Pharmaceutical Care In Community Pharmacies Research Articles

Evidence-Based Pharmaceutical Care in Community Pharmacies: A Survey of 595 French Pharmacists.

We assessed the use of evidence-based practice (EBP) among pharmacists working in community pharmacies in France and the factors linked to this practice. During 3 months in 2018, an online survey was sent to over 7000 active pharmacists and posted on pharmacists' social media sites. In total, 595 pharmacists completed the questionnaire. The responders were on average younger than the general population of community pharmacists. The 40-item questionnaire described four fictional clinical cases reflecting typical situations (conventional medicine and complementary and alternative medicine) encountered daily by community pharmacists. Multiple-choice responses were proposed and scored according to whether they reflected EBP. A high total score indicated behaviour in line with EBP. We observed 344/595 participants with a positive EBP score (57.8% [53.7-61.8%]). Univariate and multivariate analyses were used to evaluate factors that might explain adherence to EPB (the pharmacy's characteristics, the pharmacist's status, the mode of continuing education and sources of information). The majority relied on pharmaceutical industry and other biased and/or non-evidence-based sources, particularly concerning information on homeopathic products. The consultation of independent reviews, health agency recommendations and peer-reviewed scientific journals was associated with evidence-based decisions. In contrast, reliance on pharmaceutical industry documents, personal experience and informal handbooks was linked to lower EBP scores. The level of EBP use by French community pharmacists needs to be improved to ensure that good-quality, science-based advice is given to customers.

Patient satisfaction survey of the “Healthy Heart” pharmaceutical care service – evaluation of pharmacy labelling with pharmaceutical pictograms

IntroductionLow adherence is a major challenge in healthcare worldwide, being particularly dangerous for patients with chronic diseases, such as cardiovascular diseases and heart failure, where strict adherence is essential. Non-adherence is observed in almost half of patients, and the consequences encompass a lack of therapeutic effects, health deterioration, decreased quality of life, and even death. For cardiovascular patients, the great importance of health education and pharmaceutical education can be provided within pharmaceutical care in community pharmacies. Therefore, our study aimed at evaluating the level of satisfaction with the “Healthy Heart” pharmaceutical service, in which patients received pictograms with dosage information affixed to their medication.Material and methodsThe study was designed for patients who had been prescribed an antiplatelet medication for the first time. The patients were recruited by 577 pharmacies that took part in the study after completing a special course. Ultimately, 1590 patients were enrolled in the study. The project ran from November 2019 to January 2022.ResultsMost of patients had a positive attitude to the “Healthy Heart” pharmaceutical service. More than 85% of the respondents were of the opinion that the pictograms facilitated the use of the medication, and 81.7% of the respondents stated that the system of labels helped in adherence. Over 66% of the respondents thought that such labels should be included in pharmacy services, and 77.92% of the participants reported that this system of labelling medications should be offered through all pharmacies.ConclusionsPharmaceutical labels in the pharmacists’ everyday practice can largely improve patient adherence. These efforts, provided as part of their pharmaceutical services, can have a huge influence on optimisation of patient health outcomes.

Développement des soins pharmaceutiques de l’infertilité féminine à l’officine : enquête sur la perception et les attentes des patientes

We conducted a study with patients undergoing ART at the Institute of Reproductive Medicine in Marseille, using a questionnaire. The questions concerned the perception of care given at the community pharmacy on various aspects related to medication, on a scale of 1 (not at all satisfied) to 10 (very satisfied). The last question was an open-ended question about patient's expectations. In all, 105 patients answered the questionnaire. The average age of women was 34.5±4.8-years-old. The scores obtained concerning the perception of support on the themes explored varied between 2.8±2.8 for the lowest score and 4.2±3.4 out of 10 for the highest. In all, 79.6% of the respondents were in favor of the development of specific support in community pharmacies, especially about administration methods, management of adverse effects and management of waste linked to treatment. Women undergoing ART are willing to receive pharmaceutical care in community pharmacies. In order to meet their expectations, it is necessary to develop dedicated training programs.

Public Perception of Pharmacists in Poland.

Background. Pharmacists constitute one of the largest groups of medical professionals and play a significant role in public health. Pharmaceutical care in community pharmacies is one of the key elements that impact the clinical outcomes of patients. The main objective of this study was to evaluate the public perception of pharmacists in Poland, as well as the knowledge of and willingness of Polish people to use pharmaceutical care services. Methods. This study was carried out in 2017 on 1435 people. The research tool was an anonymous online questionnaire. Results. Of the participants, 61% considered pharmacists to have a position of public trust, and 25% trusted pharmacists to a lesser extent than representatives of other medical professions. The participants stated that pharmacists were kind (74%) and helpful (69%). For 52% of the participants, pharmacists were fully competent to provide information on medications. Twenty-eight percent of the participants ask pharmacists for advice related to medicinal products. Poles’ knowledge on pharmaceutical care was low (44% of the respondents knew this notion). Sixty-six percent of the participants were willing to use pharmaceutical consultations (43% free of charge, and 23% for a nominal fee). Conclusions. Although the overall perception of patients towards pharmacists was positive in Poland, it is essential to educate patients on the possibilities of using pharmaceutical services, and to promote the role of pharmacists in healthcare systems.

Assessment of Pharmacists' Willingness to Conduct Medication Use Reviews in Poland.

Introduction. Pharmacists play an important role in healthcare. Their functions are evolving and, in many countries, they actively participate in interdisciplinary patient treatment. One of the most common services provided by pharmacists as part of pharmaceutical care in community pharmacies involves medication reviews. Objective. The objective of this study was to evaluate the readiness of pharmacists to conduct medication reviews in community pharmacies. Materials and methods. This study comprises 493 pharmacists from community pharmacies in Poland. A questionnaire (developed for the purposes of this study) was used. It consisted of eight questions regarding readiness to conduct medication reviews, along with personal data. Results. A total of 63.9% of the pharmacists were ready to conduct medication reviews, and 23.1% already had experience in this area. Participants were of the opinion that this service should be funded by the Ministry of Health or a third-party public payer, and overall was valued by the participants at PLN 169.04 (SD = 280.77) net per patient. Conclusions. Pharmacists in Poland have expressed their readiness to conduct medical reviews. Implementation of this service in community pharmacies in Poland can have a significant impact on optimising patient health outcomes.

Short cognitive screening in elderlies as a part of advanced pharmaceutical care in Slovak community pharmacies - The pilot study KOGNIMET-SK

Abstract The aim of this study is to evaluate the implementation of a simple, easy-to-use cognitive screening test in the pharmaceutical care of elderly patients (aged 60 years and over) in community pharmacies and to test whether cognitive decline is associated with metabolic syndrome (MetS). Current research has reported the increasing prevalence of MetS with age and indicated a link between cardiovascular risk factors and impairment of cognitive functions. We hypothesized that the short cognitive test realised in pharmaceutical care in community pharmacies could help identify risk groups of patients with potential cognitive decline. Because of the increasing pressure on primary care, collaboration between community pharmacists and general practitioners is essential, especially in preventive programmes and regarding chronically ill patients. The study included 222 elderly patients aged 60 years and over reached between February 2018 and February 2019 in 16 community pharmacies in Slovakia. Criteria for the classification of MetS were used, following the International Diabetes Federation Worldwide Definition of MetS (2005) for European populations. Cognitive performance was evaluated using the Slovak version of the Montreal Cognitive Assessment. The scale range of the MoCA test is 0–30 points, and the cut-off for cognitive impairment is ≤ 24 points. Our outcomes show that the presence of metabolic syndrome only slightly contributes to the impairment of cognitive functions of patients receiving routine pharmaceutical care in community pharmacies. Cognitive assessment might be an important tool for identifying risk groups of patients that would benefit from a specific approach within the framework of pharmaceutical care.

PHARMACEUTICAL CARE PRACTICE IN THE COMMUNITY PHARMACY BY UTILIZING PROBLEM-BASED LEARNING IN REFLECTIVE PEDAGOGY PARADIGM METHOD

This study follows the previous study entitle Problem-based Learning (PBL) in reflective pedagogy paradigm (RPP): Innovative learning in pharmaceutical care, which identified the learning material as complicated. This study aimed to provide an appropriate method for performing pharmacy management and pharmaceutical care in Community Pharmacy. Data collection was done using an assessment instrument to identify student’s achievement. The previous study encompasses preceptors and students in developing learning material, which cause it more valid and reliable to be implemented. The study was conducted in Yogyakarta, Surakarta, and Semarang city. The effectiveness of the learning material was shown by the grade of student’s achievement in learning outcome and the clear state with confidence in the expression of reflection and action-plan. Most of the students in the 3 cities achieved an excellent grade both in the problem-solving field, and presentation of the assignment. The students reflected that the learning material is simple and suitable in practicing pharmaceutical care and pharmacy management, moreover, they can state their plan to work as a Community Pharmacist with confidence. Therefore, PBL in the RPP method is ready to be used in practicing pharmaceutical care in the Community Pharmacy.

Effect of Insecurity on the Provision of Pharmaceutical Care in Akwa Ibom State: The Community Pharmacist’s Perspective

Background: Pharmaceutical care is an important aspect of healthcare provided by pharmacists which is associated with good clinical outcomes and improved quality of life. Robberies and insecurities is a common occurrence in community pharmacies and when left unchecked can have economic, financial consequences and also influence the provision of care. The aim of this study was to assess the perceived effect of insecurity on the provision of pharmaceutical care in community pharmacies in Uyo, Akwa Ibom State. Methods: This study was a cross sectional survey among community pharmacists in community pharmacies in Uyo, Akwa Ibom State. All community pharmacies in Uyo metropolis were visited and an informed consent was obtained from the pharmacists before the beginning of the study. A semistructured questionnaire was used in the collection of data in this study. The questionnaire evaluated the perceived effect of the current robberies on pharmaceutical care where the evaluation statements were structured in Likert scale format. Results: A total of 76 pharmacists consented to participate in the study where 56 (73.7%) were males and 20 were females. The mean age of the study participants was 28.25±1.543 years and 82.9% of the participants had 1-10 years’ community pharmacy experience. Majority of the pharmacists agreed that insecurity has hindered history taking (52%), blood pressure checks (84.2%), patient counselling (80.2%) and decreased sales (52.6%). Conclusion: There is a negative perceived effect of recent insecurities on the provision of pharmaceutical care services and sales. This aspect should be explored in further studies and research.

Impact of the COVID-19 epidemic on the provision of pharmaceutical care in community pharmacies.

BackgroundCommunity pharmacists and their teams are easy accessible healthcare providers with an important role in primary care. As a consequence of the COVID-19 epidemic, (pharmaceutical) care and specifically communication between patients and healthcare providers is compromised.ObjectiveTo describe the impact of the COVID-19 epidemic on the provision of pharmaceutical care in the Netherlands.MethodsA cross-sectional study with an online questionnaire was sent to community pharmacies in the Netherlands. The questionnaire covered the following main topics: changes in pharmacy setting and logistic procedures, communication about medication and baseline characteristics.ResultsPharmacies implemented hygiene measures and minimized direct patient-provider contact, e.g. by delivering medication at home to a wider range of patients (47.0%), temporarily not conducting medication reviews (55.8%) and only performing inhalation instructions via telephone (22.3%). Only a small number of pharmacies used telepharmacy, such as video calling during patient education and counseling. A total of 76.7% of the participants expressed concerns towards the pharmaceutical care for vulnerable patients.ConclusionsOur results show considerable impact of the COVID-19 epidemic on both logistic procedures and services regarding patient education and counseling. Pharmacies should be stimulated to implement telepharmacy or remote service to optimally support patients during the COVID-19 epidemic.

Pharmaceutical care in community pharmacies in Jordan: a public survey.

Objective:This study aims to assess the views and attitudes of the general public towards the current role of pharmacists in Jordan.Methods:This study is a cross-sectional quantitative questionnaire-based study. After a thorough literature review on public perspectives of pharmaceutical care services, a draft questionnaire was designed. This questionnaire was examined and discussed in a focus group of invited public members and was amended accordingly to reach the final draft. The questionnaire was administered using a structured interview technique in which members of the public were asked a series of questions by a trained pharmacist. The study took a place over a period of six months, from January to June 2013. Individuals were recruited from urban and rural areas of Jordan.Results:A total of 1214 respondents were interviewed during the study. Of the respondents, 67.8% were female. Most of the respondent were married (64%) and had a university degree (88.5%). Approximately half of the respondents (55.1%) had no previous knowledge of pharmaceutical care. A relative majority of respondents considered the most important activity performed by pharmacists to be dispensing medications (46.2%), followed by patient counseling (34.6%). The majority of respondents (86.4%) believed that pharmacists have a role in providing healthcare services, and 68% of respondents reported that in order to serve their needs, a pharmacist must consider the patient’s needs and engage patients in determining medication timing and options.Conclusions:The plurality of respondents believed in the importance of pharmacists in providing pharmaceutical care services. However, respondents expected much from pharmacists and felt that their current role was unsatisfying.

North Cyprus Pharmacist’s Cognition and Practice of Pharmaceutical Care

The aim of this project is to assess community pharmacists’ attitudes towards their professional practice and to determine their perceived competence in various pharmaceutical activities. The philosophy of Pharmaceutical care focuses on the responsibility of pharmacist to meet all of the patient’s drug-related needs, and assist the patients in achieving their goal through collaboration with other health professionals. Materials and Methods: The study was conducted prospectively between January and March 2016. It involved community pharmacists working in pharmacies within North Cyprus. There are 190 pharmacies in North Cyprus, 110 questionnaires were administered out of which 80 completed giving a response rate of 78.0% from pharmacists working in community pharmacies. Results: The result of the current study showed that 97.5% of respondents had knowledge deficit of pharmaceutical care concepts but there is a positive attitude towards the practice of pharmaceutical care. In comparing pharmacist’s perceptions toward pharmaceutical care, no significant difference was noticed between females and males. While young and new pharmacists significantly (p=0.0001) believe more than older more experienced pharmacists that a pharmacist is only responsible to dispense or counsel the patients on the drug prescribed by him or the physicians. Conclusion: Pharmacists in North Cyprus had positive pharmaceutical care orientations. This should encourage pharmacist bodies’ educators and regulatory agencies to design initiatives to increase the frequency and quality of practicing pharmaceutical care in community pharmacy.

Practice of pharmaceutical care in community pharmacies in Jordan

Purpose: To describe the current role played by pharmacists in delivering pharmaceutical care (PC) in community pharmacies in Jordan (current activities and practices undertaken in the community and extent of provision of PC standards), pharmacists’ perspectives on PC implementation and barriers to implementing PC practices.Methods: This cross sectional study was conducted in 2014 in Amman, the capital of Jordan and Zarqa, the second biggest city in Jordan. The study involved a validated questionnaire administered at random by trained pharmacy students to 180 community pharmacists. The questionnaire was designed to collect demographic data, pharmacy practice features displayed by the pharmacists, dispensing activities undertaken, internationally proposed PC practice standards in community pharmacy settings, inter/intra-professional and public heath activities and barriers that may hinder the implementation of PC practice in Jordan.Results: 163 pharmacists agreed to participate in the study (response rate was 90.5 %). Most dispensing activities (98.1%) in the pharmacies were done under the supervision of pharmacists. All pharmacists were willing to implement PC, and nearly all of them (98.8 %) provided basic information about medication use. Nevertheless, only 31.0 % adapted standard procedures for patient’s data collection, 23.1 % formulated a therapeutic plan to be included within the patient’s permanent record in their pharmacy, 24.2 % documented over-the-counter recommendations, and 29.7 % allocated time to discuss patient’s care plans. Identified barriers preventing the provision of PC practice included lack of training on the concept (44.9 %) and lack of acceptability from the physicians (43.4 %).Conclusion: Although participating pharmacists showed willingness to implement PC practice, their actual application to the practice was found to be limited. Lack of adequate pharmaceutical training and acceptability by the physicians are the major barriers towards the provision of PC practice in the country.Keywords: Community pharmacists, Pharmaceutical care, Barriers, Jordan

Quality indicators for pharmaceutical care: a comprehensive set with national scores for Dutch community pharmacies.

Background The quality of pharmaceutical care in community pharmacies in the Netherlands has been assessed annually since 2008. The initial set has been further developed with pharmacists and patient organizations, the healthcare inspectorate, the government and health insurance companies. The set over 2012 was the first set of quality indicators for community pharmacies which was validated and supported by all major stakeholders. The aims of this study were to describe the validated set of quality indicators for community pharmacies and to report their scores over 2012. In subanalyses the score development over 5 years was described for those indicators, that have been surveyed before and remained unchanged. Methods Community pharmacists in the Netherlands were invited in 2013 to provide information for the set of 2012. Quality indicators were mapped by categories relevant for pharmaceutical care and defined for structures, processes and dispensing outcomes. Scores for categorically-measured quality indicators were presented as the percentage of pharmacies reporting the presence of a quality aspect. For numerical quality indicators, the mean of all reported scores was expressed. In subanalyses for those indicators that had been questioned previously, scores were collected from earlier measurements for pharmacies providing their scores in 2012. Multilevel analysis was used to assess the consistency of scores within one pharmacy over time by the intra-class correlation coefficient (ICC). Results For the set in 2012, 1739 Dutch community pharmacies (88 % of the total) provided information for 66 quality indicators in 10 categories. Indicator scores on the presence of quality structures showed relatively high quality levels. Scores for processes and dispensing outcomes were lower. Subanalyses showed that overall indicators scores improved within pharmacies, but this development differed between pharmacies. Conclusions A set of validated quality indicators provided insight into the quality of pharmaceutical care in the Netherlands. The quality of pharmaceutical care improved over time. As of 2012 quality structures were present in at least 80 % of the community pharmacies. Variation in scores on care processes and outcomes between individual pharmacies and over time can initiate future research to better understand and facilitate quality improvement in community pharmacies.

Knowledge Attitude and Practice towards Pharmaceutical Care in Community Pharmacy in Saudi Arabia

Objective: To assess the knowledge, attitude and practice of towards pharmaceutical care for pharmacists working in community pharmacy in Alqassim region in Kingdom of Saudi Arabia. Mthedology: Two hundred twenty four pharmacists were included using a pretested self administered questionnaire designed to carry out a cross-sectional descriptive study. Results: The response rate was 63%, there were (52.7%) of the pharmacists think that they are knowledgeable about pharmaceutical care. The majority of the pharmacists (77.7%) think that pharmaceutical care is the pharmacist responsibility. Taking patients’ medication history is a service often/always provided by (54.5%) of the pharmacists. The most important barriers to provide pharmaceutical care are overload of responsibilities (86.8%), lack of clinical knowledge of disease states (50%), and lack of technical knowledge on how to provide Pharmaceutical care (47%). Conclusion: The current pharmaceutical care situation in community pharmacies in Alqassim Original Research Article Ahmed and AL-Wahibi; BJMMR, 15(9): 1-9, 2016; Article no.BJMMR.23920 2 needs further improvement by improving pharmacist information regarding medications and disease states, and overcoming barriers to provide pharmaceutical care are useful.

Consumer satisfaction with pharmaceutical care in Slovak community pharmacies / Spokojnosť klientov lekární s lekárenskou starostlivosťou na Slovensku

Abstract The aim of this pilot study was to evaluate consumer satisfaction with pharmaceutical care provided in community pharmacies at the region level. Expectations and opinions of consumers were also confronted with the assumptions of pharmacists. Up to 82.0% of consumers confirmed their satisfaction with the care given to them by the pharmacist. A key factor of consumer satisfaction has been the professional (78.7%) and human approach (83.5%) of the pharmacist. A total of 73.6% of consumers in the survey accepted the pharmacist as an expert in medicines. The pharmacist´s self-evaluation was more negative. Monitoring and evaluation of consumer satisfactory with pharmaceutical care is not only essential for improvement of the quality of the healthcare system and for the implementation of pharmaceutical care focussed on the patient, but it may influence the economic and financial outcomes of entities providing pharmaceutical care in community pharmacies.

English

This study aimed to assess the pharmacist’s knowledge of the concept of pharmaceutical care and verify their practice in relation to this service. It involved a cross-sectional study carried out on community pharmacies in four Brazilian cities and involved pharmacists who work in community pharmacies. The pharmacists' knowledge of the concept of pharmaceutical care and their practice in respect of the service was measured. 486 pharmacies were visited and 112 pharmacists participated in the study. Of these professionals, 41% correctly identified the concept of pharmaceutical care and 70.5% said they perform it in pharmacies. The majority (n = 62) of the professionals followed standard operating procedures and four recorded data on the service offered (patient information, interventions and results). There is evidence that only 2.5% of the professionals effectively carry out the level of pharmaceutical care recommended by the Brazilian guidelines. Pharmacists are not yet ready to perform pharmaceutical care in community pharmacies. It is necessary to review the pharmacists’ training and enable the professionals to properly perform this service. Key words: Pharmaceutical care, pharmacists, knowledge, attitudes, community pharmacy.

Patients’ Perceptions of Community Pharmacy Practice in UAE: An Overview

There are limited published data available about the provision of pharmaceutical care in community pharmacies in the UAE. Almost no documentation of efforts was taking place in community pharmacy. Objectives: This study is done to evaluate pharmacists perception of their current practice, as well as their knowledge of drug regulations/ classification by the Ministry of Health (MOH). Also, investigate their opinion on the possible pharmacist patient communication barriers. Methods: 300 cross sectional surveys were distributed to community pharmacies in Ajman and Sharjah. In addition, a pharmacist played the role of a patient with a prescription to measure pharmacists' knowledge. Results: The response rate of the participants was 73.6%. Most of the pharmacists couldn't identify drugrelated problems in the prescription and dispensed antibiotic without a prescription . In addition, most pharmacists were satisfied by the dispensing role in the community pharmacy. Conclusion: Community pharmacists roles must be expanded and they must look for new challenges in their profession in order to improve their experience and capabilities.

Barriers of Pharmaceutical Care in Community Pharmacies: Evidences From Emerging Counteries

Barriers of Pharmaceutical Care in Community Pharmacies: Evidences From Emerging Counteries

Investigation on barriers to pharmaceutical care in community pharmacies: a structural equation model.

The concept of pharmaceutical care (PhC) has been popular in pharmacy during past decades. However, in some countries, including Iran, it does not seem to mature. To identify and prioritize barriers to the provision of PhC in Iranian community pharmacies, based on the perceptions of community pharmacists in Tehran. Between August and November 2013, a cross-sectional descriptive study was performed using an anonymous questionnaire asking the pharmacists' perceptions on the implementation of PhC. Of the 2000 invited community pharmacists, 505 pharmacists responded. A descriptive analysis, was conducted, and the data were also analyzed through structural equation modeling. Priorities of barriers to the implementation of PhC in Iran. Five major dimensions included in the survey instrument were confirmed by confirmatory factor analysis. According to the model developed based on pharmacists' opinions, lack of pharmacists' skills and lack of appropriate regulation and environment are the two most important barriers of the provision of PhC, and the least important is lack of resources. The results show that the main barriers to PhC in Iran are the lack of skills and of appropriate regulation and environment. These main barriers are different from those mentioned in studies conducted in other countries.

Improving adherence to lipid-lowering therapy in a community pharmacy intervention program: a cost-effectiveness analysis.

Pharmaceutical care in community pharmacies has been shown to improve adherence to chronic therapies. Long-term impact on clinical outcomes or medical cost savings, however, remains understudied. To estimate the cost-effectiveness of a pharmaceutical care intervention program in Dutch community pharmacies that improved patients' adherence to lipid-lowering therapy. An economic evaluation was performed using a time-dependent Markov model from the health care payer perspective. Participants were patients initiating lipid-lowering therapy for primary prevention (40%) or secondary prevention (60%) of cardiovascular events (CVEs). The intervention was the pharmaceutical care program MeMO (Medication Monitoring and Optimisation) in 9 community pharmacies in the Netherlands, based on continuous monitoring and optimization of lipid-lowering therapy in new patients. The follow-up period of the program was 1 year. The main outcome of the intervention program was discontinuation of lipid-lowering therapy. This outcome was extrapolated in the economic model to lifelong costs, quality of life, reductions in cardiovascular events, and incremental cost-effectiveness ratios. Patients in the MeMO program had a lower risk for therapy discontinuation, RR = 0.49 (0.37 to 0.66); the effectiveness was similar in primary and secondary prevention. In a cohort of 1,000 primary and secondary prevention patients, the MeMO program resulted in a reduction of 7 nonfatal strokes, 2 fatal strokes, 16 nonfatal myocardial infarctions (MIs), 7 fatal MIs, and 16 revascularizations over patients' lifetime. Additional medication, disease management, and intervention costs in the MeMO program were €411,000; the cost savings due to reduced CVEs were €443,000. The MeMO program resulted in 84 quality-adjusted life-years (QALYs) gained and net cost savings of €32,000. Clinical benefits and cost savings were highest in the secondary prevention population. Pharmaceutical care in community pharmacies can improve statin therapy adherence, resulting in better prevention of CVEs. The MeMO program resulted in considerable clinical benefits and net cost savings. Programs by community pharmacies targeted at improving adherence may provide good value for money, and health care insurers should consider reimbursing these activities.