title: Improving post-discharge medication adherence in patients with CVD: a pilot randomized trial.
abstract: Effective interventions to improve medication adherence are usually complex and expensive.
  
  
  
  To assess the impact of a low-cost intervention designed to improve medication adherence and clinical outcomes in post-discharge patients with CVD.
  
  
  
  A pilot RCT was conducted at a teaching hospital. Intervention was based on the four-item Morisky Medication Adherence Scale (MMAS-4). The primary outcome measure was medication adherence assessed using the eight-item MMAS at baseline, at 1 month post hospital discharge and re-assessed 1 year after hospital discharge. Other outcomes included readmission and mortality rates.
  
  
  
  61 patients were randomized to intervention (n = 30) and control (n = 31) groups. The mean age of the patients was 61 years (SD 12.73), 52.5% were males, and 57.4% were married or living with a partner. Mean number of prescribed medications per patient was 4.5 (SD 3.3). Medication adherence was correlated to intervention (p = 0.04) and after 1 month, 48.4% of patients in the control group and 83.3% in the intervention group were considered adherent. However, this difference decreased after 1 year, when adherence was 34.8% and 60.9%, respectively. Readmission and mortality rates were related to low adherence in both groups.
  
  
  
  The intervention based on a validated patient self-report instrument for assessing adherence is a potentially effective method to improve adherent behavior and can be successfully used as a tool to guide adherence counseling in the clinical visit. However, a larger study is required to assess the real impact of intervention on these outcomes.
authors.affiliation: Universidade Federal de Alagoas, Maceió, AL, Brazil.
authors.forename: Alfredo D
authors.initials: AD
authors.lastname: Oliveira-Filho
authors.affiliation: University of California Los Angeles, Los Angeles, EUA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Morisky
authors.affiliation: Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, AL, Brazil.
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Costa
authors.affiliation: Universidade Federal de Alagoas, Maceió, AL, Brazil.
authors.forename: Sara T
authors.initials: ST
authors.lastname: Pacheco
authors.affiliation: Universidade Federal de Alagoas, Maceió, AL, Brazil.
authors.forename: Sabrina F
authors.initials: SF
authors.lastname: Neves
authors.affiliation: Universidade Federal de Sergipe, Aracaju, SE, Brazil.
authors.forename: Divaldo P
authors.initials: DP
authors.lastname: Lyra
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D057566:Self Report; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D016903:Drug Monitoring