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.