Patients’ general satisfaction with telephone counseling by pharmacists and effects on satisfaction with information and beliefs about medicines: Results from a cluster randomized trial

Highlights

• We designed a telephone counseling intervention which is feasible to implement.

• This telephone counseling by pharmacists reduces concerns about medication.

• This intervention improves satisfaction with counseling in general.

• Satisfaction with information on some subjects was improved.

• The effects of telephone counseling are more pronounced in men than in women.

Abstract

Objective

Assess effects of pharmacists’ counseling by telephone on patients’ satisfaction with counseling, satisfaction with information and beliefs about medicines for newly prescribed medicines.

Methods

A cluster randomized trial in Dutch community pharmacies. Patients ≥18 years were included when starting with antidepressants, bisphosphonates, RAS-inhibitors or statins. The intervention comprised counseling by telephone to address barriers to adherent behavior. It was supported by an interview protocol. Controls received usual care. Outcomes were effects on beliefs about medication, satisfaction with information and counseling. Data was collected with a questionnaire.

Results

Responses of 211 patients in nine pharmacies were analyzed. More intervention arm patients were satisfied with counseling (adj. OR 2.2 (95% CI 1.3, 3.6)). Patients with counseling were significantly more satisfied with information on 4 items, had less concerns and less frequently had a ‘skeptical’ attitude towards medication (adj. OR 0.5 (0.3–0.9)). Effects on most outcomes were more pronounced in men than in women.

Conclusions

Telephone counseling by pharmacists improved satisfaction with counseling and satisfaction with information on some items. It had a small effect on beliefs about medicines.

Practice implications

Pharmacists can use counseling by telephone, but more research is needed to find out which patients benefit most.

Introduction

Patients starting medication need information about their medicines to support appropriate and safe use [1], [2], [3], [4], [5]. This includes practical instructions on usage but also information about possible side effects, the expected pharmacological action and what happens if a patient does not take the medication [2], [6], [7]. This information should improve patients’ understanding of the expected benefits and risks [3], [8].

Physicians and pharmacists play an important role in providing counseling about benefits, risks and correct use of medication [9]. In counseling-sessions a healthcare provider can tailor information to the patients’ needs [10], [11], [5], assess whether a patient understands the information and also assess barriers that may negatively influence adherence to medication [12].

Counseling, including education and behavioral support, can improve medication adherence [13]. Adherence to long-term therapy is generally defined as the extent to which a person's behavior (e.g. taking medication) corresponds with agreed recommendations from a healthcare provider [14]. Adherence to medication for long-term treatment is low [14], [15], [16], [17], which severely compromises the effect of the therapy. Dutch pharmacy guidelines recommend education and counseling at the pharmacy including exploration of lack of knowledge, information needs and experiences with the medication. The first period after the start of treatment is especially important since discontinuation of therapy is highest in the first weeks after the start of a new treatment [18].

In daily practice not all patients starting with medication receive optimal care from physician [19] or pharmacists [20]. Studies show that information needs of patients are not always met [6], [7], [21], [22] and that barriers to adherent behavior are not always assessed [12], [23], [24]. The quality of communication can be improved [25], [26], also because part of the information is forgotten or remembered incorrectly [27].

Considering barriers that hamper implementation of counseling in pharmacies [28], [29], a feasible alternative to face-to-face counseling may be counseling by telephone [30]. This has been proven to improve adherence measured after 4-week follow-up and to be effective in reducing mortality in non-adherent patients [31].

We designed the TelCIP trial, a cluster randomized controlled trial in patients starting with antidepressants, antihypertensives, lipid lowering drugs or bisphosphonates to study the effect of counseling by telephone on medication adherence [32]. Cluster randomization was chosen as this was supposed to increase feasibility of implementation of the study protocol in pharmacies and to reduce the risk of contamination.

In the counseling calls the pharmacists assess and address possible barriers including lack of knowledge, concerns about medication and low necessity beliefs. Our hypothesis is that this type of counseling will improve knowledge, reduce concerns about medication and improve necessity beliefs. This may ultimately improve medication adherence. Although this effect of the intervention on adherence is important, it is as important to assess the impact on the pathway that ultimately leads to adherent behavior. This is because it is this pathway where the pharmacist addresses the needs of each individual patient and where the actual intervention takes place. Therefore the objective of the present study is to assess the effect of a telephone counseling intervention at the start of pharmacotherapy on patients’ (1) general satisfaction with counseling, (2) satisfaction with information and (3) beliefs about medicines.