Background Adherence is a key factor in achieving good clinical outcomes in patients undergoing long-term treatment. Meeting with patients is fundamental in educating them on correct drug use, and recommending dietary and lifestyle changes.

Purpose To assess the clinical pharmacist (CP) counselling programme, up to the discharge and outpatient visits, to improve medicines adherence, reduce adverse drug events, and encourage positive behaviour.

Materials and Methods CP counselling was addressed to adult abdominal and cardiac surgery patients, including transplanted patients. The topics discussed were: importance of prescribed drugs and therapeutic indications, directions, and potential side effects. A drug information sheet was given to all patients. A survey was then conducted by the ISMETT Pharmacy Service from 1 May to 30 September 2012.

Results The survey included 524 patients, of whom 54.6% were transplant patients and 45.4% cardiology patients; 326 were male and 198 female, with a mean age of 56 ± 15.1. Of these patients, 97.5% (511/524) knew that respecting therapeutic recommendations improves outcomes and 85.3% (447/524) reported that the CP had explained the importance of correct dosage and mode of administration. However 11.5% (60/524) didn’t know the correct mode of administration and 6.3% (33/524) didn’t take their drugs on time. 4.8% (25/524) reported occasionally missing a dose, 32% of them (8/25) because of a lack of symptoms, and 68% (17/25) because of a regimen of multidrug treatment. CP counselling was repeated for patients who didn’t completely adhere to treatment. For clinical reasons and to increase patient compliance, the physician and CP changed the treatment from mycophenolate mofetil to mycophenolic acid for 7 patients, from immediate release tacrolimus to an extended release formulation for 1, and from mycophenolate mofetil to everolimus for 1. All patients reported that CP counselling had a positive effect and 58.6% asked to meet with the CP more often.

Conclusions Our survey confirmed that CP counselling improves patient outcomes and safety, results in stricter adherence to treatment and changes in patient behaviour, and contributes to better outcomes and faster convalescence.

No conflict of interest.