Telefonische startbegeleiding door apothekers verbetert de therapietrouw: een cluster-gerandomiseerd onderzoek

Abstract

OBJECTIVE To assess the effect of a pharmacist telephone counselling intervention on patients’ medication adherence. DESIGN AND METHODS A pragmatic cluster randomized controlled trial was performed in 53 community pharmacies in The Netherlands. Participants included were patients ≥ 18 years initiating treatment with antidepressants, bisphosphonates, renin-angiotensin system (RAS) inhibitors or statins (lipid lowering drugs). Pharmacies in arm A provided the intervention for antidepressants and bisphosphonates and usual care for RAS inhibitors and statins. Pharmacies in arm B provided the intervention for RAS inhibitors and statins and usual care for antidepressants and bisphosphonates. Intervention consisted of a telephone counselling intervention 7-21 days after the start of therapy. Counselling included assessment of practical and perceptual barriers and provision of information and motivation. Primary outcome was refill adherence measured over 1 year expressed as continuous and dichotomous outcomes (refill rate ≥ 80%). Secondary outcome was discontinuation within one year. RESULTS In the control arms 3627 patients were eligible and in the intervention arms 3094 patients. Of the latter, 1054 patients (34%) received the intervention. Intention to treat analysis showed no difference in adherence rates between the intervention and the usual care arm (74.7%; standard deviation 37.5 respectively 74.5% and 37.9). More patients starting with RAS inhibitors had a refill ratio ≥ 80% in the intervention arm compared to usual care (81.4% versus 74.9% with odds ratio 1.43; 95% confidence interval 1.11-1.99). Comparing patients with counselling to patients with usual care (per protocol analysis), adherence was statistically significant higher for patients starting with RAS inhibitors, statins and bisphosphonates. Patients initiating antidepressants did not benefit from the intervention. CONCLUSION Telephone counselling at start of therapy improved adherence in patients initiating RAS inhibitors. The per protocol analysis indicated an improvement for lipid lowering drugs and bisphosphonates. No effect on adherence in patients initiating antidepressants was found.