A pharmacist intervention for outpatients with heart failure can improve adherence to cardiovascular medications and decrease health care use and costs, but the benefit probably requires constant intervention because the effect dissipates when the intervention ceases. ClinicalTrials.gov registration number: NCT00388622.

No abstract

Purpose: We investigated whether patient-centered instructions for chronic heart failure medications increase comprehension and memory for medication information in older adults diagnosed with chronic heart failure. Design and Methods: Patient-centered instructions for familiar and unfamiliar medications were compared with instructions for the same medications from a chain pharmacy (standard pharmacy instructions). Thirty-two adults (age, M ¼ 63.8) read and answered questions about each instruction, recalled medication information (free recall), and then answered questions from memory (cued recall). Results: Patient-centered instructions were better recalled and understood more quickly than the standard instructions. Instructions for the familiar medications also were better recalled. Patient-centered instructions were understood more accurately for the unfamiliar medications, but standard instructions were understood more accurately for the familiar medications. However, the recall measures showed that the advantage of the standard format for familiar medications was short lived. Implications: The findings suggest that the patientcentered format may improve printed medication instructions available in many pharmacies, which should help older adults to better understand how to take their medications.

No abstract

No abstract

No abstract

No abstract

Objective-Data from electronic dosing monitors and published pharmacokinetic parameters were used to derive medication adherence measures for immediate-release metoprolol and examine their association with health care utilization of outpatients aged 50 years or older with heart failure.Methods-We used a 1-compartment model and published population pharmacokinetic parameters to estimate mean plasma metoprolol concentrations for patients treated for 6 to 12 months. In the absence of directly measured plasma concentrations, we calculated the intended mean plasma concentration (Cp′ ave ) under the assumption of perfect adherence to the prescribed dose and frequency of administration. Projected mean plasma concentrations (Cp ave ) were estimated by use of data from recorded dosing times. In addition to taking adherence (percentage of dose taken) and scheduling adherence (percentage of doses taken on schedule), we calculated the deviation from the intended exposure (ΔCp ave = Cp′ ave − Cp ave ) and the proportion of intended exposure achieved by the patient (Cp ave /Cp′ ave ). We assessed the association between the adherence measures and the numbers of emergency department visits and hospital admissions experienced by the patients. (N = 80) were aged 62 ± 8 years. Mean ΔCp ave and Cp ave /Cp′ ave were 7.9 ng/ mL (SD, 10.7) and 0.6 (SD, 0.3), respectively. Log-linear models adjusted for patient functional status indicated that greater deviation from the intended metoprolol exposure (ΔCp ave ) was associated with increased numbers of emergency department visits (P < .0001) and hospital admissions (P < . 0001). A higher proportion of intended exposure (Cp ave /Cp′ ave ) corresponded to a reduced number of emergency department visits (P = .0204) and hospital admissions (P = .0093). Taking adherence was univariately associated with both emergency department visits and hospital visits (P < .0001 and P = .0010, respectively). Scheduling adherence was associated with the number of emergency department visits (P = .0181) but not with the number of hospital admissions (P = .1602). Model selection procedures consistently chose the proposed measures over taking adherence and scheduling adherence. Results-PatientsConclusion-Deviation from the intended exposure and proportion of intended exposure achieved by the patient are valid adherence measures for immediate-release metoprolol and are associated with health care utilization. The potential utility of these measures for other β-adrenergic antagonists and perhaps other cardiovascular drugs should be investigated. Patients with chronic diseases must take medications regularly to prevent deteriorating illness requiring costly use of health care services such as emergency department (ED) visits and hospitalization. However, approximately half of all patients who are prescribed medications for chronic diseases do not adhere to their prescriptions. 1-3 Medication adherence is particularly important to patients with chronic heart failure (CHF) because of the propensity for suc...