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A new study looking at in-person, electronic, telephonic, fax and mail communications that counsel patients to stay on their medications concludes that pharmacists at a retail store are the most influential health care "voice" in getting patients to take medicine as prescribed.

The research, based on a review of more than 40 years of studies published in medical journals, showed that nurses talking with patients as they are discharged from a hospital are the second most influential voice encouraging patients to stay on their medicines. Both in-store pharmacists and hospital-based nurses are more effective than pharmacists communicating to a patient via the telephone or doctors instructing patients regarding prescriptions, the researchers said.

These findings are contained in two separate reviews of medical journal studies sponsored by CVS Caremark and carried out by a team of researchers from Harvard University, Brigham and Women's Hospital and CVS Caremark. This week the American Journal of Managed Care (AJMC) published a review that focused on communications between pharmacists and nurses with their patients. The AJMC study builds upon a review by the same researchers that focused on doctor and patient communications and was published last May in the Journal of General Internal Medicine.

"There have been many studies on the subject of boosting adherence. We decided it was important to review the total body of work to determine which communication channel had the greatest impact," said William Shrank, MD, MSHS, of Brigham and Women's Hospital and Harvard, and a lead author of the studies. Shrank said the researchers combed through more than 6,500 medical journal articles published between 1966 and December 31, 2008, before reviewing 168 articles in full.

The study found that programs using mail, fax and brochure-type (non-personal) communications had relatively low impact on promoting patient adherence. A review of the use of electronic communications, such as videos and interactive technology, show promise but were determined to have medium impact on increasing adherence among patients.

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