TY  - JOUR
AU  - van Lieshout, Jan
AU  - Lacroix, Joyca
AU  - van Halteren, Aart
AU  - Teichert, Martina
PY  - 2022
DA  - 2022/4/7
TI  - Effectiveness of a Pharmacist-Led Web-Based Medication Adherence Tool With Patient-Centered Communication: Results of a Clustered Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e16141
VL  - 24
IS  - 4
KW  - medication adherence
KW  - improvement
KW  - intervention
KW  - web-based
KW  - tailored intervention
KW  - patient centered
KW  - barriers
KW  - primary care
KW  - cardiovascular diseases
KW  - diabetes
AB  - Background: Growing numbers of people use medication for chronic conditions; nonadherence is common, leading to poor disease control. A web-based tool to identify an increased risk for nonadherence with related potential individual barriers might facilitate tailored interventions and improve adherence. Objective: This study aims to assess the effectiveness of a newly developed tool aimed at improving medication adherence. Methods: We performed a cluster randomized controlled trial in patients initiating cardiovascular or oral blood glucose–lowering medication. Participants were recruited from community pharmacies. They completed an online questionnaire comprising assessments of their risk for medication nonadherence and subsequently of barriers to adherence. In pharmacies belonging to the intervention group, individual barriers displayed in a graphical profile on a tablet were discussed by pharmacists and patients with high nonadherence risk in face-to-face meetings and shared with their general practitioners and practice nurses. Tailored interventions were initiated by pharmacists. Barriers of control patients were not presented nor discussed and these patients received usual care. The primary outcome was the effectiveness of the intervention on medication adherence at 8 months’ follow-up between patients with an increased nonadherence risk from the intervention and control groups, calculated from dispensing data. Results: Data from 492 participants in 15 community pharmacies were available for analyses (intervention 253, 7 pharmacies; control 239, 8 pharmacies). The intervention had no effect on medication adherence (B=–0.01; 95% CI –0.59 to 0.57; P=.96), nor in the post hoc per-protocol analysis (B=0.19; 95% CI –0.50 to 0.89; P=.58). Conclusions: This study showed no effectiveness of a risk stratification and tailored intervention addressing personal barriers for medication adherence. Various potential explanations for lack of effectiveness were identified. These explanations relate, for instance, to high medication adherence in the control group, study power, and fidelity. Process evaluation should elicit possible improvements and inform the redesign of intervention and implementation. Trial Registration: The Netherlands National Trial Register NTR5186; https://tinyurl.com/5d8w99hk 
SN  - 1438-8871
UR  - https://www.jmir.org/2022/4/e16141
UR  - https://doi.org/10.2196/16141
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35389359
DO  - 10.2196/16141
ID  - info:doi/10.2196/16141
ER  -