Community Pharmacy, Disease State Management, and Adherence to Medication: A Review

Community pharmacists are well trained healthcare professionals who are able and willing to implement extended medication services. In the past decade, a plethora of pharmaceutical care and pharmacy-based disease management programs have been developed and trialed for delivery in primary care settings. Since suboptimal medication adherence is a feature of chronic illness, it is important to review the success of disease management interventions targeting adherence. This review focuses on the programs that were developed for asthma, diabetes mellitus, and cardiovascular disease in community pharmacies and that either targeted medication adherence or reported it as an outcome. Studies of community pharmacy-based disease management programs targeting adherence in patients with asthma, diabetes mellitus, and cardiovascular disease have demonstrated positive effects on clinical outcomes other than adherence. A variety of adherence-measuring methods were used in these studies, ranging from patient self-report and qualitative descriptions to electronic recording. In most cases, strategies to improve adherence were part of a complex intervention, and a direct link between the intervention and adherence improvement could not be demonstrated. At this stage, it is not known what type of intervention results in the greatest impact and most sustained improvement in medication adherence. Future studies should provide evidence for the impact of adherence on not only clinical and patient-centered outcomes, but also economic outcomes. Evidence for the sustainability of the outcomes should be a priority for future research. DOI: 10.2165/0115677-200816040-00005