Multifaceted Intervention to Improve Medication Adherence and Secondary Prevention Measures After Acute Coronary Syndrome Hospital Discharge A Randomized Clinical Trial
Multifaceted Intervention to Improve Medication Adherence and Secondary Prevention Measures After Acute Coronary Syndrome Hospital Discharge A Randomized Clinical Trial
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DOI：
10.1001/jamainternmed.2013.12944
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发表时间：
2014-02-01
影响因子：
39
通讯作者：
Del Giacco, Eric J.
中科院分区：
文献类型：
--
作者：
Ho, P. Michael;Lambert-Kerzner, Anne;Del Giacco, Eric J.
重要性急性冠脉综合征（ACS）患者住院后一年内对心脏保护药物治疗方案的依从性较差。目的测试一种多方面干预措施以提高心脏药物治疗的依从性。设计、设置和参与者在这项随机临床试验中，来自丹佛市4个退伍军人事务部医疗中心的253名患者（科罗拉多）、西雅图（华盛顿）;达勒姆（北卡罗来纳州），和小石城（阿肯色州）收治ACS患者随机分为多方面干预（INT）组和常规护理（UC）组。干预INT组在出院后持续1年，包括（1）药剂师-引导药物协调和定制;（2）患者教育;（3）药剂师与患者的初级保健临床医生和/或心脏病专家之间的协作护理;以及（4）2种类型的语音消息传送（教育和药物补充提醒电话）主要结果和测量主要结果是基于覆盖天数的平均比例（PDC）的遵守药物治疗方案的患者比例。使用4种心脏保护药物（氯吡格雷、β-受体阻滞剂、3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂[他汀类药物]和血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂[ACEI/ARB]）的药房续药数据，出院后一年内大于0.80。次要结果包括血压（BP）和低密度脂蛋白胆固醇（LDL-C）水平目标的实现。结果253例患者中，241例（95.3%）完成了研究（INT组122例，UC组119例）。在INT组中，89.3%的患者依从，而UC组为73.9%（P = 0.003）。INT组的平均PDC更高（0.94 vs 0.87; P
IMPORTANCE Adherence to cardioprotective medication regimens in the year after hospitalization for acute coronary syndrome (ACS) is poor.OBJECTIVE To test a multifaceted intervention to improve adherence to cardiac medications.DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial, 253 patients from 4 Department of Veterans Affairs medical centers located in Denver (Colorado), Seattle (Washington); Durham (North Carolina), and Little Rock (Arkansas) admitted with ACS were randomized to the multifaceted intervention (INT) or usual care (UC) prior to discharge.INTERVENTIONS The INT lasted for 1 year following discharge and comprised (1) pharmacist-led medication reconciliation and tailoring; (2) patient education; (3) collaborative care between pharmacist and a patient's primary care clinician and/or cardiologist; and (4) 2 types of voice messaging (educational and medication refill reminder calls).MAIN OUTCOMES AND MEASURES The primary outcome of interest was proportion of patients adherent to medication regimens based on a mean proportion of days covered (PDC) greater than 0.80 in the year after hospital discharge using pharmacy refill data for 4 cardioprotective medications (clopidogrel, beta-blockers, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors [statins], and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers [ACEI/ARB]). Secondary outcomes included achievement of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) level targets.RESULTS Of 253 patients, 241 (95.3%) completed the study (122 in INT and 119 in UC). In the INT group, 89.3% of patients were adherent compared with 73.9% in the UC group (P =.003). Mean PDC was higher in the INT group (0.94 vs 0.87; P