Adherence is boosted by face-to-face contact, study finds

WOONSOCKET, R.I. — Pharmacists at a retail pharmacy are the most influential healthcare "voice" in getting patients to take their medications as prescribed, followed by nurses talking with patients as they are discharged from a hospital, according to research sponsored by CVS Caremark.

The research, based on a review of more than 40 years of studies published in medical journals, found that both in-store pharmacists and hospital-based nurses are more effective than pharmacists communicating to a patient via the telephone or doctors instructing patients regarding prescriptions. The study looked at in-person, electronic, telephonic, fax and mail communications.

These findings are contained in two separate reviews of medical journal studies sponsored by CVS Caremark and carried out by a team of researchers from Harvard University, Brigham and Women's Hospital and CVS Caremark.

This week, the American Journal of Managed Care published a review that focused on communications between pharmacists and nurses with their patients. The AJMC study built upon a review by the same researchers that focused on doctor and patient communications, which was published last May in the Journal of General Internal Medicine.

"There have been many studies on the subject of boosting adherence. We decided it was important to review the total body of work to determine which communication channel had the greatest impact," stated William Shrank of Brigham and Women's Hospital and Harvard, and a lead author of the studies. Shrank said the researchers combed through more than 6,500 medical journal articles published between 1966 and Dec. 31, 2008, before reviewing 168 articles in full.

The study found that programs using mail, fax and brochure-type (nonpersonal) communications had relatively low impact on promoting patient adherence. A review of the use of electronic communications, such as videos and interactive technology, showed promise but those communications were determined to have medium impact on increasing adherence among patients.

The highest impact programs featured work by pharmacists talking to patients in a store, followed by nurses talking face-to-face with patients who were leaving a hospital, the researchers concluded. Face-to-face discussions between pharmacists and patients in a store were twice as effective in boosting adherence rates as programs where pharmacists talked with patients on the telephone, the researchers found.

"These findings offer payers, healthcare providers and policy-makers guidance about how to develop programs that improve patient adherence," added Troyen Brennan, EVP and chief medical officer of CVS Caremark and an author of both reviews. "We know that pharmacists and nurses are among the most trusted healthcare professionals. This study shows that trust translates into effective patient communications."

The study is a product of CVS Caremark's previously announced three-year collaboration with Harvard University and Brigham and Women's Hospital to research pharmacy claims data to better understand patient behavior, particularly around medication adherence.