Evaluation of a community pharmacy-based intervention for improving patient adherence to antihypertensives : a randomized controlled trial

Lau, Rosalind, Stewart, Kay, McNamara, Kevin, Jackson, Shane, Hughes, Jeffery, Peterson, Gregory, Bortoletto, Diana, McDowell, Jenny, Bailey, Michael, Hsueh, Arthur and George, Johnson 2010, Evaluation of a community pharmacy-based intervention for improving patient adherence to antihypertensives : a randomized controlled trial, BMC health services research, vol. 10, no. 34, pp. 1-7.

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Title Evaluation of a community pharmacy-based intervention for improving patient adherence to antihypertensives : a randomized controlled trial
Author(s) Lau, Rosalind
Stewart, Kay
McNamara, Kevin
Jackson, Shane
Hughes, Jeffery
Peterson, Gregory
Bortoletto, Diana
McDowell, Jenny
Bailey, Michael
Hsueh, Arthur
George, Johnson
Journal name BMC health services research
Volume number 10
Issue number 34
Start page 1
End page 7
Publisher BioMed Central
Place of publication London, England
Publication date 2010
ISSN 1472-6963
Summary Background
The majority of patients using antihypertensive medications fail to achieve their recommended target blood pressure. Poor daily adherence with medication regimens and a lack of persistence with medication use are two of the major reasons for failure to reach target blood pressure. There is no single intervention to improve adherence with antihypertensives that is consistently effective. Community pharmacists are in an ideal position to promote adherence to chronic medications. This study aims to test a specific intervention package that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications - Hypertension Adherence Program in Pharmacy (HAPPY).

Methods/Design
The HAPPY trial is a multi-centre prospective randomised controlled trial. Fifty-six pharmacies have been recruited from three Australian states. To identify potential patients, a software application (MedeMine CVD) extracted data from a community pharmacy dispensing software system (FRED Dispense®). The pharmacies have been randomised to either 'Pharmacist Care Group' (PCG) or 'Usual Care Group' (UCG). To check for 'Hawthorne effect' in the UCG, a third group of patients 'Hidden Control Group' (HCG) will be identified in the UCG pharmacies, which will be made known to the pharmacists at the end of six months. Each study group requires 182 patients. Data will be collected at baseline, three and six months in the PCG and at baseline and six months in the UCG. Changes in patient adherence and persistence at the end of six months will be measured using the self-reported Morisky score, the Tool for Adherence Behaviour Screening and medication refill data.

Discussion

To our knowledge, this is the first research testing a comprehensive package of evidence-based interventions that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications. The unique features of the HAPPY trial include the use of MedeMine CVD to identify patients who could potentially benefit from the service, control for the 'Hawthorne effect' in the UCG and the offer of the intervention package at the end of six months to patients in the UCG, a strategy that is expected to improve retention.

Trial Registration

Australian New Zealand Clinical Trial Registry ACTRN12609000705280
Language eng
Field of Research 111799 Public Health and Health Services not elsewhere classified
Socio Economic Objective 920412 Preventive Medicine
HERDC Research category C1.1 Refereed article in a scholarly journal
HERDC collection year 2010
Copyright notice ©2010, Lau et al.
Persistent URL http://hdl.handle.net/10536/DRO/DU:30029364

Document type: Journal Article
Collection: Faculty of Health
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Created: Tue, 29 Jun 2010, 12:14:53 EST by Liz Jackway

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