Effectiveness of involving pharmacists in the process of ambulatory health care to improve drug treatment adherence and disease control

Rationale, aims and objectives: To evaluate the effectiveness of incorporating the pharmacist into the ambulatory health care team to increase the proportion of patients with type 2 diabetes mellitus (T2DM) and/or hypertension who adhere to their drug regimen and to improve disease control.

Methods: A non-randomized clinical trial was carried out in patients with T2DM and/or hypertension from two primary care clinics. Patients from one of the clinics comprised the intervention group (IG) who received 'counselling' from the pharmacist. The control group (CG) was comprised of patients who attended another clinic and received the usual care. Adherence was measured by counting pills; hypertension control was evaluated by blood pressure and diabetes control by blood glucose. Statistical analysis was carried out by intention to treat using generalized linear models.

Results: There were 440 patients included. There was no difference in the proportion of IG and CG patients who adhered to treatment according to baseline measurements. An increase in the proportion of adherence at baseline and final determination was observed in both groups (IG 71-80%, P=0.006 and CG 72-87%, P=0.000). Generalized linear models showed a 55% or higher probability of IG patients achieving control of hypertension in comparison with the CG. Patients from the IG with T2DM have 13% more possibility of achieving glycaemic control than those of the CG.

Conclusion: Counselling offered by the pharmacist proved to be effective for improving drug adherence of diabetic and hypertensive patients in ambulatory health care.