Collaborative care to boost medication adherence may not improve outcomes significantly

November 18, 2013

Collaborative care with pharmacists helped to boost medication adherence in patients with acute coronary syndrome after hospital discharge. However, after 12- month follow-up, the proportion of patients who achieved blood pressure and LDL-cholesterol goals were not significantly different from patients treated under usual care, according to a recent study published online for JAMA Internal Medicine.

Collaborative care with pharmacists helped to boost medication adherence in patients with acute coronary syndrome (ACS) after hospital discharge. However, after 12- month follow-up, the proportion of patients who achieved blood pressure and LDL-cholesterol goals were not significantly different from patients treated under usual care, according to a recent study published online for JAMA Internal Medicine.

That was the result of a randomized clinical trial of more than 250 patients with ACS released from one of four Department of Veteran Affairs medical centers. Half of the patients in the intervention group had a pharmacist consultation-either in-person or telephonic-within 7 to 10 days following discharge for medication reconciliation and discussion of any medication adverse effects or problems. Within 1 month of discharge, the pharmacist called the patients to assess any new medications and any adverse effects. Also, an attempt was made by the pharmacist to synchronize the prescription refills. Pharmacists also educated patients about the importance of medication adherence. Patients also received medication reminder and refill calls from a voice messaging system for 6 months following discharge, and medication refill calls from 7 to 12 months following discharge.

“The pharmacists notified the patient’s primary care clinician and/or cardiologist (if the patient had one) that the patient was enrolled in the adherence intervention by having them cosign the pharmacists’ initial enrollment note in the computerized medical record,” P. Michael Ho, MD, PhD, and colleagues wrote.

The enrollment note contained contact information for the physician to reach the pharmacists for any questions and concerns, Ho noted.

Results

The primary outcome of medication adherence, as measured by proportion of days covered (PDC), was greater in the intervention group (n=122) than in the control group (n=119) for the four classes of medications: statins, ACEI/ARB, clopidogrel, and beta-blockers. “The mean PDC for the 4 medications combined was greater for intervention patients (0.94 vs 0.87; P<.001),” the authors said.

The secondary outcomes of reaching BP or LDL-C level were not statistically significantly different between the 2 groups. The intervention group did trend toward greater BP control (58.6% vs 48.9%), but the LDL-cholesterol levels were not statistically significantly different (-13 vs -12 mg/dL).

“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,” the authors concluded.