Patient-centered adherence intervention after acute coronary syndrome hospitalization.
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.


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 comprises 4 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.
Denver VA Medical Center, Denver, CO, USA. anne.lambert-kerzner@va.gov
Anne
A
Lambert-Kerzner
Eric J
EJ
Del Giacco
Ibrahim E
IE
Fahdi
Chris L
CL
Bryson
S Dee
SD
Melnyk
Hayden B
HB
Bosworth
Ryan
R
Davis
Howard
H
Mun
Jennifer
J
Weaver
Casey
C
Barnett
Tiffany
T
Radcliff
Amanda
A
Hubbard
Kevin D
KD
Bosket
Evan
E
Carey
Allison
A
Virchow
Renee
R
Mihalko-Corbitt
Amy
A
Kaufman
Kathy
K
Marchant-Miros
P Michael
PM
Ho
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003157:Community Pharmacy Services / Q000458:organization & administration; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization / Q000191:economics; D006801:Humans; D033183:Interdisciplinary Communication; D055118:Medication Adherence; D059065:Medication Reconciliation / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D010351:Patient Discharge / Q000191:economics; D010353:Patient Education as Topic / Q000458:organization & administration; D010359:Patient Readmission; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D011446:Prospective Studies; D017010:Reminder Systems; D012107:Research Design; D013997:Time Factors; D014481:United States
D002317:Cardiovascular Agents