Effectiveness of a targeted and tailored pharmacist-led intervention to improve adherence to antihypertensive drugs among patients with type 2 diabetes in Indonesia: a cluster randomised controlled trial

Sofa D Alfian*, Job F M van Boven, Rizky Abdulah, Hadyana Sukandar, Petra Denig, Eelko Hak

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
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AIM: To assess the effects of a targeted and tailored pharmacist-led intervention among patients with type 2 diabetes (T2DM) who are non-adherent to antihypertensive drugs.

METHODS: A cluster-randomised controlled trial was conducted in 10 community health centres (CHCs) in Indonesia among T2DM patients aged ≥18 years who reported non-adherence to antihypertensive drugs according to the Medication Adherence Report Scale (MARS-5). Patients in CHCs randomised to the intervention group received a tailored intervention based on their adherence barriers (e.g., forgetfulness, lack of knowledge, lack of motivation, and/or other drug-related problems) using a simple question-based flowchart at baseline and 1-month follow-up. Patients in control CHCs received usual care. Primary outcome was the between-group difference in change in MARS-5 score from baseline to 3-months follow-up. Secondary outcomes included changes in patients' blood pressure and their medication beliefs. Differences in difference in primary and secondary outcomes between groups were assessed using General Linear Models.

RESULTS: In total, 201 patients were screened for eligibility, 113 met the inclusion criteria and participated; 89 (79%) patients had complete follow-up. Forgetfulness (42%) and lack of knowledge (18%) were the most common adherence barriers identified at baseline. The intervention improved medication adherence by 4.62 points on the MARS-5 scale [95%CI: 0.93 to 8.34, p-value = 0.008]. There were no significant changes in blood pressure levels and beliefs about antihypertensive drugs.

CONCLUSION: A tailored low-cost pharmacist-led intervention aimed at non-adherent T2DM patients resulted in an improvement in medication adherence to antihypertensive drugs. There were no significant changes in secondary outcomes.

Original languageEnglish
Pages (from-to)2032-2042
Number of pages11
JournalBritish Journal of Clinical Pharmacology
Issue number4
Early online date15-Oct-2020
Publication statusPublished - 2-Apr-2021



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