title: Can We Identify Minority Patients at Risk of Nonadherence to Antiplatelet Medication at the Time of Coronary Stent Placement?
abstract: BACKGROUND
  Lack of medication adherence is associated with significant morbidity and mortality, particularly among minorities. We aim to identify predictors of nonadherence to antiplatelet medications at the time of percutaneous coronary intervention (PCI) with stent among African American and Hispanic patients.
  
  
  METHODS
  We used data collected for a randomized clinical trial that recruited 452 minority patients from a large US health insurance organization in 2010 post-PCI to compare telephone-based motivational interviewing by trained nurses with an educational video. The primary outcome was 12-month adherence to antiplatelet medications measured by the claims-based medication possession ratio (MPR). Adequate adherence was defined as an MPR of 0.80 or higher.
  
  
  RESULTS
  More than half of the sample (age, 69.52 ± 8.8 years) was male (57%) and Hispanic (57%). Most (78%) had a median income below $30 000 and 22% completed high school or higher. Univariate analyses revealed that symptoms of depression (<.01) and not having a spouse (P = .03) were associated with inadequate adherence. In multivariate analysis, baseline self-reported adherence (1.4; 95% confidence interval [CI], 1.05-1.89), depressive symptoms (0.49; 95% CI, 0.7-0.90), comorbidity (0.89; 95% CI, 0.80-0.98), and telephone-based motivational interviewing by trained nurses (3.5; 95% CI, 1.9-2.70) were associated with adherence.
  
  
  CONCLUSIONS
  Having multiple comorbidities, depression, suboptimal adherence to medications, and low English proficiency at the time of PCI increase the risk of poor 12-month adherence to antiplatelets among minorities. Identifying these risk factors can guide PCI therapy and the use of evidence-based strategies to improve long-term adherence.
authors.affiliation: Ana M. Palacio, MD, MPH Associate Professor, School of Medicine, Departments of Medicine and Public Health Sciences and Veterans Affairs Medical Center, University of Miami Miller, Florida. Denise C. Vidot, PhD Assistant Professor, School of Nursing and Health Studies, University of Miami, Florida. Leonardo J. Tamariz, MD, MPH Associate Professor, School of Medicine, Departments of Medicine and Public Health Sciences, and Veterans Affairs Medical Center, University of Miami Miller, Florida. Claudia Uribe, MD, MHA Research Manager, Comprehensive Health Insights, Miami, Florida. Leslie Hazel-Fernandez, PhD Researcher, Comprehensive Health Insights, Miami, Florida. Hua Li, MD, PhD Biostatistician, School of Medicine, Departments of Medicine and Public Health Sciences, and Veterans Affairs Medical Center, University of Miami Miller, Florida. Sylvia D. Garay, MD Assistant Scientist/Motivational Interviewing Coach, School of Medicine, Department of Medicine, University of Miami Miller, Florida. Olveen Carrasquillo, MD, MPH Professor, School of Medicine, Departments of Medicine and Public Health Sciences, University of Miami Miller, Florida.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Palacio
authors.forename: Denise C
authors.initials: DC
authors.lastname: Vidot
authors.forename: Leonardo J
authors.initials: LJ
authors.lastname: Tamariz
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: Sylvia D
authors.initials: SD
authors.lastname: Garay
authors.forename: Olveen
authors.initials: O
authors.lastname: Carrasquillo
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000368:Aged; D003324:Coronary Artery Disease / Q000523:psychology / Q000628:therapy; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology*; D062405:Motivational Interviewing; D010353:Patient Education as Topic; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D015607:Stents; D013689:Telephone
chemical_list: D010975:Platelet Aggregation Inhibitors