Barriers to medication adherence in chronic heart failure patients during home visits

Aim: To identify barriers to medication adherence in chronic heart failure patients during home visits; and to find solutions to address medication non-adherence.Method: This was an observational study of home visits by the chronic heart failure pharmacist that was made after referral from a multidisciplinary chronic heart failure service. The reasons for medication non-adherence and solutions to overcome them were recorded in 66 consecutive chronic heart failure patients. Barriers to medication adherence and subsequent interventions (education, counselling, motivational interviews), hospital readmissions, length of stay, mortality and cause of death were analysed 3 months after the first home visit.Results: Main reasons for medication non-adherence were poor and/or complex medication instructions (71%), running out of medications (33%) and adverse drug reactions (20%). Interventions included education and counselling (100%), reducing dosing frequency (64%) and introducing dose administration aids (32%). 10 complex chronic heart failure patients (15%) required multiple home visits, motivational interviews and telephone coaching. Hospital readmissions, average length of stay for readmissions and deaths due to chronic heart failure 3 months after the first home visit were 4.5%, 6.3 days and 3%, respectively.Conclusion: Multiple strategies were necessary to overcome barriers to medication adherence in chronic heart failure patients. Home visits by the pharmacist optimised medication adherence, thus potentially minimising unplanned hospital admissions.