***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To review the literature on strategies to optimize medication adherence in community-dwelling older adults and to make recommendations for clinical practice . METHODS : A systematic literature search was conducted using the MEDLINE , CINAHL , PsycINFO , International Pharmaceutical Abstract s , and EMBASE data bases for r and omized controlled trials examining strategies to optimize medication adherence in patients aged 65 or older prescribed long-term medication regimens . Additional studies were found by examining the reference lists of systematic review s and selected papers . 34 papers reporting on 33 studies met the eligibility criteria and were included in this review . RESULTS : Improvement in adherence was mixed across the studies examining educational interventions , with only 12 of the 28 studies showing improvement in adherence ; most were delivered by pharmacists . Effect sizes for the statistically significant educational interventions ranged from Cohen 's d = 0.14 to 4.93 . Four of the 5 interventions using memory aids and cues , some in conjunction with newer technologies , improved adherence . Effect sizes for the statistically significant interventions using memory aids and cues ranged from Cohen 's d = 0.26 to 2.72 . CONCLUSION : The evidence from this review does not clearly support one single intervention to optimize medication adherence in older patients . Future studies should explore suggestive strategies , such as tailored interventions involving ongoing contact , and should endeavor to correct method ologic weaknesses found in the literature OBJECTIVE To compare patients ' adherence to therapy , expectations , satisfaction with pharmacy services , and health-related quality of life ( HRQOL ) after the provision of pharmaceutical care with those of patients who received traditional pharmacy care .  DESIGN R and omized controlled cluster design . SETTING Sixteen community pharmacies in Alberta , Canada . PATIENTS AND OTHER PARTICIPANTS Ambulatory elderly ( > or = 65 years of age ) patients covered under Alberta Health & Wellness 's senior drug benefit plan and who were concurrently using three or more medications according to pharmacy profiles . INTERVENTION Pharmacies were r and omly assigned to either treatment ( intervention ) or control ( traditional pharmacy care ) groups . Patients at treatment pharmacies were recruited into the study , and pharmacists provided comprehensive pharmaceutical care services . Pharmacists at control pharmacies continued to provide traditional pharmacy care . MAIN OUTCOME MEASURES Study participants ' opinions , adherence to therapy , and scores on the Medical Outcomes Study 36-Item Short Form Health Survey ( SF-36 ) . RESULTS Compared with those of patients receiving traditional care , treatment patients ' expectations that their pharmacist would perform activities congruent with pharmaceutical care changed over the study period . Treatment patients ' satisfaction with the constructs " trust , " " evaluation and goal setting , " and " communicates with doctor " were also positively affected . HRQOL and patient adherence were not significantly affected by pharmaceutical care interventions . CONCLUSION Successful implementation of a pharmaceutical care practice model has the potential to increase patients ' satisfaction with their pharmacists ' activities and may increase patients ' expectations that pharmacists will work on their behalf to assist them with their health care needs . If pharmaceutical care affects patients ' HRQOL , instruments more specific than the SF-36 may be needed to detect the differences RATIONALE , AIMS AND OBJECTIVES DEPICT ( Descriptive Elements of Pharmacist Intervention Characterization Tool ) was created in response to the frequently reported issue of poor intervention description across studies assessing the impact of clinical pharmacy activities . The aim of this study was to create an improved version of DEPICT ( i.e. DEPICT 2 ) to better characterize clinical pharmacy services in order to ensure consistent reporting , therefore enhancing reproducibility of interventions in practice . METHOD A qualitative approach through a thematic content analysis was performed to identify components of pharmacist interventions described in 269 r and omized controlled trials . A preliminary version of DEPICT 2 was applied independently by two authors to a r and om sample of 85 of the 269 RCTs and reliability determined by the prevalence-adjusted bias-adjusted kappa ( PABAK ) or the intraclass correlation coefficient ( ICC ) . The final version of DEPICT 2 was compared against DEPICT 1 . RESULTS The final version of DEPICT 2 comprised 146 items and 11 domains . The inter-rater agreement analysis showed that DEPICT presented good to optimal reproducibility , with a mean PABAK value of 0.87 ( 95 % CI 0.85 - 0.89 ) and a mean ICC value of 0.88 ( 95 % CI 0.62 - 1.14 ) . The mean difference between items checked in the two versions ( DEPICT 2 - DEPICT 1 ) was 10.58 ( 95 % CI 9.55 - 11.61 ) , meaning that approximately 11 more components were identified in the new version of DEPICT . CONCLUSIONS DEPICT 2 is a reliable tool to characterize components of clinical pharmacy services , which should be used to ensure consistent reporting of interventions to allow their reproducibility in practice The objective of this systematic review was to evaluate the impact of pharmacist delivered community-based services to optimise the use of medications for mental illness . Twenty-two controlled ( r and omised and non-r and omised ) studies of  pharmacists ' interventions in community and residential aged care setting s identified in international scientific literature were included for review . Papers were assessed for study design , service recipient , country of origin , intervention type , number of participating pharmacists , method ological quality and outcome measurement . Three studies showed that pharmacists ' medication counselling and treatment monitoring can improve adherence to antidepressant medications among those commencing treatment when calculated using an intention-to-treat analysis . Four trials demonstrated that pharmacist conducted medication review s may reduce the number of potentially inappropriate medications prescribed to those at high risk of medication misadventure . The results of this review provide some evidence that pharmacists can contribute to optimising the use of medications for mental illness in the community setting . However , more well design ed studies are needed to assess the impact of pharmacists as members of community mental health teams and as providers of comprehensive medicines information to people with schizophrenia and bipolar OBJECTIVE : To compare medication adherence calculated from four different data sources including a pill count and self-report obtained during a home medication history , as well as calculations based on refill frequency derived from a provincial prescription cl aims data base ( manual and electronic ) . DESIGN : Baseline medication adherence was collected as part of a prospect i ve , r and omized , controlled study . Mean medication adherence results obtained from the four data sources were compared using repeated- measures ANOVA followed by a Tukey 's multiple range test . SETTING : A pharmacy consultation service located at an interdisciplinary wellness center for noninstitutionalized elderly . PATIENTS : 65 years or older , noninstitutionalized , taking one or more prescribed or nonprescribed medications . Clients would either present to the wellness center or be referred by the Provincial Home Care program . RESULTS : When calculated from self-report or manual or electronic prescription cl aims data , mean percent adherence by drug was high and not statistically different ( 95.8 % ± 17.1 % , 107.6 % ± 40.3 % , and 94.6 % ± 24.0 % , respectively ) , whereas the pill count adherence was significantly lower at 74.0 % ± 41.5 % ( p < 0.0001 ) . CONCLUSIONS : An unexpected finding was that the pill count technique used in this study of elderly clients using chronic , repeat medications appeared to underestimate medication adherence . Numerous other limitations of pill count , self-report , and a province-wide prescription cl aims data base in estimating medication adherence are presented . When using medication adherence as a process measure , the research er and practitioner should be aware of the limitations unique to the data source they choose , and interpret data cautiously The objectives of this study were to compare indices of 24-hour blood pressure ( BP ) following a physician-pharmacist collaborative intervention and to describe the associated changes in antihypertensive medications . This was a secondary analysis of a prospect i ve , cluster-r and omized clinical trial conducted in 6 family medicine clinics r and omized to co-managed ( n=3 clinics , 176 patients ) or control ( n=3 clinics , 198 patients ) groups .  Mean ambulatory systolic BP ( SBP ) was significantly lower in the co-managed vs the control group : daytime BP 122.8 mm Hg vs 134.4 mm Hg ( P<.001 ) ; nighttime SBP 114.8 mm Hg vs 123.7 mm Hg ( P<.001 ) ; and 24-hour SBP 120.4 mm Hg vs 131.8 mm Hg ( P<.001 ) , respectively . Significantly more drug changes were made in the co-managed than in the control group ( 2.7 vs 1.1 changes per patient , P<.001 ) , and there was greater diuretic use in co-managed patients ( 79.6 % vs 62.6 % , P<.001 ) . Ambulatory BPs were significantly lower for the patients who had a diuretic added during the first month compared with those who never had a diuretic added ( P<.01 ) . Physician-pharmacist co-management significantly improved ambulatory BP compared with the control group . Antihypertensive drug therapy was intensified much more for patients in the co-managed group A consecutive sample of 64 healthy adults ( 33 female and 31 male ) were recruited at the University of Michigan Medical Center , Ann Arbor . Data were available for analysis on 57 subjects . The participants were asked to take a single daily dose of aspirin ranging from 0 to 640 mg . Adherence to the daily aspirin ingestion was measured by self-report and the  Medication Event Monitoring System  ( MEMS , Aprex Corp , Fremont , Calif ) ; adherence rate for the study population was 35 % . The adherence rates for all dosing errors between self-report and Medication Event Monitoring System were significantly different ( P = .002 ) . There was no significant gender difference in adherence rates . Adherence to regular aspirin ingestion was poor in healthy , paid subjects despite explicit , written and verbal instructions . Patient self-report alone is not a reliable measure of adherence BACKGROUND Nonadherence to cardiovascular medications is a significant public health problem . This r and omized study evaluated the effect on medication adherence of linking hospital and community pharmacists . METHODS Hospitalized patients with coronary artery disease discharged on aspirin , β-blocker , and statin who used a participating pharmacy were r and omized to usual care or intervention . The usual care group received discharge counseling and a letter to the community physician ; the intervention group received enhanced in-hospital counseling , attention to adherence barriers , communication of discharge medications to community pharmacists and physicians , and ongoing assessment of adherence by community pharmacists . The primary end point was self-reported use of aspirin , β-blocker , and statin at 6 months postdischarge ; the secondary end point was a ≥ 75 % proportion of days covered ( PDC ) for β-blocker and statin through 6 months postdischarge . RESULTS Of 143 enrolled patients , 108 ( 76 % ) completed 6-month follow-up , and 115 ( 80 % ) had 6-month refill records . There was no difference between intervention and control groups in self-reported adherence ( 91 % vs 94 % , respectively , P = .50 ) . Using the PDC to determine adherence to β-blockers and statins , there was better adherence in the intervention versus control arm , but the difference was not statistically significant ( 53 % vs 38 % , respectively , P = .11 ) . Adherence to β-blockers was statistically significantly better in intervention versus control ( 71 % vs 49 % , respectively , P = .03 ) . Of 85 patients who self-reported adherence and had refill records , only 42 ( 49 % ) were also adherent by PDC . CONCLUSIONS The trend toward better adherence by refill records with the intervention should encourage further investigation of engaging pharmacists to improve continuity of care This study was conducted to evaluate the effect of automated telephone patient monitoring and counseling on patient adherence to antihypertensive medications and on blood pressure control . A r and omized controlled trial was conducted in 29 greater Boston communities . The study subjects were 267 patients recruited from community sites who were > or= 60 years of age , on antihypertensive medication , with a systolic blood pressure ( SBP ) of > or= 160 mm Hg and /or a diastolic blood pressure ( DBP ) of > or= 90 mm Hg . The study compared subjects who received usual medical care  with those who used a computer-controlled telephone system in addition to their usual medical care during a period of 6 months . Weekly , subjects in the telephone group reported self-measured blood pressures , knowledge and adherence to antihypertensive medication regimens , and medication side-effects . This information was sent to their physicians regularly . The main study outcome measures were change in antihypertensive medication adherence , SBP and DBP during 6 months , satisfaction of patient users , perceived utility for physicians , and cost-effectiveness .  The mean age of the study population was 76.0 years ; 77 % were women 
    Output:
    
Clinical pharmacy services that focused on specific medical conditions , such as hypertension or diabetes mellitus , revealed a positive impact of pharmacists ’ interventions on patient outcomes .
For other medical conditions , however , the results were inconclusive ( e.g. , dyslipidemia or thromboprophylaxis ) .
Interventions that targeted medication adherence and assessed the impact of clinical pharmacy services in prescription appropriateness also produced inconclusive results because of the variability of methods used to assess both medication adherence and medication appropriateness .
Conclusions Systematic review s that assessed clinical pharmacy services targeting specific conditions were more conclusive given that the intervention was well defined , and the measured outcomes were unequivocal and tangible .
Conversely , the results were inconclusive for interventions with a broader target and with monitoring parameters that were unclearly established or inconsistently assessed across studies .