Community pharmacist-led interventions to improve medication adherence in patients with cardiovascular disease: a systematic review of randomised controlled trials

Abstract

Objectives: Medication adherence in cardiovascular disease (CVD) is reported to be suboptimal. Therefore, an intervention to tackle non-adherence is important. Pharmacists' intervention may have the potential to enhance medication adherence, leading to improvements in clinical outcomes in patients with CVD. This study assesses the impact of a community pharmacist intervention on improving medication adherence and clinical outcomes in patients with CVD. This study also describes the characteristics and actual contents of the interventions.

Methods: Electronic databases (MEDLINE (Ovid), PsycINFO (Ovid), Cochrane library and PubMed Central) were systematically searched for randomised controlled trials (RCTs), assessing the impact of community pharmacists' interventions on medication adherence in patients with CVD. Eligible RCTs were those published in English from database inception to April 2021. A narrative analysis was performed. The RCTs included were assessed using the Cochrane Risk of Bias. This review included eight RCTs. The majority included a multifaceted intervention with medication reviews and adherence counselling. Sample sizes varied from 225 to 1906, and intervention duration ranged from 2 to 12 months. Seven of the RCTs reported that interventions enhanced medication adherence. Five RCTs assessed the effect of the interventions on the clinical outcomes and reported a trend towards improvement in blood pressure and low-density lipoprotein cholesterol level in the intervention arm. Regarding the quality of evidence, most RCTs were classified as poor, due to the high risk of bias or insufficient reporting of information.

Summary: Community pharmacist-led interventions show improvements in medication adherence and clinical outcomes, but the content and delivery of the interventions vary. Future research should focus on identifying the most effective components that contribute to enhancing medication adherence and clinical outcomes for patients with CVD.