To the Editor: In their randomized controlled trial, Dr Lee and colleagues1 found a beneficial effect of a pharmacy care program on patient medication adherence. They attempted to compare broad strategies rather than isolate single processes, which is an appropriate focus.2 However, there are 2 points that need to be considered when interpreting their results.
First, while the increases in medication adherence and persistence are likely a result of the pharmacy care program, the same cannot be concluded about the clinical outcomes of blood pressure and lipid levels. This is because some nonpharmacological variables that could act as confounders were either not assessed or not adjusted for in their analyses. These factors include physical activity, diet, obesity, work status, and family history.3 - 4 It would be informative if the authors could present a baseline comparison of these variables in the 2 study groups and present an adjusted analysis if there were differences.
Second, this study may have more limited generalizability than was addressed by the authors. While they discussed the potential importance of financial barriers, it is also important to consider that the study population had a relatively high education level (only 7.5% of the participants had less than a high school education). Because limited education or literacy may be expected to attenuate the effects of an education program, their results may not be relevant for other countries that have a lower average education level5 or for segments of the US population with less literacy.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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