REVIEW
Optimising medication adherence : health literacy and the role of the hospital pharmacist
This article describes the prevalence and implications of medication non-adherence . It focuses on the factors that can impact adherence and how awareness of these factors can help the hospital pharmacist to devise tailored strategies for use with their patients
Laura Sahm PhD Vice Dean School of Pharmacy ; Senior Lecturer in Clinical Pharmacy Practice , University College Cork , Ireland
Medication adherence can be defined as the extent to which patients are able to follow the recommendations for prescribed treatments . 1 There are many other terms including concordance , therapeutic alliance and medication compliance , the latter of which has fallen from favour . As healthcare professionals , pharmacists are generally pro-medication and convinced of the relative benefits of therapy versus the relative risks . A study published in the British Medical Journal examined the correlation between adverse outcomes in patients following myocardial infarction – association with statin adherence and lipid targets – and found that those with adherence < 50 % had an increased risk of not meeting lowdensity lipoprotein levels ≤1.8mmol / l ( adjusted odds ratio ( OR ) 2.03 , 95 % CI 1.78 – 2.31 , < 0.0001 ). The authors concluded that non-achievement of lipid and adherence targets were associated with increased risks of all-cause and cardiovascular disease mortality . 2 It is thought that non-adherence contributes to the premature deaths of 200,000 Europeans per year . 3 The financial cost of non-adherence is also substantial . In the UK , this was estimated to be of the order of £ 500 million annually . 4
The questions from patients : “ Will this medicine help me ?” and “ Will this medicine harm me ?” oddly have the same answer . This is “ Yes , but only if you take it ”, and this is the crux of the issue . We know as pharmacists that millions of Euros are spent on research and development of a new drug . It will go through all phases of clinical trials , and gathering safety , efficacy , and long-term data , and yet when this medicine is prescribed and dispensed , the final stage , that is , the administration , becomes the ultimate determinant of its therapeutic success .
Every medicine , including placebos , have side effects and as medicines experts , pharmacists are aware that the benefit : risk ratio is heavily weighted in favour of the former and that only an acceptable level of risk would result in successful registration by Regulatory bodies . The lay person ,
26 | Issue 100 | hospitalpharmacyeurope . com