Multifaceted Intervention to Improve Medication Adherence and Secondary Prevention Measures After Acute Coronary Syndrome Hospital Discharge

Abstract

IMPORTANCE Adherence to cardioprotective medication regimens in the year after hospitalization for acute coronary syndrome (ACS) is poor.OBJECTIVE To test a multifaceted intervention to improve adherence to cardiac medications. DESIGN, SETTING, AND PARTICIPANTSIn this randomized clinical trial, 253 patients from 4 Department of Veterans Affairs medical centers located in Denver (Colorado), Seattle (Washington); Durham (North Carolina), and Little Rock (Arkansas) admitted with ACS were randomized to the multifaceted intervention (INT) or usual care (UC) prior to discharge. INTERVENTIONSThe INT lasted for 1 year following discharge and comprised (1) pharmacist-led medication reconciliation and tailoring; (2) patient education; (3) collaborative care between pharmacist and a patient's primary care clinician and/or cardiologist; and (4) 2 types of voice messaging (educational and medication refill reminder calls). MAIN OUTCOMES AND MEASURESThe primary outcome of interest was proportion of patients adherent to medication regimens based on a mean proportion of days covered (PDC) greater than 0.80 in the year after hospital discharge using pharmacy refill data for 4 cardioprotective medications (clopidogrel, β-blockers, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors [statins], and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers [ACEI/ARB]). Secondary outcomes included achievement of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) level targets. RESULTSOf 253 patients, 241 (95.3%) completed the study (122 in INT and 119 in UC). In the INT group, 89.3% of patients were adherent compared with 73.9% in the UC group (P = .003). Mean PDC was higher in the INT group (0.94 vs 0.87; P< .001). A greater proportion of intervention patients were adherent to clopidogrel (86.8% vs 70.7%; P = .03), statins (93.2% vs 71.3%; P < .001), and ACEI/ARB (93.1% vs 81.7%; P = .03) but not β-blockers (88.1% vs 84.8%; P = .59). There were no statistically significant differences in the proportion of patients who achieved BP and LDL-C level goals. CONCLUSIONS AND RELEVANCEA multifaceted intervention comprising pharmacist-led medication reconciliation and tailoring, patient education, collaborative care between pharmacist and patients' primary care clinician and/or cardiologist, and voice messaging increased adherence to medication regimens in the year after ACS hospital discharge without improving BP and LDL-C levels. Understanding the impact of such improvement in adherence on clinical outcomes is needed prior to broader dissemination of the program.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00903032

Patients’ and Providers’ Perspectives of a Polypill Strategy to Improve Cardiovascular Prevention in Australian Primary Health Care

“…Multifaceted approaches to improve adherence have been trialled internationally. 8,36,37 In Australian primary health care, a quality improvement intervention with pharmacists-led education to improve health literacy and electronic decision support for the prescribing of preventative medications has been shown to be effective. 36 Our study findings suggest that the polypill strategy could potentially be used successfully and synergistically with similar health service strategies to improve medication persistence in this setting.…”

Multi-center randomized trial on the impact of “CONFIDENCE” communication program aimed at evaluating therapy adherence of patients with registered myocardial infarction who underwent successful revascularization by stenting or thrombolysis after discharg

“…Пациенты будут разделены на две группы: стандартное амбулаторное наблюдение (n = 2 000), программа «До-верие» (n = 2 000). Необходимый объем выборки для данного исследования рассчитывался на основе дан-ных Ho P.M. [10]. В исследовании 253 пациентов (122 в группе с программой по улучшению приверженности, включавшей обучение пациентов и звонки с напомина-ниями, и 119 пациентов в группе со стандартным веде-нием) была получена разница в 89,3% приверженных пациентов в группе с программой против 73,9% в груп-пе без программы (приверженными считали больных, которые принимали каждый из 4 препаратов не менее 80% дней в году).…”

Prediction of high risk of non-adherence to antiplatelet treatment

“…Adherence was defined as the proportion of drug availability (the number of purchased clopidogrel tablets) to drug requirement (the number of clopidogrel tablets needed to complete the treatment = number of follow-up days). Following previously published studies [15][16][17][18], adherence was arbitrarily judged adequate when the proportion exceeded 80%.…”