A framework for pharmacist-assisted medication adherence in hard-to-reach patients

Abstract

Background: Medication adherence rates are notably lower in hard-to-reach populations than in the general population. Pharmacists are uniquely qualified to address barriers to improve adherence. A number of pharmacist-led interventions have lacked theoretical underpinnings and thus have limited generalizability across disease states and care settings.

Objective: This study aims to create a model for use in patient-centered, pharmacist-led interactions to improve medication adherence.

Methods: The Health Action Process Approach (HAPA), a behavioral change framework, was adapted to known barriers of medication adherence. Semi-structured interviews were conducted with patients from the target population. Thematic analysis was performed after two weeks. Each subsequent interview was analyzed for additional themes.

Main findings: Themes from the interviews fit into the following domains: outcomes expectancies, risk awareness, goals and motivations, planning, and follow through. The framework was then adapted to include thematic data.

Conclusions: The newly developed framework provides a patient centered approach to facilitate and improve pharmacist-patient conversations regarding medication adherence. Its basis in a theoretical model allows for potential application across multiple care settings and multiple medications, regardless of disease state.

Keywords: Hard-to-reach; Medication adherence; Pharmacist.