title: Patient-focused intervention to improve long-term adherence to evidence-based medications: a randomized trial.
abstract: BACKGROUND
  Nonadherence to cardiovascular medications is a significant public health problem. This randomized study evaluated the effect on medication adherence of linking hospital and community pharmacists.
  
  
  METHODS
  Hospitalized patients with coronary artery disease discharged on aspirin, β-blocker, and statin who used a participating pharmacy were randomized to usual care or intervention. The usual care group received discharge counseling and a letter to the community physician; the intervention group received enhanced in-hospital counseling, attention to adherence barriers, communication of discharge medications to community pharmacists and physicians, and ongoing assessment of adherence by community pharmacists. The primary end point was self-reported use of aspirin, β-blocker, and statin at 6 months postdischarge; the secondary end point was a ≥ 75% proportion of days covered (PDC) for β-blocker and statin through 6 months postdischarge.
  
  
  RESULTS
  Of 143 enrolled patients, 108 (76%) completed 6-month follow-up, and 115 (80%) had 6-month refill records. There was no difference between intervention and control groups in self-reported adherence (91% vs 94%, respectively, P = .50). Using the PDC to determine adherence to β-blockers and statins, there was better adherence in the intervention versus control arm, but the difference was not statistically significant (53% vs 38%, respectively, P = .11). Adherence to β-blockers was statistically significantly better in intervention versus control (71% vs 49%, respectively, P = .03). Of 85 patients who self-reported adherence and had refill records, only 42 (49%) were also adherent by PDC.
  
  
  CONCLUSIONS
  The trend toward better adherence by refill records with the intervention should encourage further investigation of engaging pharmacists to improve continuity of care.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. sara.calvert@duke.edu
authors.forename: Sara Bristol
authors.initials: SB
authors.lastname: Calvert
authors.forename: Judith M
authors.initials: JM
authors.lastname: Kramer
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kaltenbach
authors.forename: Judith A
authors.initials: JA
authors.lastname: Stafford
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Allen LaPointe
mesh_terms: D018674:Adrenergic Antagonists / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy*; D003376:Counseling; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D018802:Patient-Centered Care; D010595:Pharmacists; D011446:Prospective Studies; D016903:Drug Monitoring
chemical_list: D018674:Adrenergic Antagonists; D000894:Anti-Inflammatory Agents, Non-Steroidal; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin