The area where pharmacists’ interventions have proven to be most effective in relation to older people’s care is adherence to medication.
Failure to adhere to medication among older people is a widespread and costly problem. Evidence shows that 65% of people who are 60 and more years of age have two or more chronic conditions, but also that frequent adherence rates in this age group are 60% or less. In addition, up to 50% of cardiovascular disease admissions may be due to poor adherence. This suggests that, although an intensive pharmacist-led approach could imply a higher cost, the end result when solving the problem of adherence will be a total lower healthcare cost.
Older patients are subject to specific risk factors for non-adherence. Because they often suffer from more than one chronic condition and have a higher prevalence of certain diseases such as Alzheimer, Parkinson, glaucoma, osteoarthritis, and congestive heart failure they tend to take more medicines than their younger counterparts. Moreover, older patients are more likely to face problems of memory and of understanding regimens and instructions. Finally, problems with visual acuity (e.g., reading the information leaflet or the mode of use on the label) and dexterity (e.g., opening the vial of a bottle or pushing a pill out of a blister) may hinder their ability to take their medication properly.
Furthermore, older patients are very sensitive to adverse effects of psychotropic medicines, e.g. cardiac toxicity, confusion and unwanted sedation.
European Innovation Partnership on Active and Healthy AgeingThe European Commission has identified active and healthy ageing as a major societal challenge common to all European countries, and an area which presents considerable potential for Europe to lead the world in providing innovative responses to this challenge. The Partnership brings together key stakeholders (end users, public authorities, industry); all actors in the innovation cycle, from research to adoption (adaptation), along with those engaged in standardisation and regulation. The pilot partnership provides these actors with a forum in which they can cooperate, united around a common vision that values older people and their contribution to society, identify and overcome potential innovations barriers and mobilise instruments.
One of the key action areas addressed by the partnership is adherence to prescribed medication. At a community pharmacy level several initiatives and actions aimed to improve medication adherence and achieve optimal patient outcomes were identified. They range from less to more systematic approaches, some of them already recognised by national governments and made part of national strategies to improve patient outcomes and lead to health cost savings. Spanish General Council of Pharmacists in collaboration with other stakeholders have developed a pilot action called 'Adhierete' which was included in the Partnership.
ADHIÉRETE is a research program to evaluate the impact of new technologies in the improvement of adherence to treatment in polymedicated and non-complying elderly patients with chronic disease, increasing the healthcare systems sustainability through community pharmacy initiatives. The project assesses the value offered by several supporting tools including ICT tools and Personalised Dosage Systems (PDS) in improving adherence. The project also assesses the impact of electronic prescriptions on improving adherence in terms of efficiency and effectiveness.
Out of the five patients (per pharmacy) included in the study, two will receive the Personalised Dosage Systems (PDS) service, two will receive telepharmacy services and one patient will receive PDS combined with a remote alert system. Data will be collected in an electronic Data Collection Notebook and the information recorded will be periodically reviewed by the study monitor.
A web based platform will be also used to allow medication management and monitoring which sends notifications, reminders and ad hoc messages to the patient from the pharmacist. The application will allow the patient or caregiver, via a cell phone application to be alerted of any non-
compliance with medication regimens, registering such incidences, thus offering a greater control of adherence, and an increase in communication between the pharmacist and the patient’s home.
Results obtained from a pilot study conducted between 2009 and 2010 in pharmacies in Azuaga (Badajoz) show that after pharmacists’ intervention, patient adherence improved from 41.2% to 70.6%.
More information on http://www.portalfarma.com/profesionales/investigacionfarmacia/adhierete/Paginas/Programa-Adhierete.aspx