An intervention study to enhance medication compliance in community-dwelling elderly individuals.
OBJECTIVE
To determine whether daily videotelephone or regular telephone reminders would increase the proportion of prescribed cardiac medications taken in a sample of elderly individuals who have congestive heart failure (CHF).


METHODS
The authors recruited community-dwelling individuals age 65 and older who had the primary or secondary diagnosis of CHF into a randomized controlled trial of reminder calls designed to enhance medication compliance. There were three arms: a control group that received usual care; a group that received regular daily telephone call reminders; and a group that received daily videotelephone call reminders. Compliance was defined as the percent of therapeutic coverage as recorded by Medication Event Monitoring System (MEMS) caps. Subjects were recruited from 2 sources: a large urban home health care agency and a large urban ambulatory clinic of a major teaching hospital. Baseline and post-intervention MOS 36-Item Short-Form Health Survey (SF-36) scores and Minnesota Living with Heart Failure (MLHF) scores were obtained.


RESULTS
There was a significant time effect during the course of the study from baseline to post-intervention (F[2,34] = 4.08, p < .05). Over time the elderly individuals who were called, either by telephone or videotelephone, showed enhanced medication compliance relative to the control group. There was a trend, but no significant difference between the two intervention groups. Both SF-36 and MLHF scores improved from baseline to post-intervention for all groups. There was no significant change in the SF-36 scores for the sample, but there was a significant change for the MLHF scores (p < .001). The control group had a significant fall off in the medication compliance rate during the course of the study, dropping from 81% to 57%.


CONCLUSIONS
Telephone interventions are effective in enhancing medication compliance and may prove more cost effective than clinic visits or preparation of pre-poured pill boxes in the home. Technologic advances which enable clinicians to monitor and enhance patient medication compliance may reduce costly and distressing hospitalization for elderly individuals with CHF.
Fulmer
T T
TT
Division of Nursing, New York University, NY 10012, USA.
Feldman
P H
PH
Kim
T S
TS
Carty
B
B
Beers
M
M
Molina
M
M
Putnam
M
M
D000359:Aftercare / Q000379:methods*; D000368:Aged; D000369:Aged, 80 and over; D003152:Community Health Nursing / Q000379:methods*; D006333:Heart Failure / Q000188:drug therapy* / Q000451:nursing / Q000523:psychology; D006801:Humans; D015403:Nursing Evaluation Research; D010349:Patient Compliance / Q000523:psychology*; D013689:Telephone