Effect of a Medication-Taking Behavior Feedback Theory–Based Intervention on Outcomes in Patients With Heart Failure

Abstract

BACKGROUND Medication nonadherence contributes to hospitalization and mortality, yet there have been few interventions tested that improve adherence and reduce hospitalization and mortality in heart failure (HF). OBJECTIVE To determine whether an education intervention improved medication adherence and cardiac event-free survival. METHODS A randomized controlled trial was conducted on 82 HF patients. The intervention was based on the Theory of Planned Behavior (TPB) and included feedback of medication-taking behavior using the Medication Event Monitoring System (MEMS). Patients were assigned to one of three groups: 1) theory-based education plus MEMS feedback (PLUS), 2) theory-based education only (LITE), or 3) a usual care control group. Cardiac events were collected for 9 months. RESULTS Patients in both intervention groups were more adherent over follow-up compared to control group. In Cox regression, patients in either intervention group had a longer event-free survival compared to those in the control group before and after controlling age, marital status, financial status, ejection fraction, New York Heart Association functional class, angiotensin-converting enzyme inhibitor use, and presence or absence of a significant other during the intervention (p < .05). CONCLUSION Use of an intervention based on the TPB improves medication adherence and outcomes in patients with HF, and as such, offers promise as a clinically applicable intervention to help patients with HF adhere to their prescribed regimen.

Improving medication adherence of patients with chronic heart failure: challenges and solutions

“…The adherence rates measured using this method ranged from 65% to 94% in five studies. [29][30][31][32][33] MEMS devices cannot assess whether a patient took the pill once the bottle was opened which limits its utilization. 15 Other limitations of MEMS device are that it is too expensive, only one prescription can be used in one MEMS bottle, and many patients are using pill box.…”

“…The results from these studies provide insight on the current status of medication adherence. For purposes of this paper, these studies were grouped into four categories: 1) pharmacist-led education, 16,22,29,33 2) registered nurse-or case mangers-led education, 21,23,32 3) usage of tele-health or web-based modules, 19,30,31 and 4) interdisciplinary team-led education. 24 …”

The European Heart Failure Self-care Behaviour Scale: New insights into factorial structure, reliability, precision and scoring procedure

“…HF is associated with frequent hospital admissions, emergency department visits, and low quality of life but better self-care has been shown to improve patients outcomes [2,3].…”

Desirability and feasibility of wireless electronic monitoring of medications in clinical trials

“…Just as people are electronically tracking other parts of their personal regimens (e.g., minutes of exercise, steps, caloric intake) and health outcomes or progress toward health goals (e.g., weight, blood pressure, pain) through various devices (e.g., fitbit, pedometer), apps, and websites, they now have useful, accurate, timely tools for quantifying their medication usage, providing data for better understanding their behavior so as to be more capable of changing it. EMDs provide feedback consistent with control systems theory [39] and have the potential to enhance health behavior in accord with other health behavior change models such as the theory of planned behavior [37].…”

“…The costs of providing monitored clinical care perhaps are best viewed relative to the overall costs for managing conditions, including NA and its consequences. For example, the estimated costs of heart failure in 2010 in the USA were $39.2 billion with NA considered to be contributing substantially to those costs [37]. To the extent that EMDs can help to reduce NA [37], the costs of using EMDs could prevent and offset other health care costs.…”