Background

In pharmaceutical care, healthcare professionals collaborate with patients to optimise medication therapy. For patients using long-term medications, the process of medication use can be extensive and complex, and usafe care transitions may further complicate it. Medication beliefs strongly influence adherence, which is poor in this group and associated with adverse outcomes such as hospitalisations, mortality, and increased healthcare costs. Further research on effective interventions to optimise medication use is therefore needed.

Aim

To investigate clinical and patient-related aspects of pharmaceutical care in long- term medication use, supporting the development of interventions that improve continuity of care and medication adherence.

Methods

Four studies were conducted. Study I was a process evaluation of a pharmacist- led intervention using motivational interviewing and medication reviews in a randomised controlled trial with patients with coronary heart disease, examining drug-related problems, prescribing quality assessed with the Medication Assessment Tool for Secondary Prevention of Coronary Heart Disease (MAT- CHDsp), and beliefs measured with the Beliefs about Medicines Questionnaire Specific (BMQ-S). Study II was a three-year follow-up of the same trial that examined time to first event and number of emergency visits and hospitalisations from enrollment to 36 months, using survival analysis and comparative statistics. Study III was a feasibility study that tested a correct medication list intervention at discharge and a person-centred adherence intervention with medication beliefs and adherence assessed using the BMQ-S and the Medication Adherence Report Scale (MARS-5). Study IV was a multistage focus group study exploring Arabic- speaking women’s experiences and perspectives on medication information and use.

Results

Study I found that clinical pharmacists identified 500 DRPs among the 159 patients randomised to the intervention group, most of which were resolved or improved. Prescribing quality did not differ between groups, but mean concern scores decreased more in the intervention group (p=0.025), and more patients in shifted from an ambivalent to an accepting attitudinal category in the BMQ-S (p=0.051). In Study II, the intervention group recorded 46 hospital contacts compared to 49 in the control group (p=0.440). Thirty patients in the intervention group and 37 in the control group experienced an event with Kaplan-Meier survival probability estimates at 36 months of approximately 0.80 and 0.76, respectively (p=0.365). Study III's processes, design, and interventions were feasible in several aspects, including identifying medication discrepancies at hospital discharge, conducting post-discharge follow-ups, and holding person- centred meetings using patient narratives and health plans. Several participants reported reduced concerns and improved adherence scores. Recruitment was challenging with 13 of 87 participants included, and only 10 of 24 agreed discrepancies were corrected in the discharge medication list. Study IV identified three themes: receiving or not receiving professional medication information, medication adherence patterns, and needs and suggestions for improved medication information–a call for action. Suggestions included providing a written medication list at discharge in native language and a current medication list detailing overall medication information and potential drug interactions.

Conclusions

This thesis provides insights into how pharmaceutical care interventions can optimise medication therapy and improve adherence in patients on long-term treatment, supporting further development of such interventions. The findings emphasise that optimising therapy and improving adherence requires creating a correct medication list, addressing drug-related problems and needs, medication beliefs, and considering patient medication experience.