Medication adherence program: Adherence challenges and interventions in type 2 diabetes

Objectives: To describe medication adherence problems for adults with type 2 diabetes and to assess the nature and frequency of pharmacist activities in addressing them and proximate outcomes. Design: Pre-post analysis. Setting: Four community chain pharmacies located in Seattle, WA, from April 2008 to October 2009. Patients: 120 patients (mean age >60 years) with type 2 diabetes taking oral diabetes medications and who were 6 or more days late for refills. Intervention: Pharmacist telephone-initiated adherence support. Main outcomes measures: Nature and frequency of adherence-related problems and intervention activities and impact on reduction in refill gaps. Results: The primary adherence challenge was difficulty taking medications (27.1%). Failure to remember doses and forgetting refills were reported by 24.6% and 26.3% of patients at baseline, respectively. Pharmacists provided support through some form of patient education (35.6% of encounters) or other adherence support (40.7%). Pharmacist time averaged slightly greater than 5 minutes per intervention and 12.6 +/- 10.7 minutes (mean +/- SD) over 12 months, with 3.4 +/- 2.4 interventions per patient. Patient-specific education and adherence support by pharmacists and total intervention time were positively correlated, with a modest but significant reduction in refill gaps during 12 months of follow-up. Conclusion: Not remembering to refill medications was the most commonly reported problem. Patient encounters averaged 4 to 6 minutes for the first visit and 12 to 13 minutes over 12 months. Phone calls by pharmacists to adults who were late for oral diabetes medication refills were effective in identifying adherence-related problems and developing support strategies to promote medication self-management in busy urban community chain pharmacy settings.