Multifaceted Intervention Improves Medication Adherence for Veterans following Hospitalization for Acute Coronary Syndrome
BACKGROUND:
Adherence to cardio-protective drugs, in particular lipid-lowering agents, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARBs), and anti-platelet agents following hospital discharge for acute coronary syndrome (ACS) is poor. Moreover, among patients taking their cardiac medications, one-third stop at least one medication by one month. This randomized controlled study tested a multifaceted intervention to improve adherence to cardiac medications in the year after ACS hospital discharge. Investigators recruited 253 Veterans with ACS from four VAMCs, who were then randomized to the intervention (n=129) or usual care (n=124) prior to hospital discharge. The intervention lasted one year following hospital discharge and included four key components: 1) pharmacist-led medication reconciliation and tailoring, 2) patient education, 3) collaborative care between pharmacist and primary care provider and/or cardiologist, and 4) two types of voice messaging (educational and medication refill reminders). The primary outcome measure was the proportion of Veterans adherent to medications (i.e., beta-blockers, statins, ACE-I, ARB); secondary outcomes included achieved targets for blood pressure (< 140/90 mm Hg or < 130/80 mm Hg for patients with diabetes or chronic kidney disease) and low-density lipoprotein (LDL) cholesterol (< 100 mg/dL).
FINDINGS:
- Based on the four classes of cardio-protective medications, a greater proportion of Veterans in the intervention group were adherent to medications in the year following hospitalization for ACS compared to Veterans in the usual care group: 89% vs. 74%, respectively.
- For the secondary prevention measures, there were no differences in the proportion of patients who achieved BP and LDL goals.
- There were no significant differences between Veterans in the intervention and usual care groups for rehospitalization for myocardial infarction (7% vs. 4%), revascularization (12% vs. 18%), or death (9% vs. 8%).
LIMITATIONS:
- This study used pharmacy refill data to assess adherence in contrast to clinical trials that have traditionally used pill counts to assess adherence.
- This study included all Veterans who consented to participate, regardless of prior adherence behavior. In future studies, the authors suggest targeting patients who have exhibited non-adherence to medications, as they might obtain a greater benefit from an adherence intervention.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 08-302). Dr. Ho is co-Director of HSR&D's Center for Innovation for Veteran-Centered and Value-Driven Care in Denver, CO.
Ho P, Lambert-Kerzner A, Carey E, et al. Multifaceted Intervention to Improve Medication Adherence and Secondary Prevention Measures (Medication Study) after Acute Coronary Syndrome Hospital Discharge. JAMA Internal Medicine November 18, 2013;e-pub ahead of print.
