Lyons, I; (2015) The Medicines Advice Service Evaluation (MASE): a mixed methods randomised controlled trial of an intervention to improve medication adherence in a mail-order pharmacy population. Doctoral thesis , UCL (University College London).

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Abstract

Non-adherence to medicines for long-term conditions is a complex and prevalent phenomenon, with significant clinical and economic consequences for patients and health providers worldwide. Simple effective solutions have eluded researchers over many decades. A mixed methods randomised controlled trial was conducted to test the effectiveness of a pharmacist-led intervention to improve adherence, in the context of mail-order pharmacy. 677 patients prescribed at least one oral medication for type 2 diabetes and/or lipid regulation were recruited from a UK pharmacy, and randomised (340 interventions, 337 controls). The intervention was patient-centred, comprising spoken information and advice by phone, and written information by post, delivered by a pharmacist. All elements of the intervention were tailored to the individuals’ needs. The primary outcome was self-reported adherence to medication at six-month follow up. Secondary outcomes included prescription refill adherence, lipid and glycaemic control, and patient satisfaction. Patients who received the intervention had 54% increased odds of being adherent (defined as ≥90% of medication taken in the past 7 days), compared to the control group (OR 1.54, 95%CI 1.11-2.15, p=0.01). Analyses of dispensing data also showed that the odds of being classified as adherent (≥90%) were 60% greater for the intervention group compared to the control group (OR 1.60, 95%CI 1.14-2.24, p<0.01). For patients who provided a blood sample at six-month follow up, 67% vs 31% (16 interventions, 5 controls, p=0.06) and 65% vs 55% (64 interventions, 38 controls, p=0.24) achieved guideline targets for glycaemic and lipid control, respectively. Satisfaction with the Medicines Advice Service was high, with 91.8% (n=245) agreeing that they were satisfied overall. Intervention, led by a pharmacist and tailored to the individuals’ needs, can significantly improve medication adherence in patients with long-term conditions. The findings provide further support for the enhanced role of pharmacists in supporting and advising patients, and improving outcomes.

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