Introduction
In recent years, the roles and the missions entrusted to hospital
pharmacists have evolved and pharmacists have gained more and more
importance in the support of clinical patients[1,2] particularly
through the advent of clinical pharmacy[3]. Clinical pharmacists
interventions in clinical services are valued by health care
providers[4,5] and result in reducing medication errors[6,7] and
drug related hospitalization[8] cost savings[9,10] and even
reducing mortality[11]. When addressed to patients, pharmaceutical
interventions improved patient satisfaction and decreased non-adherence
to medication [12–16].
Non-adherence to medication has become a new public health burden since
chronic diseases have supplanted acute diseases in leading death and
morbidity causes in modern medicine. The World Health Organization
estimates that 50% of patients treated for chronic diseases do not
properly take their treatment[17], which has been confirmed by
epidemiologic and experimental studies[18–20]. Beside increasing
morbidity and mortality[21–24], non-adherence has been estimated to
cost annually 100 to 300 billion dollars of avoidable healthcare costs
in the USA[25,26].
Then, if pharmaceutical interventions allow to increase the adherence,
it should increase clinical outcomes. But is it really the case? All
adherence evaluating methods show limitations in determining the real
level of adherence[27,28]. Then, an increase in the adherence score
does not necessarily mean an improvement in patient clinical condition.
Moreover, improving adherence to a treatment is not a final goal but
only a way to ultimately improve the pathology control and patient
clinical condition. Today, few studies have investigated the direct
impact of a pharmaceutical intervention on the patient clinical
condition. A recent exhaustive review of randomized controlled studies
evaluating general practice‐based pharmacist interventions on the
pathologies parameters of patients with hypertension, type 2 diabetes or
dyslipidemia retrieved only 21 studies, of variable quality[29]. But
despite the small number of these studies, there are very encouraging
results. Some studies highlighted the usefulness of the pharmacist in
decreasing blood pressure (BP)[12,30–33], glycated hemoglobin
(HbA1c)[34–37] or low-density lipoprotein cholesterol
(LDL-c)[38–40], also suggesting an economically positive effect of
this kind of intervention[41–45]. However, the decrease of a
pathology parameter does not mean the patient will reach the recommended
target of this parameter, and today few studies have focused on the
achievement of therapeutic goals set by physicians or recommendations.
Moreover, to our knowledge, no such studies have been conducted in
France.
In this context, we conducted a randomized controlled physician-blinded
clinical study to evaluate the concrete impact in terms of clinical
outcomes of a pharmacist interview immediately after a medical
consultation, in patients treated for hypertension, hypercholesterolemia
or type 2 diabetes but not reaching their therapeutic objectives.