Pre-packaged daily medications raises adherence and persistence in elderly patients

A 36% increase in adherence to taking all daily medications was found in a multiphase, prospective study that assessed the effect of providing elderly patients their medications in customized blister packs, along with education from the pharmacist. The results of the Federal study of Adherence to Medications in the Elderly were presented at the Scientific Sessions of the American Heart Association by Dr. Allen J. Taylor, chief of Cardiology, Walter Reed Army Medical Center, Washington, D.C., and published simultaneously online by the Journal of the American Medical Association.

Adherence improved from 61.2% at baseline to 96.9% at 6 months (p<0.001) in Phase I of the single center study that evaluated the change in the proportion of pills taken compared to baseline. Taylor stated, “That’s a previously unseen increase in the degree of medicine adherence.”

Phase II of FAME evaluated the between-group comparison of medication persistence and showed that in the patients who returned to usual care (receiving each medication individually) adherence decreased to 69.1%, while it was sustained at 95.5% in the pharmacy care intervention group (p<0.001). A significant reduction in systolic blood pressure of 6.9 mmHg was found in the pharmacy intervention group compared to a reduction of 1.0 mmHg in the usual care group at 14 months (p=0.04). No difference in LDL reduction, another secondary endpoint, was found.

A total of 200 patients over 65 years old (mean age 78 years, range 65 to 91)) were enrolled; 77.1% were men, 91.5% had hypertension and 80.6% had hyperlipidemia. The mean number of drugs taken by the patients was 9, considered average for the elderly.

During the 2-month run-in phase, baseline adherence, blood pressure, and LDL were measured. Phase I, months 2-8, was a 6-month intervention that comprised of standardized education by the pharmacist about why each drug is needed, regular follow-up by the pharmacist every 2 months, and a 1-month supply of customized pre-packaged medications in a blister pack, categorized by day of the month and time of day. In Phase II, months 8-14, patients were randomized to either continue the intervention or return to usual care.  

FAME is the first clinical trial to look at what is called “America’s other drug problem”, the lack of medication adherence in the elderly, and one of a few randomized trials to show benefit in both adherence and outcomes with reminder strategies. Taylor commented that more efforts are needed to identify and provide successful strategies to improve adherence and persistence to prescribed medications, and other treatments and recommendations within health care delivery systems and policy making bodies.