HSR&D Home » Research » RCD 05-026 – HSR&D Study
Improving Medication Adherence After ACS Hospitalization
P. Michael Ho, MD PhD
Rocky Mountain Regional VA Medical Center, Aurora, CO
Funding Period: July 2006 - June 2011
Acute coronary syndromes, including acute myocardial infarction (MI) are the leading causes of hospitalization for veterans. Recent advances in the treatment of acute MI have led to declines in hospital mortality. Despite this, the risk of recurrent events and mortality after the index MI hospitalization remains substantial in the following year. Non-adherence to proven cardioprotective medications is a potentially modifiable risk factor that contributes to the persistently high risk of adverse outcomes following MI hospitalization. Prior studies have found that adherence to cardioprotective medications declines rapidly in the year following MI hospital discharge with only ~60% of patients still taking statins routinely at 1-year.
As a natural progression from my RCD which identified a high prevalence of medication non-adherence and the negative impact of non-adherence on adverse outcomes, the CDTA will focus on implementing a multi-faceted intervention to improve adherence to cardiovascular medications after ACS hosptial discharge. Addition details and the project objectives are outlined further below. This project was submitted and approved as an IIR in June 2008 with a score of 21.6.
The proposed IIR study will test the hypothesis that a multi-faceted patient-centered adherence intervention targeting veterans following ACS hospitalization improves adherence to cardioprotective medications, achievement of secondary prevention goals (achievement of BP and LDL targets), and is cost-effective. The proposed intervention will be based on the Chronic Care Model and the Medication Adherence Model conceptual frameworks. The intervention will adapt elements of prior successfully adherence interventions, including: collaborative care, patient education, tailoring of medication regimens, and tele-monitoring via interactive voice response (IVR) technology. This study will be tested at 3 sites randomizing 280 patients to intervention versus usual care for 12-months. The specific aims of the project as as follows:
1. To determine the effectiveness of a multi-faceted patient-centered adherence intervention versus usual care for improving adherence to cardioprotective medications (i.e., -blockers, statins, clopidogrel, and ACE-inhibitors/ARB) (primary outcome).
2. To determine the effectiveness of a multi-faceted intervention versus usual care for achieving secondary prevention targets for blood pressure and LDL cholesterol.
3. To determine the effectiveness of a multi-faceted intervention versus usual care for reducing the cardiovascular endpoints of MI, revascularization and all-cause mortality.
4. To assess the incremental cost-effectiveness of the multi-faceted patient-centered adherence intervention compared with usual care.
The CDTA will be critical to my continued development into an independent investigator. It will provide the necessary protected time to acquire additional research skills such as the conduct of a multi-center effectiveness clinical trial and formative evaluation of the intervention which is crucial prior to any widespread implementation efforts. The proposed mentors are nationally recognized VA health services researchers and include: 1) Dr. John S. Rumsfeld, nationally recognized VA cardiovascular health services researcher and Clinical Director of IHD-QUERI; 2) Dr. Mary K. Goldstein, Director of Clinical Services Geriatrics Research Education and Clinical Center (GRECC); and 3)Dr. Hayden Bosworth, Associate Director Center for Health Services Research in Primary Care. A CDTA will be crucial in continuing to build on the foundation of knowledge that I have acquired and my progression to an independent VA cardiovascular health services researcher.
Not yet available.
The project is still being conducted.
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DRA: Cardiovascular Disease, Health Systems
DRE: Epidemiology, Treatment - Observational, Prevention, Treatment - Efficacy/Effectiveness Clinical Trial
MeSH Terms: none