title: Can phone-based motivational interviewing improve medication adherence to antiplatelet medications after a coronary stent among racial minorities? A randomized trial.
abstract: BACKGROUND
  Minorities have lower adherence to cardiovascular medications and have worst cardiovascular outcomes post coronary stent placement
  
  
  OBJECTIVE
  The aim of this study is to compare the efficacy of phone-delivered Motivational Interviewing (MINT) to an educational video at improving adherence to antiplatelet medications among insured minorities.
  
  
  METHODS
  This was a randomized study.
  
  
  METHODS
  We identified minorities with a recently placed coronary stent from an administrative data set by using a previously validated algorithm.
  
  
  METHODS
  MINT subjects received quarterly phone calls and the DVD group received a one-time mailed video.
  
  
  METHODS
  Outcome variables were collected at baseline and at 12-month post-stent, using surveys and administrative data. The primary outcome was antiplatelet (clopidogrel and prasugrel) adherence measured by Medication Possession Ratio (MPR) and self- reported adherence (Morisky score). We also measured appropriate adherence defined as an MPR ≥ 0.80.
  
  
  RESULTS
  We recruited 452 minority subjects with a new coronary stent (44 % Hispanics and 56 % Black). The patients had a mean age of 69.5 ± 8.8, 58 % were males, 78 % had an income lower than $30,000 per year and only 22 % had achieved high school education or higher. The MPR for antiplatelet medications was 0.77 for the MINT group compared to 0.70 for the DVD group (p < 0.05). The percentage of subjects with adequate adherence to their antiplatelet medication was 64 % in the MINT group and 50 % in the DVD group (p < 0.01). Self-reported adherence at 12 months was higher in the MINT group compared to the DVD group (p < 0.01). Results were similar among drug-eluting stent (DES) recipients.
  
  
  CONCLUSIONS
  Among racial minorities, a phone-based motivational interview is effective at improving adherence to antiplatelet medications post coronary stent placement. Phone-based MINT seems to be a promising and cost-effective strategy to modify risk behaviors among minority populations at high cardiovascular risk.
authors.affiliation: Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA, APalacio2@med.miami.edu.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Palacio
authors.forename: Claudia
authors.initials: C
authors.lastname: Uribe
authors.forename: Leslie
authors.initials: L
authors.lastname: Hazel-Fernandez
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.forename: Leonardo J
authors.initials: LJ
authors.lastname: Tamariz
authors.forename: Sylvia D
authors.initials: SD
authors.lastname: Garay
authors.forename: Olveen
authors.initials: O
authors.lastname: Carrasquillo
mesh_terms: D000368:Aged; D044383:Black People / Q000208:ethnology / Q000523:psychology; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery; D005260:Female; D006630:Hispanic or Latino / Q000208:ethnology / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic / Q000379:methods*; D008297:Male; D055118:Medication Adherence / Q000208:ethnology* / Q000523:psychology; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology; D062405:Motivational Interviewing / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015607:Stents
chemical_list: D010975:Platelet Aggregation Inhibitors