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Nonadherence to treatment plans is a contributing factor in for many second myocardial infarctions.
About 790,000 Americans will suffer a myocardial infarction this year. For slightly more than a quarter of them, it will be their second, according to American Heart Association (AHA) statistics.
A contributing cause for many will be nonadherence to the treatment plan that was prescribed by their doctors after their initial attack. Recent research indicates that pharmacists can play a valuable role in reducing the risk of a repeat attack.
How big a problem is noncompliance among cardiac patients? One study reported in JAMA Cardiology found a compliance rate for secondary prevention therapies of as low as 63% after 3 months and 54% after a year.1 One relatively simple solution to noncompliance, switching to 90-day refills for patient medications, was reported on in Medicare and Medicaid Research and Review.2 The study concluded that the 90-day-refill adherence rate was 20% higher than the rate for 30-day refills. It also minimized waste and helped controll costs.
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This approach is ideal for patients who are already optimized on their regimens, said Germin Fahim, PharmD, Clinical Assistant Professor of Pharmacy at Rutgers University. But, “it can be a hassle for the patient when the medications are still being titrated, because then they end up with 90-day supply of a strength of a medication that was changed. There can be confusion and duplicate therapy if they are not counseled appropriately,” she stipulates.
But 90-day supplies are only one way to help reduce the rate of repeat MIs. Patients benefit when pharmacists serve as care managers and health coaches.
Medicaid claims data released by Community Care of North Carolina (CCNC) indicate that high-risk patients visit community pharmacies 35 times per year - ten times the rate at which they see their primary care providers. CCNC established the Community Pharmacist Enhanced Services Network (CPESN) to broaden community pharmacists’ capacity for care management and medication optimization and improve quality of care, patient outcomes ,and reduce total cost of care.
“We’re not doing autofill. We call our patients every month and ask how they’re doing,” said Amina Abubakar, PharmD, Owner and Operator of Rx Clinic Pharmacy in Charlotte, NC. “Did anything change? Did they have to go to the hospital? Did they start taking anything over the counter? Did they change their diet? What’s their most recent blood pressure? Pharmacists are becoming health coaches, an integral part of the team and a great access point to share feedback to the provider.”
More validation for the role of pharmacists comes from the RxEACH trial, a Canadian community-pharmacy program for patients at high risk for cardiovascular events. In this trial, half the 700 participants received standard physician/pharmacy care while the other half received intervention care. Researchers found that the intervention program reduced the estimated risk for cardiovascular events by 21% in 3 months.3
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Although pharmacists in Canada are generally given more latitude in prescribing and adjusting medications than U.S. pharmacists, Fahim agrees that similar intervention programs could work here. The key to improving compliance among cardiac patients is an approach that fosters a high level of trust with patients to keep them returning to the clinic, she said.
A pharmacist who is able to focus on medications is able to tell patients what side effects they may experience, what to do if they occur, and what can be adjusted to make the regimen a little simpler, she said. “Those are all ways pharmacists can help in the clinical setting.”
1. Faridi KF, Peterson ED, McCoy LA, et al. Timing of first postdischarge follow-up and medication adherence after acute myocardial infarction. JAMA Cardiol. 2016 May 1;1(2):147-55.
2. Taitel M, Fensterheim L, Kirkham H, et al. Medication days’ supply, adherence, wastage, and cost among chronic patients in Medicaid. Medicare Medicaid Res Rev. 2012; 2(3): mmrr.002.03.a04.
3. Tsuyuki RT, Al Hamarneh YN, Jones CA, Hemmelgarn BR. The effectiveness of pharmacist interventions on cardiovascular risk: The multicenter randomized controlled RxEACH trial. J Amer Coll Cardiol. 2016 Jun 21;67(24) 2855-2857.