A randomized trial of direct-to-patient communication to enhance adherence to beta-blocker therapy following myocardial infarction.
BACKGROUND
Although beta-blockers are routinely prescribed at hospital discharge after myocardial infarction (MI), patients' adherence has been shown to decline substantially over time. We sought to test the hypothesis that a simple, direct-to-patient intervention can improve adherence to beta-blocker therapy following MI.


METHODS
We conducted a cluster randomized controlled trial in 4 geographically dispersed health maintenance organizations testing the hypothesis that a simple direct-to-patient intervention could improve adherence. The study was carried out from June 2004 to March 2005. The primary analyses were based on 836 post-MI patients who were dispensed a beta-blocker prescription after discharge. The intervention consisted of 2 mailings 2 months apart describing the importance of beta-blocker use. The main outcomes were proportion of days covered with beta-blocker therapy and percentage of patients with at least 80% of days covered in the 9 months after the first mailing. Analyses were adjusted for age, sex, total medications dispensed, days between MI and intervention, and intervention site.


RESULTS
Over the entire follow-up period, patients in the treatment arm had a mean absolute increase of 4.3% of days covered per month compared with patients in the control arm (a 5.7% relative change from baseline), representing 1.3 extra days (P = .04). Treatment patients were 17% more likely (relative risk, 1.17; 95% confidence interval, 1.02-1.29) to have 80% of days covered. For every 16 patients receiving the intervention, 1 additional patient would become adherent (80% or more days covered per month).


CONCLUSIONS
A low-cost, easily replicable effort to increase adherence can have a demonstrable impact on beta-blocker adherence following MI. Trial Registration clinicaltrials.gov Identifier: NCT00211172.
Smith
David H
DH
Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA. david.h.smith@kpchr.org
Kramer
Judith M
JM
Perrin
Nancy
N
Platt
Richard
R
Roblin
Douglas W
DW
Lane
Kimberly
K
Goodman
Michael
M
Nelson
Winnie W
WW
Yang
Xiuhai
X
Soumerai
Stephen B
SB
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010349:Patient Compliance; D010353:Patient Education as Topic; D011177:Postal Service; D016016:Proportional Hazards Models; D014481:United States
D000319:Adrenergic beta-Antagonists