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      Impact of pharmacist intervention on adherence and measurable patient outcomes among depressed patients: a randomised controlled study

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      BMC Psychiatry
      BioMed Central

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          Abstract

          Background

          Adherence to antidepressant treatment is essential for the effective management of patients with major depressive disorder. Adherence to medication is a dynamic decision-making process, and pharmacists play an important role in improving adherence to antidepressant treatment in different settings within the healthcare system. The aim of this study was to assess whether pharmacist interventions based on shared decision making improved adherence and patient-related outcomes.

          Methods

          This was a randomised controlled study with a 6-month follow-up. Participants were randomly allocated to two groups: 1) intervention group (IG) (usual pharmacy services plus pharmacist interventions based on shared decision making); or 2) control group (CG) (usual pharmacy services). Recruited patients fulfilled the following inclusion criteria: aged 18 to 60 years diagnosed with a major depressive disorder, and no history of psychosis or bipolar disorders. A research assistant blinded to the group allocations collected all data.

          Results

          Two hundred and thirty-nine patients met the inclusion criteria and were randomised to the IG ( n = 119) or CG ( n = 120). Nineteen patients dropped out of the study during the follow-up phase. After 6 months, patients in the IG had significantly more favorable medication adherence, treatment satisfaction, general overuse beliefs, and specific concern beliefs. However, the groups did not differ in severitye of depression or health-related quality of life after 6 months.

          Conclusions

          Our findings emphasise the important role of pharmacists in providing direct patient care in regular pharmacy practice to improve adherence to medications and other patient-reported outcomes.

          Trial registration

          ISRCTN34879893, Date assigned: 30/12/2014

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          Most cited references39

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          Concurrent and predictive validity of a self-reported measure of medication adherence.

          Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P less than 0.01).
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            Shared Treatment Decision Making Improves Adherence and Outcomes in Poorly Controlled Asthma

            American Journal of Respiratory and Critical Care Medicine, 181(6), 566-577
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              A literature review to explore the link between treatment satisfaction and adherence, compliance, and persistence

              Purpose To explore the published evidence on the link between treatment satisfaction and patients’ compliance, adherence, and/or persistence. Methods Articles published from January 2005 to November 2010 assessing compliance, adherence, or persistence and treatment satisfaction were identified through literature searches in Medline, Embase, and PsycInfo. Abstracts were reviewed by two independent researchers who selected articles for inclusion. The main attributes of each study examining the link between satisfaction and adherence, compliance, or persistence were summarized. Results The database searches yielded 1278 references. Of the 281 abstracts that met the inclusion criteria, 20 articles were retained. In the articles, adherence and compliance were often used interchangeably and various methods were used to measure these concepts. All showed a positive association between treatment satisfaction and adherence, compliance, or persistence. Sixteen studies demonstrated a statistically significant link between satisfaction and compliance or persistence. Of these, ten demonstrated a significant link between satisfaction and compliance, two showed a significant link between satisfaction and persistence, and eight demonstrated a link between either a related aspect or a component of satisfaction (eg, treatment convenience) or adherence (eg, intention to persist). An equal number of studies aimed at explaining compliance or persistence according to treatment satisfaction (n = 8) and treatment satisfaction explained by compliance or persistence (n = 8). Four studies only reported correlation coefficients, with no hypothesis about the direction of the link. The methods used to evaluate the link were varied: two studies reported the link using descriptive statistics, such as percentages, and 18 used statistical tests, such as Spearman’s correlation or logistic regressions. Conclusion This review identified few studies that evaluate the statistical association between satisfaction and adherence, compliance, or persistence. The available data suggested that greater treatment satisfaction was associated with better compliance and improved persistence, and with lower regimen complexity or treatment burden.
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                Author and article information

                Contributors
                khalafaljumaah@yahoo.com
                alamalpharmacy@yahoo.com
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                16 September 2015
                16 September 2015
                2015
                : 15
                : 219
                Affiliations
                [ ]Department of Pharmacy, Al-Amal Psychiatric Hospital, P.O. Box 33626, Riyadh, 11458 Saudi Arabia
                [ ]School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
                Article
                605
                10.1186/s12888-015-0605-8
                4574071
                26376830
                0449c600-21f1-4a86-a8e3-34291a044172
                © Aljumah and Hassali. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 5 October 2014
                : 10 September 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Clinical Psychology & Psychiatry
                Clinical Psychology & Psychiatry

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