older, prescribed four or more regular medicines and living alone. A random sample of patients was visited at home and assessed for adherence‐related problems using a structured interview. The pharmacist then drew up an action plan in conjunction with the patient and general practitioner (GP), and returned for a second home visit, where the revised regime was delivered and explained. A self‐reported adherence questionnaire was also administered. After two months an independent researcher visited the patients at home to assess progress. Setting — Six community pharmacies in the city of Leeds, UK, and patients' homes. Key findings — A total of 143 patients were recruited and 441 medicine‐related problems were identified. Of these, 241 (55 per cent) required the provision of information and advice, 106 (24 per cent) required consultation with the GP and 86 (20 per cent) required changes in the presentation of the medicines. The median number of regular prescribed medicines fell from six to five (P<0.001). Overall, there was a reduction in the number of patients with one or more problems from 94 per cent to 58 per cent (P<0.001). The proportion of patients who reported non‐adherence fell from 38 per cent to 14 per cent (P<0.001). Conclusion — This study shows that community pharmacists can target patients at risk of medication non‐adherence and, using a structured approach, identify problems and implement solutions. The pharmacy patient medication record is an underutilised tool for identifying patients with adherence problems. The software needs enhancing to enable pharmacists to maximise their use of these records in adherence support. An adherence support programme needs to take more account of intentional non‐adherence and should be closely linked with the rest of the primary health care team.     

A patient‐held medication record and a patient medication profile to support the continuity of acute cancer care

□ The sharing of care of patients receiving medical oncology care is vulnerable to errors in their documented drug history □ A patient‐held medication record identified over 90 per cent of patients' medications but was ‘forgotten’ by the patient in a third of contacts with a pharmacist □ Discrepancies between the medication records of GPs, community pharmacists and the medical oncology clinic were highly prevalent □ A posted patient medication profile issued by the hospital pharmacist to both the patient's GP and their community pharmacist was associated with a significant convergence in their records (discrepancies reduced from 17 to 6 % P<0.001) □ The patient‐held record had little impact on the accuracy of practitioners' records and its value lies more in facilitating patient education than rectifying errors in documentation     

Extended adherence support by community pharmacists for patients with hypertension: a randomised controlled trial

Objective — To determine the effects of a patient‐centred intervention by community pharmacists on adherence to treatment for hypertension. Study design — Randomised controlled trial. Method — Randomisation was at pharmacy level. Pharmacists in the intervention group used a structured, brief questioning protocol to identify patients' medication‐related problems and their information needs relating to hypertension and its treatment. Advice, information and referral to the general practitioner (GP) were provided by the pharmacist, based on patients' responses. Pharmacists in the control group provided usual care. The intervention was delivered three times at approximately two‐month intervals. Blood pressure measurements were collected retrospectively from GP medical records. Patients completed feedback questionnaires at baseline and post‐study. The questionnaire comprised a self‐reported adherence measure and explored satisfaction with pharmaceutical services. Setting — Twenty community pharmacy sites (11 intervention and nine controls) in one health authority area in England. Outcome measures — Control of blood pressure; patient satisfaction with pharmaceutical services; self‐reported adherence. Results — In total, 180 patients (101 intervention and 79 control) from 43 general medical practices completed the trial. Patients whose blood pressure was uncontrolled prior to the study were more likely to become controlled in the intervention group (P<0.05). Most of the effect on self‐reported adherence was seen after the first intervention. Patient satisfaction was high prior to the study and was increased in the intervention group after the study. The increase was statistically significant for five items relating to communication between pharmacist and patient. Conclusion — A simple intervention delivered by community pharmacists produces positive effects on blood pressure control, self‐reported adherence and on patient satisfaction with pharmaceutical services.     

The influence of depression and perceived health competence on adherence in patients with heart disease

Depression is believed to be associated with non‐adherence with medical advice in a number of disease states Of the patients interviewed to date, 15.6 per cent were found to be non‐adherent with their medication, and 44.9 per cent were found to have scores indicative of depression, as determined by the Centre for Epidemiological Studies depression scale Analysis revealed a significant association between scores indicative of depression and non‐adherence with medication (P<0.05) It is likely that patients with heart disease would benefit from some form of treatment for depression, which may in turn, may improve adherence rates     

Factors related to medication adherence among homeless women and children

Objective The primary objective of this study was to examine factors related to medication adherence among homeless women and children. A secondary purpose was to describe the medication informational needs of homeless women. Method Fifty‐seven women at six different shelters for homeless women in Wake County, North Carolina were interviewed during the summer of 2001. Key findings Fifty‐eight per cent of women reported having at least one medical condition and 84% of the women had taken at least one medication during the past week. Twenty‐six per cent of women said that during the last week they had not taken a medication on purpose and 30% purposively cut back on a medication. A woman with a substance abuse problem was five times more likely to purposively not take a medication. Almost half of the women who had children living with them had a child that had taken medication during the past week. The primary reasons cited for not using medications as directed were access issues. Fifty‐eight per cent of the women wanted to learn more about their or their children's medications. The majority of women preferred to receive more verbal and written drug information. Conclusions Pharmacists need to work with local homeless shelters and the women in these shelters to help make sure that they receive needed medications and information for themselves and their children.     

Concordance in Muslim patients in primary care

□ The study examined the perceptions of Muslim patients and general practitioners (GPs) about ways in which the Muslim faith may influence medicine concordance □ Fifty Muslim patients (100 per cent response) and 18 general practitioners (53 per cent response) were surveyed using self‐completion questionnaires in order to determine attitudes towards dietary requirements and medicines □ A large proportion of the Muslim patients sampled stated that they would stop taking a medicine if they found out that it was not halaal □ Pharmaceutical manufacturers also need to be sensitive towards the requirements of Muslim patients □ In specific cases, doctors should seek guidance from Islamic leaders as to the correct interpretation of Islamic law with regard to the use of medicines considered haraam     

Haemodialysis patients' beliefs about treatment: implications for adherence to medication and fluid‐diet restrictions

Objectives — To assess haemodialysis patients' beliefs about treatment and to investigate which beliefs correlate with adherence to medication and fluid‐diet restrictions. Methods — Forty‐seven haemodialysis patients receiving intermittent hospital haemodialysis completed questionnaires assessing their beliefs about medication and fluid‐diet restrictions. Key findings — Adherence rates varied between and within patients, and were related to specific treatment beliefs in a logically consistent way. Reported intentional non‐adherence to medication correlated with concerns about the potential adverse effects of renal medication. Low adherence to fluid‐diet restrictions (assessed by inter‐dialysis weight gain) was associated with the personal belief that the restrictions were too strict. Most patients (90 per cent) agreed that medicines prescribed for their renal condition were necessary for maintaining health. However, 32 per cent harboured concerns about their medication, arising from beliefs about the potential for dependence, long‐term effects, or disruption of life. Concerns about renal medication correlated with more general beliefs that medicines as a whole are harmful, addictive poisons which are overused by doctors. Although specific treatment beliefs (medication or fluid‐diet restrictions) were related to specific adherence behaviours, these two areas of beliefs and behaviours were unrelated. Conclusions — Patients' perceptions of treatment merit further study. Eliciting and addressing patients' perceptions of treatment may be a target for pharmaceutical care and a foundation for partnership in medicine‐taking.     

Patient self‐eports of potential adverse drug reactions

□ A systematic questionnaire was found to be a feasible method of facilitating patients to report symptoms they perceived to be potential adverse effects of drugs □ Although 89 per cent of patients who had taken tramadol and venlafaxine reported at least one symptom in questionnaires, only 58 per cent of these claimed to have reported their symptoms to their doctor □ Only 22 per cent of symptoms reported by a sample of patients were found to be recorded in medical records and only 23 yellow card reports were submitted to the CSM for the same period □ Low reporting rates to GPs and low recording rates would appear to be contributory factors to low rates of reporting to the CSM.     

SIGN guidelines and the management of sore throat in community pharmacy

□ Scottish Intercollegiate Guidelines Network guidance on the management of sore throat recommends analgesia and refer to the role of the community pharmacist in advising symptomatic relief □ Advice given to 749 patients from 65 community pharmacies; 49 patients (6.5 per cent) were referred to their general practitioner □ Paracetamol, drug of choice from SIGN guideline, was recommended to 219 patients (29 per cent); a preparation for symptomatic relief either alone or in combination with an analgesic was advised for 590 patients (79 per cent) and of these, 315 patients (42 per cent) were recommended lozenges with anaesthetic and antibacterial action □ Compliance with SIGN guidelines was observed regarding choice of analgesic □ Evidence is required for choice of symptomatic relief.     

Effect of pharmaceutical pre‐assessment on post‐operative interventions

□ The study determined the extent of post‐operative interventions required for patients admitted for elective hip or knee arthroplasty □ In Phase 1, patients were pre‐assessed by nurses at admission, according to existing practice; in Phase 2, patients received pharmacist‐led pre‐assessment □ There were 131 interventions (2.05 per patient) in Phase 1 compared with 40 (0.68 per patient) in Phase 2, a reduction of approximately 70 per cent □ This study demonstrates that pharmaceutical pre‐assessment substantially reduces the number of interventions made during patients' post‐operative stay.     

Cross‐sectional survey of medication used for headache in a general population

Objective To determine the level and types of medication used to treat headache in the general population and to compare this with current recommendations. Methods Cross‐sectional survey to an adult general population sample. A questionnaire gathered information on occurrence, characteristics of, and medication use for headaches in the previous three months. Setting Patients aged 18 years and over registered with five general practices in North Staffordshire, England. Key findings The response rate was 56%. Eighty‐five per cent of headache sufferers (60% of all questionnaire respondents) reported using medication for their headaches in the three months prior to the survey. Medication use was more likely to be reported by women, respondents aged 36 to 50 years, those reporting more painful and more disabling headaches, those experiencing at least five associated symptoms, and those whose untreated headaches lasted 4 to 24 hours. Paracetamol was by far the most widely used medication, with 74% of medication users taking it in the three‐month period. Fifty‐eight per cent of acute medication users took only one single therapy for their headaches. Only a small number of medication users (3%) took their headache medication before the pain began, with most (63%) taking it when the pain started and the remainder waiting until the pain was unbearable. Half of medication users (47%) reported that the medication completely relieved their headache, 51% obtained partial relief and 2% did not obtain relief. Conclusion Medication use for headache appears to be appropriate for most patients. Although only a minority used combination therapy, the high prevalence of headache means that this translates to substantial numbers in the population as a whole. Some headache sufferers might benefit from advice to make better use of the treatments available.     

Patients' experience of hospital pharmaceutical services

Objective This study aimed to investigate inpatients' and outpatients' need for information about medication, to what extent those needs were addressed and patient attitudes regarding pharmaceutical services. Method Self‐administered questionnaires were distributed to a sample of outpatients and inpatients in a UK district general hospital. Themes included satisfaction with information given about medication, potential confusion over medication prescribed by the general practitioner and by the hospital, access to a member of the pharmacy team and preferences on how information on medication should be given. Key findings Ninety‐one outpatient and 126 inpatient questionnaires were available for analysis. All outpatients who responded acknowledged that they were told how long they might need to wait for their medicines to be dispensed, although approximately one‐fifth felt they had to wait a long time. Nearly three‐quarters of outpatients felt there was an opportunity to ask medication‐related questions of the pharmacy team. Nearly three‐quarters of inpatients reported they were encouraged to bring into any hospital any medication they were taking at home. Twenty‐eight per cent of 95 inpatients reported that some of their existing medication was stopped while in hospital. For the inpatients who received information about new medication, this was explained to the patient verbally (76%) and both verbally and in writing (22%). Forty‐two per cent of inpatients (and 36% of outpatients) expressed a preference to receive information about medication both verbally and in writing. Thirty‐five (32%) of 110 inpatients were not aware that a pharmacy team had a presence on the ward. Conclusions Overall the majority of both in‐ and outpatients appeared to be receiving appropriate pharmaceutical services. There is a need to raise the profile of the pharmacy team in regards to provision of medication advice for inpatients. Consideration needs to be given to better provision of written information about medication for patients.     

The use of sublingual glyceryl trinitrate and aspirin in angina patients and enhancement of coronary heart disease databases

□ Audit involving 95 per cent of community pharmacists in one LHCC □ Data were gathered using a semi‐structured questionnaire □ A list of all participating patients was sent to each GP surgery in the locality to enhance their CHD database □ Not all appropriate angina patients are receiving aspirin □ Patients' knowledge of GTN management was poor and should be improved upon by input from healthcare professionals     

The impact of hospital antimicrobial policy on the incidence of Clostridium difficile infection

□ An antibiotic policy specifically targeting high risk drugs for Clostridium difficile‐associated diarrhoea (CDAD) development was introduced in the study site hospital □ Despite an increased usage of antibiotics (calculated in defined daily doses) within the hospital, the policy led to a 19.7 per cent decreased incidence of CDAD □ Further improvements are predicted with improved adherence of hospital staff to the hospital antibiotic policy