Community pharmacy represents an important setting to identify patients who may benefit from an adherence intervention, however it remains unclear whether it would be feasible to monitor antihypertensive adherence within the workflow of community pharmacy. The aim of this study was to identify facilitators and barriers to monitoring antihypertensive medication adherence of older adults at the point of repeat dispensing. We undertook a factorial survey of Irish community pharmacists, guided by a conceptual model adapted from the Theory of Planned Behaviour (TPB). Respondents completed four sections, 1) five factorial vignettes (clinical scenario of repeat dispensing), 2) a medication monitoring attitude measure, 3) subjective norms and self-efficacy questions, and 4) demographic and workplace questions. Barriers and facilitators to adherence monitoring behaviour were identified in factorial vignette analysis using multivariate multilevel linear modelling, testing the effect of both contextual factors embedded within the vignettes (section 1), and respondent-level factors (sections 2–4) on likelihood to perform three adherence monitoring behaviours in response to the vignettes. Survey invites (n = 1543) were sent via email and 258 completed online survey responses were received; two-thirds of respondents were women, and one-third were qualified pharmacists for at least 15 years. In factorial vignette analysis, pharmacists were more inclined to monitor antihypertensive medication adherence by examining refill-patterns from pharmacy records than asking patients questions about their adherence or medication beliefs. Pharmacists with more positive attitudes towards medication monitoring and normative beliefs that other pharmacists monitored adherence, were more likely to monitor adherence. Contextual factors also influenced pharmacists’ likelihood to perform the three adherence monitoring behaviours, including time-pressures and the number of days late the patient collected their repeat prescription. Pharmacists’ normative beliefs and the number of days late the patient collected their repeat prescription had the largest quantitative influence on responses. This survey identified that positive pharmacist attitudes and normative beliefs can facilitate adherence monitoring within the current workflow; however contextual time-barriers may prevent adherence monitoring. Future research should consider these findings when designing a pharmacist-led adherence intervention to be integrated within current pharmacy workflow.

中文翻译：

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决定在爱尔兰社区药房中监测降压药依从性的决定因素：一项析因调查

社区药房是确定可能从依从性干预中受益的患者的重要场所，但是目前尚不清楚在社区药房工作流程中监测降压依从性是否可行。这项研究的目的是确定在重复分配时监测老年人降压药物依从性的促进因素和障碍。我们在根据计划行为理论（TPB）改编的概念模型的指导下，对爱尔兰社区药剂师进行了析因调查。受访者完成了四个部分，1）5个析因小插曲（重复配药的临床情况），2）药物监测态度测度，3）主观规范和自我效能问题以及4）人口统计学和工作场所问题。使用多变量多级线性建模，在因子小插图分析中确定了遵守监测行为的障碍和促进者，测试了小插曲中嵌入的情境因素（第1节）和受访者水平因素（第2-4节）对执行可能性的影响响应小插图的三个依从性监视行为。通过电子邮件发送了调查邀请（n = 1543），并且收到了258份完整的在线调查回复；三分之二的受访者是女性，三分之一的人是合格的药剂师，至少持续了15年。在析因小插图分析中，与询问患者有关其依从性或用药信念的问题相比，药剂师更倾向于通过检查药房记录中的补充模式来监测降压药物的依从性。药剂师对药物监测的态度更加积极，并且规范性地相信其他药剂师监测了依从性，因此更有可能监测依从性。上下文因素还影响了药剂师执行三种依从性监测行为的可能性，包括时间压力和患者延迟收集重复处方的天数。药剂师的规范性信念以及患者收集重复处方的天数对反应有最大的定量影响。这项调查表明，积极的药剂师态度和规范性信念可以促进当前工作流程中的依从性监测；但是，上下文时间障碍可能会阻止遵守情况监视。