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August 29, 2016Frontiers in PharmacologyOpen Access

Effects of Telephone Counseling Intervention by Pharmacists (TelCIP) on Medication Adherence; Results of a Cluster Randomized Trial

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Key result

A pharmacist telephone counseling intervention provided 7 to 21 days after therapy initiation did not significantly improve overall 1-year medication adherence compared to usual care.

Why the study?

Does a pharmacist telephone counseling intervention shortly after treatment initiation improve medication adherence in patients starting new therapies?

Population

6,731 adults initiating treatment with antidepressants, bisphosphonates, Renin-Angiotensin…

Comparison

Telephone counseling intervention by a… vs Usual care, consisting of written and oral…

Design

RCT, Pharmacies were randomized in two arms in a 1:1 ratio., Effect analyses…

Follow-up

1 year

Authors

MKMarcel J. KooijEHEibert R. HeerdinkLDLiset van Dijk

Discussion

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Member takes

Overview

Does not support routine pharmacist telephone counseling 7-21 days post-initiation; challenges this timed approach for adherence improvement.

Study Design

Type

RCT (n=6,731)

Blinding

Single-blind

Randomization

Cluster randomized

Multicenter

Yes

Structured PICO

Does a pharmacist telephone counseling intervention shortly after treatment initiation improve medication adherence in patients starting new therapies?

P
Population
6,731 adults initiating treatment with antidepressants, bisphosphonates, RAS-inhibitors, or statins across 53 community pharmacies, followed for 1 year.
I
Intervention
Telephone counseling intervention by a pharmacist or pharmacy practitioner 7-21 days after the start of therapy, supported by a pre-tested interview protocol addressing information needs, actual intake behavior, practical barriers (including side effects), and perceptual barriers.
C
Comparator
Usual care, consisting of written and oral information at the start of pharmacotherapy and inquiry about experiences at the first refill.
O
Outcome
Refill adherence measured over 1 year, expressed as a continuous outcome (modified Medication Possession Ratio, MPRm) and dichotomous outcome (refill rate ≥80%).

Main Result

Odds Ratio: 0.92 (95% CI 0.68–1.27)

Absolute Event Rate: 69% vs 69.9%

A pharmacist-led telephone counseling intervention shortly after initiating therapy improved adherence to RAS-inhibitors, though intention-to-treat analysis showed no significant improvement across all medication classes combined due to low intervention delivery rates.

Limitations

  • Only 34% of eligible patients in the intervention arm actually received the telephone counseling.
  • High baseline adherence rates in both arms may have caused a ceiling effect.
  • Lack of verified clinical diagnoses for prescribed medications (e.g., antidepressants).
  • Potential selection bias or failure by pharmacists to register all calls.
  • Implementation issues including software selection failures, staffing problems, and failure to register calls.
  • Lack of verified clinical diagnosis for the prescribed medications (e.g., antidepressants).

Cite This Study

Kooij et al. (2016) conducted an RCT in Initiation of antidepressants, bisphosphonates, RAS-inhibitors, or statins (n=6,731). Telephone Counseling Intervention by Pharmacists (TelCIP) vs. Usual care was evaluated on Proportion of patients with refill adherence (MPRm ≥ 80%) over 1 year (OR 0.92, 95% CI 0.68-1.27). A pharmacist telephone counseling intervention provided 7 to 21 days after therapy initiation did not significantly improve overall 1-year medication adherence compared to usual care.

synapsesocial.com/papers/6a6f2dbca528af2d65c2ddb3https://doi.org/10.3389/fphar.2016.00269
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Also Consider

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