Patient-focused intervention to improve long-term adherence to evidence-based medications: A randomized trial

Background Nonadherence to cardiovascular medications is a significant public health problem. This randomized study evaluated the effect on medication adherence of linking hospital and community pharmacists. Methods Hospitalized patients with coronary artery disease discharged on aspirin, beta-blocker, and statin who used a participating pharmacy were randomized to usual care or intervention. The usual care group received discharge counseling and a letter to the community physician; the intervention group received enhanced in-hospital counseling, attention to adherence barriers, communication of discharge medications to community pharmacists and physicians, and ongoing assessment of adherence by community pharmacists. The primary end point was self-reported use of aspirin, beta-blocker, and statin at 6 months postdischarge; the secondary end point was a >= 75% proportion of days covered (PDC) for beta-blocker and statin through 6 months postdischarge. Results Of 143 enrolled patients, 108 (76%) completed 6-month follow-up, and 115 (80%) had 6-month refill records. There was no difference between intervention and control groups in self-reported adherence (91% vs 94%, respectively, P = .50). Using the PDC to determine adherence to beta-blockers and statins, there was better adherence in the intervention versus control arm, but the difference was not statistically significant (53% vs 38%, respectively, P = .11). Adherence to beta-blockers was statistically significantly better in intervention versus control (71% vs 49%, respectively, P = .03). Of 85 patients who self-reported adherence and had refill records, only 42 (49%) were also adherent by PDC. Conclusions The trend toward better adherence by refill records with the intervention should encourage further investigation of engaging pharmacists to improve continuity of care. (Am Heart J 2012;163:657-665.e1.)