A Randomized trial of direct-to-patient communication to enhance adherence to β-blocker therapy following myocardial infarction
A Randomized trial of direct-to-patient communication to enhance adherence to β-blocker therapy following myocardial infarction
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DOI：
10.1001/archinternmed.2007.132
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发表时间：
2008-03-10
影响因子：
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通讯作者：
Soumerai, Stephen B.
中科院分区：
文献类型：
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作者：
Smith, David H.;Kramer, Judith M.;Soumerai, Stephen B.
背景：虽然心肌梗塞（MI）出院时通常会开出β受体阻滞剂，但患者的依从性已被证明随着时间的推移而大幅下降。我们试图检验这样的假设：简单的、直接针对患者的干预措施可以提高 MI 后对 β 受体阻滞剂治疗的依从性。方法：我们在 4 个地理位置分散的健康维护组织中进行了一项整群随机对照试验，检验简单的直接针对患者的干预措施可以提高依从性的假设。该研究于 2004 年 6 月至 2005 年 3 月期间进行。主要分析基于 836 名心梗后患者，他们在出院后服用了 β 受体阻滞剂处方。该干预措施包括两封间隔 2 个月的邮件，描述使用 β 受体阻滞剂的重要性。主要结果是接受 β 受体阻滞剂治疗的天数比例以及首次邮寄后 9 个月内接受至少 80% 天数的患者百分比。根据年龄、性别、配药总量、心梗和干预之间的天数以及干预地点对分析进行了调整。结果：在整个随访期间，与对照组患者相比，治疗组患者每月的治疗天数平均绝对增加了 4.3%（与基线相比相对变化 5.7%），相当于额外增加了 1.3 天 (P = .04)。接受治疗的患者完成 80% 天数的可能性高出 17%（相对风险为 1.17；95% 置信区间为 1.02-1.29）。每 16 名接受干预的患者，就会有 1 名额外的患者成为依从性（每月覆盖 80% 或更多天数）。结论：低成本、易于复制的提高依从性的努力可以对 MI 后 β 受体阻滞剂的依从性产生明显的影响。试验注册：临床试验。政府标识符：NCT00211172。
Background: Although beta-blockers are routinely prescribed at hospital discharge after myocardial infarction (MI), patients' adherence has been shown to decline substantially over time. We sought to test the hypothesis that a simple, direct-to-patient intervention can improve adherence to beta-blocker therapy following MI.Methods: We conducted a cluster randomized controlled trial in 4 geographically dispersed health maintenance organizations testing the hypothesis that a simple direct-to-patient intervention could improve adherence. The study was carried out from June 2004 to March 2005. The primary analyses were based on 836 post-MI patients who were dispensed a beta-blocker prescription after discharge. The intervention consisted of 2 mailings 2 months apart describing the importance of beta-blocker use. The main outcomes were proportion of days covered with beta-blocker therapy and percentage of patients with at least 80% of days covered in the 9 months after the first mailing. Analyses were adjusted for age, sex, total medications dispensed, days between MI and intervention, and intervention site.Results: Over the entire follow-up period, patients in the treatment arm had a mean absolute increase of 4.3% of days covered per month compared with patients in the control arm (a 5.7% relative change from baseline), representing 1.3 extra days (P = .04). Treatment patients were 17% more likely (relative risk, 1.17; 95% confidence interval, 1.02-1.29) to have 80% of days covered. For every 16 patients receiving the intervention, 1 additional patient would become adherent (80% or more days covered per month).Conclusion: A low-cost, easily replicable effort to increase adherence can have a demonstrable impact on beta-blocker adherence following MI. Trial Registration: clinicaltrials. gov Identifier: NCT00211172.