December 4, 2013
Pharmacist Involvement Improved Heart Patients’
Medication Adherence

Denver—Personalized attention from pharmacists helped improve patient adherence to medication regimens in the year following hospitalization for acute coronary syndrome (ACS), according to a new study that compared the intervention with usual care.

Typically, about a third of patients discontinue at least one oral medication within a month of hospital discharge, past research has shown.

For the study, published recently in JAMA Internal Medicine, researchers randomized 253 patients from four Department of Veterans Affairs medical centers in Denver, Seattle, Durham, North Carolina, and Little Rock, Akansas, to usual care or an intervention that included direct contact with a pharmacist to discuss medications shortly after discharge, patient education, collaboration with a patient's pharmacist, and voice messaging reminders.

With the study completed by 241 patients, including122 in the intervention group and 119 with usual care, researchers measured the proportion of patients adhering to their medication regimens, along with the proportion achieving blood pressure and low-density lipoprotein cholesterol (LDL-C) level targets.

Results indicate that the intervention increased adherence to mediation regimens—89.3% in the intervention versus 73.9% in the usual care group—but demonstrated no difference in the proportion of patients who achieved BP and LDL-C level goals.

The low-cost intervention—at about $360 per patient—was conducted within an integrated healthcare delivery, but study authors note that “none of the components were unique to it and can be replicated in other health care settings.”

“In our study,” they added, “a pharmacist reconciled pre-hospital and post-hospital medications within 7 to 10 days of discharge and contacted patients at 30 days to address any interim medication issues; contact thereafter was based on patient needs. The pharmacist notified the patient’s primary care clinician and/or cardiologist of any interim changes and provided education to patients focusing on the importance of adherence.”

In an editor's note, JAMA Internal Medicine editor Rita F. Redberg, MD, MSc, writes: “For many reasons, the relatively modest increases in already high rates of medication regimen adherence in the patients studied may not translate into improved outcomes even if maintained for three to five years or longer. Of course, we hope that they do. But before recommending investment in this strategy, it would be prudent to know that patient outcomes will actually improve.”

The authors also conclude that “additional studies are needed to understand the impact of the magnitude of adherence improvement shown in our study on clinical outcomes prior to broader dissemination of such an adherence program.”

U.S. Pharmacist Social Connect