Another Pharmacist Success: Improved Adherence After ACS Admission

Author: Jeannette Y. Wick, RPh, MBA, FASCP

A trial found that in the year after hospitalization for acute coronary syndrome, patients who received personalized attention from a pharmacist had higher levels of medication adherence.

Medication adherence in the year following hospitalization for acute coronary syndrome (ACS) is known to be a crucial predictor of recovery and survival. Adherence is also notoriously low, as patients are challenged by the need to take multiple medications daily—a typical regimen includes HMG-CoA reductase inhibitors (statins), β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB), and antiplatelet agents. At 1 month, most ACS patients have dropped at least 1 medication. Now, researchers at the Denver VA Medical Center have identified a key factor in improving adherence: the pharmacist.
 
In a randomized controlled trial examining the effects of personalized attention from a pharmacist compared with usual care, patients who received increased attention from a pharmacist adhered to their medication regimens more closely in the year following hospitalization than did those who received usual care. The researchers randomized 253 patients from Department of Veterans Affairs medical centers in four cities: Denver, Seattle, Durham, N.C., and Little Rock, Ark. They published their results online on November 18, 2013, in JAMA Internal Medicine.
 
Patients in the intervention arm had direct contact with a pharmacist to discuss medications shortly after discharge in the form of medication reconciliation. Pharmacists also provided patient education at visits 1 week and 1 month following discharge, collaborated with each patient's physician, and left voice messaging reminders. Voice messaging covered medication reminders each month and medication refill calls 14 days before refill due dates, 7 days before refill due dates, and on the due dates. Those in the control arm received usual care. Researchers measured levels of medication adherence and the portion of patients who met blood pressure and low-density lipoprotein cholesterol (LDL-C) level targets.
 
Of the 253 initial participants, 241 patients completed the study (122 in the intervention arm and 119 in the usual care arm). Of the patients in the intervention arm, 89.3% were adherent, compared with 73.9% of the patients in the usual care arm. The portion of patients who achieved blood pressure and LDL-C level goals was similar in the 2 arms. (However, it is important to note that the study covered only 12 months. Previous work has shown that differences in clinical end points between optimal and usual prescription adherence generally begin to diverge after 12 months.)
 
The intervention, which cost approximately $360 per patient, increased the portion of patients who were adherent by approximately 15% and increased the mean adherence to 4 critical cardioprotective medications (β-blockers, statins, clopidogrel, and ACEI/ARB) combined by approximately 7%. All components of the intervention are common, well-described methods that can easily be replicated in other health care settings.
 
“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 conclude.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.