title: Can a Multifaceted Intervention Including Motivational Interviewing Improve Medication Adherence, Quality of Life, and Mortality Rates in Older Patients Undergoing Coronary Artery Bypass Surgery? A Multicenter, Randomized Controlled Trial with 18-Month Follow-Up.
abstract: Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for extended periods, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence in this patient group is therefore important.
  
  
  
  The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery.
  
  
  
  Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment-as-usual (TAU; n = 144) groups using cluster randomization at center level. Medication adherence was evaluated using the Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL was evaluated using Short Form-36. Data were collected at baseline; 3, 6, and 18 months after intervention. Survival status was followed up at 18 months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses.
  
  
  
  Compared with patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved 6 months after surgery (p < 0.01) and remained so 18 months after surgery (p < 0.01). QoL also increased among patients in the EXP group as compared with those who received TAU at 18 months post-surgery (physical component summary score p = 0.02; mental component summary score p = 0.04). HR in the EXP group compared with the TAU group was 0.38 (p = 0.04).
  
  
  
  The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after 18 months. QoL and survival rates increased as a function of better medication adherence. ClinicalTrials.gov NCT02109523.
authors.affiliation: Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
authors.forename: Chung-Ying
authors.initials: CY
authors.lastname: Lin
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Yaseri
authors.affiliation: Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahounar BLV, Qazvin, 3419759811, Iran. pakpour_amir@yahoo.com.|Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden. pakpour_amir@yahoo.com.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Pakpour
authors.affiliation: Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.|Department of Internal Medicine, Country Hospital Ryhov, Jönköping, Sweden.
authors.forename: Dan
authors.initials: D
authors.lastname: Malm
authors.affiliation: Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Broström
authors.affiliation: School of Health and Welfare, Jönköping University, Jönköping, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Fridlund
authors.affiliation: Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.|Department of Anaesthesia and Perioperative Medicine, Waitemata Pain Service, North Shore Hospital, Auckland, New Zealand.
authors.forename: Andrea
authors.initials: A
authors.lastname: Burri
authors.affiliation: Department of Psychology, The University of Sheffield, Sheffield, UK.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Webb
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D062405:Motivational Interviewing / Q000592:standards* / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D010593:Pharmaceutical Services / Q000592:standards* / Q000706:statistics & numerical data; D011788:Quality of Life; D016019:Survival Analysis; D016903:Drug Monitoring