Multifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge: a randomized clinical trial.
| dc.contributor.author | Ho, P Michael | |
| dc.contributor.author | Lambert-Kerzner, Anne | |
| dc.contributor.author | Carey, Evan P | |
| dc.contributor.author | Fahdi, Ibrahim E | |
| dc.contributor.author | Bryson, Chris L | |
| dc.contributor.author | Melnyk, S Dee | |
| dc.contributor.author | Bosworth, Hayden B | |
| dc.contributor.author | Radcliff, Tiffany | |
| dc.contributor.author | Davis, Ryan | |
| dc.contributor.author | Mun, Howard | |
| dc.contributor.author | Weaver, Jennifer | |
| dc.contributor.author | Barnett, Casey | |
| dc.contributor.author | Barón, Anna | |
| dc.contributor.author | Del Giacco, Eric J | |
| dc.date.accessioned | 2024-02-01T15:35:05Z | |
| dc.date.available | 2024-02-01T15:35:05Z | |
| dc.date.issued | 2014-02 | |
| dc.description.abstract | ImportanceAdherence to cardioprotective medication regimens in the year after hospitalization for acute coronary syndrome (ACS) is poor.ObjectiveTo 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. RESULTS Of 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 registrationclinicaltrials.gov Identifier: NCT00903032. | |
| dc.identifier | 1779681 | |
| dc.identifier.issn | 2168-6106 | |
| dc.identifier.issn | 2168-6114 | |
| dc.identifier.uri | ||
| dc.language | eng | |
| dc.publisher | American Medical Association (AMA) | |
| dc.relation.ispartof | JAMA internal medicine | |
| dc.relation.isversionof | 10.1001/jamainternmed.2013.12944 | |
| dc.rights.uri | ||
| dc.subject | Cardiotonic Agents | |
| dc.subject | Prognosis | |
| dc.subject | Patient Discharge | |
| dc.subject | Retrospective Studies | |
| dc.subject | Follow-Up Studies | |
| dc.subject | Interprofessional Relations | |
| dc.subject | Physician-Patient Relations | |
| dc.subject | Time Factors | |
| dc.subject | Patient Education as Topic | |
| dc.subject | Acute Coronary Syndrome | |
| dc.subject | Medication Adherence | |
| dc.subject | Secondary Prevention | |
| dc.title | Multifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge: a randomized clinical trial. | |
| dc.type | Journal article | |
| duke.contributor.orcid | Bosworth, Hayden B|0000-0001-6188-9825 | |
| pubs.begin-page | 186 | |
| pubs.end-page | 193 | |
| pubs.issue | 2 | |
| pubs.organisational-group | Duke | |
| pubs.organisational-group | School of Medicine | |
| pubs.organisational-group | Basic Science Departments | |
| pubs.organisational-group | Clinical Science Departments | |
| pubs.organisational-group | Institutes and Centers | |
| pubs.organisational-group | Medicine | |
| pubs.organisational-group | Psychiatry & Behavioral Sciences | |
| pubs.organisational-group | Medicine, General Internal Medicine | |
| pubs.organisational-group | Duke Cancer Institute | |
| pubs.organisational-group | Duke Clinical Research Institute | |
| pubs.organisational-group | Institutes and Provost's Academic Units | |
| pubs.organisational-group | Center for the Study of Aging and Human Development | |
| pubs.organisational-group | Initiatives | |
| pubs.organisational-group | Duke Science & Society | |
| pubs.organisational-group | Population Health Sciences | |
| pubs.organisational-group | Duke Innovation & Entrepreneurship | |
| pubs.organisational-group | Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences | |
| pubs.organisational-group | Duke - Margolis Center For Health Policy | |
| pubs.publication-status | Published | |
| pubs.volume | 174 |