Factors influencing the provision of adherence support by community pharmacists: A structural equation modeling approach

BackgroundNon-adherence to medication represents an important barrier to achieving optimum patient outcomes. Community pharmacists are well placed to deliver interventions to support adherence.AimsTo investigate community pharmacists' activities in supporting patient adherence; and identify factors influencing pharmacists' provision of adherence support.MethodA random sample of 2020 Australian community pharmacies was mailed a questionnaire investigating their provision of adherence support. The self-completed, structured questionnaire consisted of eight sections, five of which were relevant to this study: strategies used to identify non-adherent patients, strategies used to support patients' adherence to medications, pharmacists' attitudes toward provision of adherence support, perceived barriers to provision of adherence support, and demographics. Structural equation modeling (SEM) was used to determine potential influencing factors.ResultsA response rate of 31% was achieved (n = 627). Pharmacists reported using strategies to identify non-adherent patients for less than half (45%) of the prescriptions dispensed. A mean of 8.4 ± 14.9 (mean ± SD) strategies was used by respondents in the 7 days prior to survey completion. Dose administration aids was the most commonly used strategy (provided by 96.5% of respondents). Time pressure for patients (68%) was perceived by pharmacists as the main barrier to adherence support. SEM identified “stakeholders/skills” and “number of full time equivalent staff” as influencing provision of adherence support strategies.ConclusionProvision of adherence support by pharmacists was episodic and infrequent, impeded by a number of barriers. By addressing barriers, it is possible to enable pharmacists to become more proactive and effective in supporting patient adherence.