MIPS researchers’ Cochrane review findings could help to improve adherence and reduce hospitalisations among older adults

Medication non-adherence is a significant problem amongst older Australians, more than one third of whom are taking more than five medications simultaneously. Researchers from the Centre for Medicine use and Safety at the Monash Institute of Pharmaceutical Sciences have found that behavioural-only or mixed behavioural and educational interventions may improve the proportion of older people who are adherent to their medication. Mixed behavioural and educational interventions can also improve older people’s medication knowledge and reduce the number of emergency department (ED) admissions.

Researchers from Monash University’s Centre for Medicine Use and Safety (CMUS) have published a review in the prestigious Cochrane Library on improving medication adherence in older populations.

Amanda Cross

The review has found that behavioural-only or mixed educational and behavioural interventions - especially those initiated at the hospital-community/primary care interface - may improve the proportion of older adults who stick to their medication schedules.

Lead researcher Dr Amanda Cross said: “Pharmacists are particularly well positioned to support these patients with their medication use, especially across transitions of care, for example when they are discharged from hospital and preparing to go home”.

The systematic review, titled ‘Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications’, was led by CMUS researchers Dr Amanda Cross and Dr Johnson George, along with researchers from Austin Health and Barwon Health.

The review identified 50 studies with over 14,000 participants. The impact of interventions on clinical health outcomes was also explored and it was found that mixed educational and behavioural interventions may improve older people’s medication knowledge and reduce the number of ED/hospital admissions.

“Polypharmacy is becoming a growing issue within Australia and we know that poor adherence contributes to adverse drug events and increases risk of hospitalisations. Our review has shown that mixed behavioural and educational interventions may help to improve adherence and reduce hospital admissions among older adults taking multiple medications,” said Dr Cross.

“Highlighting the importance of behavioural interventions, either alone or in combination with education, has implications for health-care providers. Pharmacists in particular are uniquely placed to implement behavioural interventions, including simplifying medication regimens or organising dose administration aids.

Recent changes that allow pharmacists to complete follow-up visits after medication reviews provide a great avenue for identifying patient-specific barriers to adherence and tailoring interventions to help patients stick to their medication schedules.

“The other key finding from our review is the need for further robust randomised controlled trials of behavioural and educational interventions, particularly ones that evaluate medication-taking ability and cost-effectiveness. This evidence is required in order to see wide-spread policy and practice change.“

Dr Cross said while the review highlighted the value of behavioural interventions, the quality of the wider body of evidence was low and further well-designed studies and innovations are needed to improve medication taking.

Contact: Divya Krishnan

Phone: 0466910111

Email: divya.krishnan@monash.edu