Alessandra Marengoni

Alexandra Prados-Torres

Anna Giardini

Caitriona Cahir

Elísio Costa

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Editorial
Interventional Tools to Improve Prescription and
Adherence to Medical Plans
Elísio Costa,1 Anna Giardini,2 Alexandra Prados-Torres,3
Caitriona Cahir,4 and Alessandra Marengoni5
1UCIBIO, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira No. 228,
4050-313 Porto, Portugal
2Psychology Unit of the S. Maugeri Foundation, IRCCS, Scientific Institute of Montescano (PV), Via Per Montescano 31,
27040 Montescano, Italy
3Spanish National Health System, Aragon Health Sciences Institute (IACS) and Department of Preventive Medicine,
Zaragoza University, Via Universitas 36, 50017 Zaragoza, Spain
4Department of Pharmacology andTherapeutics, Trinity College Dublin, College Green, Dublin 2, Ireland
5Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
Correspondence should be addressed to Eĺısio Costa; emcosta@ff.up.pt
Received 8 October 2015; Accepted 8 October 2015
Copyright © 2015 Eĺısio Costa et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
In developed countries, nonadherence to treatment in pa-
tients with chronic diseases ranges from 30% to 50%, and
this rate is even higher in developing countries [1, 2]. Indeed,
medication adherence and persistence are recognized as a
worldwide public health problem and a challenge for re-
searchers and health care providers, since efforts and inter-
ventions to improve patient’s adherence and persistence
appeared to be ineffective [3].
Nonadherence tomedical plans is manifests at every level
of the population, but particularly in older adults due to
the high number of coexisting chronic diseases and geri-
atric syndromes and the consequent polypharmacy [4, 5].
Polypharmacy is often associated with inappropriate pre-
scriptions, drug-drug and drug-disease interactions, pre-
scription cascade, which can all increase the risk of adverse
drug reactions and therefore the discontinuation of treatment
[6]. In addition, themanagement of chronic diseases requires
the patient’s continuous psychological adaptation and behav-
ioral reorganization to face recurrent changes in therapeutic
indications.
In the literature, many interventions to improve medica-
tion adherence have been implemented in different clinical
conditions. However, most interventions showed low effec-
tiveness not only in improving adherence, but also in other
outcomes, namely, quality of life, health outcomes, and health
care costs [7].
This special issue proposed in the context of a collabora-
tive work of A1 Action Group on Prescription and Adherence
to Medical Plans of the European Innovation Partnership on
Active and Healthy Ageing (EIP-AHA) includes two reviews
and three original research articles. In one of the review arti-
cles, C. Jäger et al. showed that regular receipt of an updated
and comprehensive medication list may reduce patients’
concerns and increase the perceived necessity of their medi-
cation. This paper supports not only the demand to establish
standardized, high-qualitymedication reviewed lists, but also
the need to improve the communication between health care
providers (physicians, clinical pharmacists, etc.) and patient’s
communication. In the other review article, W. Y. Lam
et al. revised the validated and commonly used medication
adherence measures with the general aim to identifying
nonadherence in everyday situations. Concerning the three
original articles, M. Lelubre et al. described the experience of
a well-established adherence program in Lausanne, Switzer-
land. The intervention comes from an interdisciplinary col-
laboration between all healthcare professionals and includes
motivational interviews, electronic pillmonitors, and reports.
It is committed to patients affected by chronic conditions
experiencing or at risk of experiencingmedication adherence
problems. Y.-C. Li et al. studied the effects of adherence to
statin therapy on health care outcomes and utilizations in
Taiwan.The authors showed that goodmedication adherence
Hindawi Publishing Corporation
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2 BioMed Research International
brings better outcomes and saves onmedical costs for patients
who were taking statinmedications. Finally, S. S. Allemann et
al. analyzed the general prescription patterns of split tablets in
Switzerland and its implications for community pharmacies,
patients, and patient care organizations. The authors showed
that prescription of fragmented tablet is frequent and it
represents not only a safety issue for the patient, but also a
pharmaceutical care issue for the pharmacist.
We believe that the reasons behind poor adherence in
persons affected by chronic diseases and prescribed with
polypharmacy are multifactorial and complex, related to
social and economic aspects, health systems and profession-
als characteristics, specific diseases, and individual patient’s
features. This is possibly the reason why measurements of
adherence and interventions to improve it are so challeng-
ing. This special issue on adherence to medical plans will
contribute to increase and spread of knowledge on already
available but also new scientific evidence on this topic. Of
course, further research is needed. We would suggest that a
comprehensive approach based on a multistep and interdis-
ciplinary strategy would be helpful in planning intervention
programs and new strategies able to increase adherence and
impact on major clinical outcomes.
Acknowledgments
The authors wish to thank the A1 Action Group members on
Prescription andAdherence toMedical Plans of the European
Innovation Partnership on Active and Healthy Ageing for
their contributions.
Eĺısio Costa
Anna Giardini
Alexandra Prados-Torres
Caitriona Cahir
Alessandra Marengoni
References
[1] L. S. Morris and R. M. Schulz, “Patient compliance—an over-
view,” Journal of Clinical Pharmacy andTherapeutics, vol. 17, no.
5, pp. 283–295, 1992.
[2] J. L. Donovan, “Patient decisionmaking.Themissing ingredient
in compliance research,” International Journal of Technology
Assessment in Health Care, vol. 11, no. 3, pp. 443–455, 1995.
[3] B. B. Granger and H. B. Bosworth, “Medication adherence:
emerging use of technology,” Current Opinion in Cardiology,
vol. 26, no. 4, pp. 279–287, 2011.
[4] R. D. Goldney and L. J. Fisher, “Use of prescribed medications
in a South Australian community sample,” Medical Journal of
Australia, vol. 183, no. 5, pp. 251–253, 2005.
[5] R. A. Elliott, “Problems with medication use in the elderly: an
Australian perspective,” Journal of Pharmacy Practice and Re-
search, vol. 36, no. 1, pp. 58–66, 2006.
[6] S. Rambhade, A. Chakarborty, A. Shrivastava, U. K. Patil, and
A. Rambhade, “A survey on polypharmacy and use of inappro-
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[7] E. Costa, A. Giardini, M. Savin et al., “Interventional tools to
improve medication adherence: review of literature,” Patient
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Editorial Interventional Tools to Improve Prescription and Adherence to Medical Plans

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