Patient-Centered Adherence Intervention After Acute Coronary Syndrome Hospitalization

• DOI: 10.1161/circoutcomes.111.962290
• Publication Date: 2012-07-18T22:16:39Z
• Authors: Anne Lambert-Kerzner; Eric J. Del Giacco; Ibrahim E. Fahdi; Chris L. Bryson; S. Dee Melnyk; Hayden B. Bosworth; Ryan Davis; Howard Mun; Jennifer Weaver; Casey Barnett; Tiffany Radcliff; Amanda Hubbard; Kevin D. Bosket; Evan Carey; Allison Virchow; Renee Mihalko-Cor...; Amy Kaufman; Kathy Marchant-Miros; P. Michael Ho
• Keywords: Patient Care Team; Health Knowledge, Attitudes, Practice; Cost-Benefit Analysis; Reminder Systems; Cardiovascular Agents; Community Pharmacy Services; Health Care Costs; Patient Readmission; Patient Discharge; Medication Adherence; 3. Good health; Hospitalization; 03 medical and health sciences; Medication Reconciliation; 0302 clinical medicine; Patient Education as Topic; Research Design; Patient-Centered Care; Humans; Interdisciplinary Communication; Prospective Studies; Acute Coronary Syndrome; Cooperative Behavior

Background— Adherence to cardioprotective medications in the year after acute coronary syndrome hospitalization is generally poor and is associated with increased risk of rehospitalization and mortality. Few interventions have specifically targeted this high-risk patient population to improve medication adherence. We hypothesize that a multifaceted patient-centered intervention could improve adherence to cardioprotective medications.

Methods and Results— To evaluate this intervention, we propose enrolling 280 patients with a recent acute coronary syndrome event into a multicenter randomized, controlled trial. The intervention comprises4 main components: (1) pharmacist-led medication reconciliation and tailoring; (2) patient education; (3) collaborative care between pharmacist and primary care provider/cardiologist; and (4) 2 types of voice messaging (educational and medication refill reminder calls). Patients in the intervention arm will visit with the study pharmacist ≈1 week post-hospital discharge. The pharmacist will work with the patient and collaborate with providers to reconcile medication issues. Voice messages will augment the educational process and remind patients to refill their cardioprotective medications. The study will compare the intervention versus usual care for 12 months. The primary outcome of interest is adherence using the ReComp method. Secondary and tertiary outcomes include achievement of targets for blood pressure and low-density lipoprotein, and reduction in the combined cardiovascular end points of myocardial infarction hospitalization, coronary revascularization, and all-cause mortality. Finally, we will also evaluate the cost-effectiveness of the intervention compared with usual care.

Conclusions— If the intervention is effective in improving medication adherence and demonstrating a lower cost, the intervention has the potential to improve cardiovascular outcomes in this high-risk patient population.