Results of the chronic heart failure intervention to improve medication adherence study: A randomized intervention in high-risk patients
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2015-04-01
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Background Poor adherence to evidence-based medications in heart failure (HF) is a major cause of avoidable hospitalizations, disability, and death. To test the feasibility of improving medication adherence, we performed a randomized proof-of-concept study of a self-management intervention in high-risk patients with HF. Methods Patients with HF who screened positively for poor adherence (<6 Morisky Medication Adherence Scale 8-item) were randomized to either the intervention or attention control group. In the intervention group (n = 44), a nurse conducted self-management training before discharge that focused on identification of medication goals, facilitation of medication-symptom associations, and use of a symptom response plan. The attention control group (n = 42) received usual care; both groups received follow-up calls at 1 week. However, the content of follow-up calls for the attention control group was unrelated to HF medications or symptoms. General linear mixed models were used to evaluate the magnitude of change in adherence and symptom-related events at 3-, 6-, and 12-month follow-up clinic visits. Efficacy was measured as improved medication adherence using nurse-assessed pill counts at each time point. Results Pooled over all time points, patients in the intervention group were more likely to be adherent to medications compared with patients in the attention control group (odds ratio 3.92, t = 3.51, P =.0007). Conclusions A nurse-delivered, self-care intervention improved medication adherence in patients with advanced HF. Further work is needed to examine whether this intervention can be sustained to improve clinical outcomes.
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Granger, BB, I Ekman, AF Hernandez, T Sawyer, MT Bowers, TA Dewald, Y Zhao, J Levy, et al. (2015). Results of the chronic heart failure intervention to improve medication adherence study: A randomized intervention in high-risk patients. American Heart Journal, 169(4). pp. 539–548. 10.1016/j.ahj.2015.01.006 Retrieved from https://hdl.handle.net/10161/29982.
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Bradi Bartrug Granger
Dr. Bradi Granger is a Research Professor at Duke University School of Nursing, Director of the Duke Heart Center Nursing Research Program, and adjunct faculty at the University of Gothenburg, Sweden. She is also a core faculty at the Duke-Margolis Center for Health Policy. Dr. Granger received her doctorate in nursing from the University of North Carolina at Chapel Hill, her MSN from Duke University, and her BSN from the University of Tennessee at Knoxville.
Dr. Granger has extensive clinical experience in cardiovascular nursing, and her clinical work as a Clinical Nurse Specialist has been dedicated to overcoming barriers to the use and conduct of research in the service setting through the development of pragmatic tools that change the way nurses learn about, apply, and conduct nursing science. She has developed an innovative model for clinical inquiry and research in the hospital setting, which has been adopted in clinical settings across the U.S. and abroad. Dr. Granger is an active member of the Council for the Advancement of Nursing Science, the American Association of Critical Care Nurses, the American Heart Association, and the European Society for Patient Adherence, Compliance, and Persistence.
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