Patients with coronary artery disease who get ongoing support from their community pharmacy may adhere better to medications
Patients with coronary artery disease (CAD), who are discharged from the hospital on aspirin, a beta-blocker, and a statin, are more likely to keep taking their medications if the community pharmacist and physicians are more actively engaged and linked as part of a patient-focused intervention. That's the conclusion of a new study. The researchers developed an intervention to address some of the main reasons for lack of long-term adherence to prescribed medications such as incomplete knowledge of medications (including their benefits or harms), poor medication management skills, and insufficient social support.
The researchers compared patients discharged from the hospital who received the intervention with those who received usual care (discharge counseling and a letter to the community physician). The intervention consisted of educational materials beyond routine discharge counseling and a hospital pharmacist counseling patients and providing tools to overcome adherence barriers, such as a pocket medication card, list of tips, and a pillbox.
The hospital pharmacist in turn communicated the discharge medications and contact information to community pharmacists and physicians at the time of discharge, after which there was ongoing assessment of patient medication adherence by community pharmacists with physician contact as needed.
The researchers found no difference between self-reported adherence to the three medication types in the intervention and control groups (91 percent vs. 94 percent). For beta blocker and statin use through 6 months following discharge assessed with prescription refill records, adherence to these two drugs (defined as having the drugs for at least 75 percent of the follow-up days) was better for the intervention than the control group (53 percent vs. 38 percent), but this difference was not statistically significant. Adherence to beta blockers, however, was significantly better in the intervention than the control group (71 percent vs. 41 percent).
The researchers enrolled a total of 143 patients treated for CAD at Duke University Hospital or Southeastern Regional Medical Center in the trial, randomly assigning 71 patients to the intervention and 72 to the control arm. Out of the total, 108 (76 percent) completed the 6-month followup and 115 (80 percent) had 6-month refill records.
This study was funded in part by the Agency for Healthcare Research and Quality (HS10548) to the Duke Center for Education and Research on Therapeutics (CERT). For more information on the CERTs program, visit http://www.certs.hhs.gov.
More details are in "Patient-focused intervention to improve adherence to evidence-based medications: A randomized trial," by Sara Bristol Calvert, Pharm.D., Judith M. Kramer, M.D., M.S., Kevin J. Anstrom, Ph.D., and others in the April 2012 American Heart Journal 163(4), pp. 657-665.e1.