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8 9 As such, there are no one-size-fits-all solutions to address non-adherence.
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4–7 In addition, there may be other drug-related problems, such as difficulties with intake or high costs, that can lead to non-adherence. These reasons include lack of attention, lack of knowledge, high concerns and/or low necessity beliefs, which can reduce motivation. 4–7 The reasons underlying intentional and unintentional non-adherence are not entirely independent and are heterogeneous. Non-adherence could arise following a conscious decision after balancing the pros and cons of medication (intentional non-adherence), could be due to a lack of understanding of the medication regimen or due to forgetfulness (unintentional non-adherence). Previous studies showed that patients may not take their medication for various reasons. 3 Therefore, effective intervention strategies to enhance adherence are urgently required. 2 Notably, non-adherence to antihypertensive medications is associated with poor health outcomes and increased healthcare costs. 1 However, although effective pharmacological treatment is available, adherence to antihypertensive medications in patients with type 2 diabetes is known to be suboptimal. In patients with type 2 diabetes, the pharmacological treatment of comorbid hypertension can substantially reduce the risk of cardiovascular complications. The implementation process will be evaluated using the RE-AIM framework, which will enable us to carefully interpret the results and guide us when scaling up the intervention to include a larger population in Indonesia and other lower-middle-income settings.Īs is common with many behavioural intervention studies, it is not possible to blind the researchers and pharmacists to the group allocation of patients.
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This study is designed as a cluster randomised controlled trial to reduce the risk of bias and contamination across study groups. The intervention aligns with the current workflow and resources in the daily clinical practice of a lower-middle-income country and will not require a substantial change to the current care system. Simple question-based flowcharts and an innovative adherence intervention wheel are provided to support the pharmacy staff. The pharmacist-led intervention programme uses principles of targeting by screening for non-adherence and tailoring to the patients’ personal adherence problems to enhance its potential effect.