The pharmacist role in predicting and improving medication adherence in heart failure patients

Estella M. Davis, Kathleen A. Packard, Cynthia A. Jackevicius

Research output: Contribution to journalReview article

17 Citations (Scopus)

Abstract

Background: Heart failure is one of the most common reasons for hospital admissions in patients aged 65 years and older, with an estimated 1 million hospitalizations annually. In 2010, health care expenditures for heart failure were estimated to be $32 billion. Nonadherence to medications and lifestyle contributes to hospital admissions in up to one-third of patients. Efforts to reduce readmissions are of critical importance. Pharmacist involvement in the management of heart failure patients has been shown to reduce heart failure hospitalizations, with trends towards a reduction in mortality. Literature is scarce on instruments that clinicians can use to identify patients at risk for medication nonadherence. Objectives: To (a) describe factors that predict medication adherence for patients with heart failure, (b) evaluate the impact and value of pharmacist interventions on adherence and outcomes, and (c) assess tools to predict medication nonadherence in heart failure patients. Methods: From inception to September 2013, a search was conducted in the databases MEDLINE, PubMed, CINAHL, and The Cochrane Library to identify relevant studies for 3 separate searches, identifying predictors of medication adherence in heart failure patients, pharmacist involvement to impact medication adherence, and tools to predict medication nonadherence in this population. Results: Many significant predictors of both medication adherence and nonadherence have been identified in heart failure patients. Studies evaluating the effect of pharmacist involvement in the management of heart failure demonstrated improvements in medication adherence that dissipated once the intervention was withdrawn. The Morisky Medication Adherence Scale and the Merck Adherence Estimator are simple and practical tools that may be useful for identifying nonadherence in heart failure patients. Conclusions: Clinicians should be cognizant of factors that may affect medication adherence in heart failure patients and be aware of instruments available to predict the risk for medication nonadherence. Pharmacist interventions should be part of a multidisciplinary system of care initiated at discharge that involve personal contact and are continued indefinitely in order to sustain these benefits.

Original languageEnglish
Pages (from-to)741-755
Number of pages15
JournalJournal of Managed Care Pharmacy
Volume20
Issue number7
StatePublished - 2014

Fingerprint

Medication Adherence
Pharmacists
Heart Failure
Hospitalization
Health care
Patient Admission
Health Expenditures
PubMed
MEDLINE
Libraries
Life Style

All Science Journal Classification (ASJC) codes

  • Pharmaceutical Science
  • Health Policy
  • Pharmacy
  • Medicine(all)

Cite this

The pharmacist role in predicting and improving medication adherence in heart failure patients. / Davis, Estella M.; Packard, Kathleen A.; Jackevicius, Cynthia A.

In: Journal of Managed Care Pharmacy, Vol. 20, No. 7, 2014, p. 741-755.

Research output: Contribution to journalReview article

@article{e6a16161a560498aae4716fe77f0cbb2,
title = "The pharmacist role in predicting and improving medication adherence in heart failure patients",
abstract = "Background: Heart failure is one of the most common reasons for hospital admissions in patients aged 65 years and older, with an estimated 1 million hospitalizations annually. In 2010, health care expenditures for heart failure were estimated to be $32 billion. Nonadherence to medications and lifestyle contributes to hospital admissions in up to one-third of patients. Efforts to reduce readmissions are of critical importance. Pharmacist involvement in the management of heart failure patients has been shown to reduce heart failure hospitalizations, with trends towards a reduction in mortality. Literature is scarce on instruments that clinicians can use to identify patients at risk for medication nonadherence. Objectives: To (a) describe factors that predict medication adherence for patients with heart failure, (b) evaluate the impact and value of pharmacist interventions on adherence and outcomes, and (c) assess tools to predict medication nonadherence in heart failure patients. Methods: From inception to September 2013, a search was conducted in the databases MEDLINE, PubMed, CINAHL, and The Cochrane Library to identify relevant studies for 3 separate searches, identifying predictors of medication adherence in heart failure patients, pharmacist involvement to impact medication adherence, and tools to predict medication nonadherence in this population. Results: Many significant predictors of both medication adherence and nonadherence have been identified in heart failure patients. Studies evaluating the effect of pharmacist involvement in the management of heart failure demonstrated improvements in medication adherence that dissipated once the intervention was withdrawn. The Morisky Medication Adherence Scale and the Merck Adherence Estimator are simple and practical tools that may be useful for identifying nonadherence in heart failure patients. Conclusions: Clinicians should be cognizant of factors that may affect medication adherence in heart failure patients and be aware of instruments available to predict the risk for medication nonadherence. Pharmacist interventions should be part of a multidisciplinary system of care initiated at discharge that involve personal contact and are continued indefinitely in order to sustain these benefits.",
author = "Davis, {Estella M.} and Packard, {Kathleen A.} and Jackevicius, {Cynthia A.}",
year = "2014",
language = "English",
volume = "20",
pages = "741--755",
journal = "Journal of managed care & specialty pharmacy",
issn = "2376-0540",
publisher = "Academy of Managed Care Pharmacy (AMCP)",
number = "7",

}

TY - JOUR

T1 - The pharmacist role in predicting and improving medication adherence in heart failure patients

AU - Davis, Estella M.

AU - Packard, Kathleen A.

AU - Jackevicius, Cynthia A.

PY - 2014

Y1 - 2014

N2 - Background: Heart failure is one of the most common reasons for hospital admissions in patients aged 65 years and older, with an estimated 1 million hospitalizations annually. In 2010, health care expenditures for heart failure were estimated to be $32 billion. Nonadherence to medications and lifestyle contributes to hospital admissions in up to one-third of patients. Efforts to reduce readmissions are of critical importance. Pharmacist involvement in the management of heart failure patients has been shown to reduce heart failure hospitalizations, with trends towards a reduction in mortality. Literature is scarce on instruments that clinicians can use to identify patients at risk for medication nonadherence. Objectives: To (a) describe factors that predict medication adherence for patients with heart failure, (b) evaluate the impact and value of pharmacist interventions on adherence and outcomes, and (c) assess tools to predict medication nonadherence in heart failure patients. Methods: From inception to September 2013, a search was conducted in the databases MEDLINE, PubMed, CINAHL, and The Cochrane Library to identify relevant studies for 3 separate searches, identifying predictors of medication adherence in heart failure patients, pharmacist involvement to impact medication adherence, and tools to predict medication nonadherence in this population. Results: Many significant predictors of both medication adherence and nonadherence have been identified in heart failure patients. Studies evaluating the effect of pharmacist involvement in the management of heart failure demonstrated improvements in medication adherence that dissipated once the intervention was withdrawn. The Morisky Medication Adherence Scale and the Merck Adherence Estimator are simple and practical tools that may be useful for identifying nonadherence in heart failure patients. Conclusions: Clinicians should be cognizant of factors that may affect medication adherence in heart failure patients and be aware of instruments available to predict the risk for medication nonadherence. Pharmacist interventions should be part of a multidisciplinary system of care initiated at discharge that involve personal contact and are continued indefinitely in order to sustain these benefits.

AB - Background: Heart failure is one of the most common reasons for hospital admissions in patients aged 65 years and older, with an estimated 1 million hospitalizations annually. In 2010, health care expenditures for heart failure were estimated to be $32 billion. Nonadherence to medications and lifestyle contributes to hospital admissions in up to one-third of patients. Efforts to reduce readmissions are of critical importance. Pharmacist involvement in the management of heart failure patients has been shown to reduce heart failure hospitalizations, with trends towards a reduction in mortality. Literature is scarce on instruments that clinicians can use to identify patients at risk for medication nonadherence. Objectives: To (a) describe factors that predict medication adherence for patients with heart failure, (b) evaluate the impact and value of pharmacist interventions on adherence and outcomes, and (c) assess tools to predict medication nonadherence in heart failure patients. Methods: From inception to September 2013, a search was conducted in the databases MEDLINE, PubMed, CINAHL, and The Cochrane Library to identify relevant studies for 3 separate searches, identifying predictors of medication adherence in heart failure patients, pharmacist involvement to impact medication adherence, and tools to predict medication nonadherence in this population. Results: Many significant predictors of both medication adherence and nonadherence have been identified in heart failure patients. Studies evaluating the effect of pharmacist involvement in the management of heart failure demonstrated improvements in medication adherence that dissipated once the intervention was withdrawn. The Morisky Medication Adherence Scale and the Merck Adherence Estimator are simple and practical tools that may be useful for identifying nonadherence in heart failure patients. Conclusions: Clinicians should be cognizant of factors that may affect medication adherence in heart failure patients and be aware of instruments available to predict the risk for medication nonadherence. Pharmacist interventions should be part of a multidisciplinary system of care initiated at discharge that involve personal contact and are continued indefinitely in order to sustain these benefits.

UR - http://www.scopus.com/inward/record.url?scp=84903216599&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84903216599&partnerID=8YFLogxK

M3 - Review article

VL - 20

SP - 741

EP - 755

JO - Journal of managed care & specialty pharmacy

JF - Journal of managed care & specialty pharmacy

SN - 2376-0540

IS - 7

ER -