Adherence program improves health of elderly


Pharmacists at one of the nation's largest military medical centers found that elderly patients are likelier to comply with drug regimens following a program of patient education, pharmacy counseling, and specially packaged drug blisterpacks. Jeannie Lee, Pharm.D., and Karen Grace, Pharm.D., clinical pharmacists at the Walter Reed Army Medical Center, led the research. "The Federal Study of Adherence to Medications in the Elderly" (FAME) was published in the Dec. 6 issue of the Journal of the American Medical Association.

"Most elderly patients have multiple diseases, some of which are asymptomatic, such as high blood pressure," said principal investigator Lee, in a statement. "They also often have complex medication regimens. They might stop taking medications because they don't feel any different or cannot remember what the medications are for or when to take them. Resulting health problems can lead to emergency department visits, hospitalizations, and increased healthcare costs."

The research, funded by the American Society of Health-System Pharmacists Research & Education Foundation, followed 200 elderly patients aged 65 or older who were seen at either Walter Reed Army Medical Center or the geriatric pharmacy clinic in the Armed Forces Retirement Home in Washington, D.C. Patients took a mean of nine different chronic daily medications.

During the first six months of the study, patients saw a pharmacist every two months for disease education and medication counseling. Patients were also provided with customized medication blisterpacks that organized their drugs according to their individual needs.

What researchers discovered surprised them and their patients: The medication adherence rate soared to 96.9% during the first six months of the study. Before participation in the program, patients' rate of medication adherence was 61.2%.

"We were surprised by the greatly increased adherence rate," said Lee. "We customized blisterpacks according to each patient's medication regimen-some patients had as many as 19 medications. They just had no idea what to take or when. We made medication charts for them and updated them each time their medications changed."

The researchers also reported encouraging results in patients' cardiovascular health outcomes. They found a reduction in hypertension as well as in LDL cholesterol. Systolic blood pressure went from 133.2 to 129.9 mmHg (diastolic pressure was not significantly affected). Among patients with drug-treated cholesterol, LDL cholesterol declined from 91.7 to 86.8 mg/dL.

During the second six months of the study, patients were randomized to continue the program or return to their usual medication routine. Rates improved dramatically for patients randomized to continue in the program-a 95.5% rate of medication adherence. The drug compliance rate dropped to 69.1% for patients who returned to their usual care.

"We learned that elderly patients have to stay in a pharmacy care program long-term in order to reach a successful medication persistence," explained Lee.

Lee hopes to use the program results in developing a clinic for patients at high risk for nonadherence, especially elderly patients. "It's important to be able to provide medications to patients, but we also need a system that helps them actually take those medications and take them correctly. There is such a lack of education, and pharmacists can play a key role in this problem. We are the ones who can help with this."

THE AUTHOR is a pharmacy writer based in Brooklyn, N.Y.

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