title: [Organisational determinants of adherence to secondary prevention medications after acute myocardial infarction].
abstract: OBJECTIVE
  to identify organisational determinants of adherence to evidence-based drug treatments after acute myocardial infarction (AMI), under the hypothesis that low adherence is associated with higher mortality and risk of reinfarction. In particular, we investigated the effect of group vs. single handed practice and multi-professional practice characteristics on patients' adherence to polytherapy after AMI.
  
  
  METHODS
  retrospective cohort study.
  
  
  METHODS
  residents in the Local Health Authority of Bologna (Italy) who were discharged from any Italian hospital between 2008 and 2011 with a diagnosis of AMI, and followed-up for a year.
  
  
  METHODS
  adherence to at least three out of the four drug therapies recommended for secondary prevention of AMI (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, antiplatelet agents, statins). Patients who had at least 80% of days of follow-up covered by drug doses were considered adherent.
  
  
  RESULTS
  of the 4,828 post-AMI patients, 31.6% were adherent to polytherapy. General practice characteristics were unrelated to adherence, whereas discharge from cardiology hospital wards was significantly associated with higher patients' adherence (OR 1.97; 95%CI 1.56-2.48).
  
  
  CONCLUSIONS
  general practice organisational models are not associated with higher adherence to evidence-based medications after AMI, whereas cardiologists seem to play a key role in improving patient adherence to polytherapy. Healthcare delivery models should be designed; in them, general practitioners are responsible for the provision of patient-centred care pathways and for care co-ordination with other primary care professionals and specialists, and take an advocacy role for the patient when needed.
authors.affiliation: Dipartimento di scienze biomediche e neuromotorie, Alma Mater Studiorum, Università di Bologna.
authors.forename: Enrica
authors.initials: E
authors.lastname: Perrone
authors.affiliation: Dipartimento di scienze biomediche e neuromotorie, Alma Mater Studiorum, Università di Bologna.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Lenzi
authors.affiliation: Dipartimento di scienze biomediche e neuromotorie, Alma Mater Studiorum, Università di Bologna.
authors.forename: Vera Maria
authors.initials: VM
authors.lastname: Avaldi
authors.affiliation: Unità operativa complessa "Programmazione e controllo", Azienda unità sanitaria locale di Bologna.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Castaldini
authors.affiliation: Unità operativa complessa "Programmazione e controllo", Azienda unità sanitaria locale di Bologna.
authors.forename: Adalgisa
authors.initials: A
authors.lastname: Protonotari
authors.affiliation: Dipartimento di scienze biomediche e neuromotorie, Alma Mater Studiorum, Università di Bologna.
authors.forename: Paola
authors.initials: P
authors.lastname: Rucci
authors.affiliation: Dipartimento di scienze mediche e chirurgiche, Alma Mater Studiorum, Università di Bologna.
authors.forename: Carlo
authors.initials: C
authors.lastname: Piccinni
authors.affiliation: Dipartimento di cure primarie, Azienda unità sanitaria locale di Bologna.
authors.forename: Mara
authors.initials: M
authors.lastname: Morini
authors.affiliation: Dipartimento di scienze biomediche e neuromotorie, Alma Mater Studiorum, Università di Bologna. mariapia.fantini@unibo.it.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Fantini
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D055502:Secondary Prevention
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors