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Yusufali A, Zidan M, Khatib R, Kelishadi R, Alhabib K, Alshamsi MA, Rais AF, Bintouq AK, Bahonar A, Mohammadifard N, Al Shamiri M, Rangarajan S, Khansaheb H, Yusuf S. Use of Cardiovascular Disease Secondary Prevention Medications in Four Middle East Countries in a Community Setting. Glob Heart 2024; 19:70. [PMID: 39219849 PMCID: PMC11363892 DOI: 10.5334/gh.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Background Evidence-based International clinical practice guidelines, universally recommend secondary prevention medications for those with previous cardiovascular disease (CVD). There is limited data on the community use of these medications in the Middle East (ME). Objectives This study assesses the use and predictors of evidence based secondary prevention medications in individuals with a history of CVD [coronary heart disease (CHD) or stroke]. Methods Between 2005 and 2015, we enrolled 11,228 individuals aged between 35-70 years from 52 urban and 35 rural communities from four ME countries, United Arab Emirates (n = 1499), Kingdom of Saudi Arabia (n = 2046), Occupied Palestinian Territory (n = 1668) and Islamic Republic of Iran (n = 6013). With standardized questionnaires, we report estimates of medication use in those with CVD at national level and the independent predictors of their utilization through a multivariable analysis model. Results: Of the total ME cohort, 614 (5.5%) had CVD, of which 115 (1.0%) had stroke, 523 (4.7%) had CHD and 24 (0.2%) had both. The mean age of those with CVD was 56.6 ± 8.8 years and 269 (43.8%) were female. Overall, only 23.5% of those with CVD reported using three or more proven secondary prevention medications, and a substantial proportion (stroke 27.8%, CHD 25.8%) did not take any of these medications. In a fully adjusted analysis, increasing age, female gender, higher education, higher wealth in individual household, residence in a higher income country as well as being obese, hypertensive or diabetic were independent predictors of medication use. Conclusion The use of secondary prevention medication is low in ME and has not reached the modest recommended WHO target of 50% use of 3 or more medications. Independent factors of higher use were, better socioeconomic status (household wealth, country wealth and education) and better contact and accessibility to health care (increasing age, female gender, obesity, diabetes and hypertension).
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Affiliation(s)
| | | | - Rasha Khatib
- Academic Research and Strategic Partnerships, Advocate Aurora Research Institute (AARI), Milwaukee, USA
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - khalid Alhabib
- College of Medicine, Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | - Ahmad Bahonar
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Al Shamiri
- College of Medicine, Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
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2
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Kawa KL, Jacobs C, Wiens EJ. Outcome disparities in acute coronary syndrome patients from rural versus urban settings: A narrative review of causes, and strategies to minimize them. Curr Probl Cardiol 2024; 49:102682. [PMID: 38795806 DOI: 10.1016/j.cpcardiol.2024.102682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Abstract
Acute coronary syndrome (ACS) remains an important cause of morbidity and mortality worldwide. Critical elements of improving outcomes in ACS patients include timely access to acute care including prompt revascularization if indicated, and subsequent ongoing secondary prevention and risk factor modification, ideally with cardiovascular specialists. It is being increasingly realized that ACS patients from rural settings suffer from inferior outcomes compared to their urban counterparts due to factors such as delayed diagnosis, delayed access to acute care, and less accessibility to specialized follow up. This narrative review will examine the importance of timely access to care in ACS patients, particularly in ST-elevation myocardial infarction; how barriers in access to care affects outcomes in various rural populations; and strategies that have been shown to improve such access, and therefore hopefully achieve more equitable health outcomes compared to patients who live in urban settings.
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Affiliation(s)
- Kristal L Kawa
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cheryl Jacobs
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Evan J Wiens
- Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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3
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Nelson AJ, Pagidipati NJ, Bosworth HB. Improving medication adherence in cardiovascular disease. Nat Rev Cardiol 2024; 21:417-429. [PMID: 38172243 DOI: 10.1038/s41569-023-00972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Non-adherence to medication is a global health problem with far-reaching individual-level and population-level consequences but remains unappreciated and under-addressed in the clinical setting. With increasing comorbidity and polypharmacy as well as an ageing population, cardiovascular disease and medication non-adherence are likely to become increasingly prevalent. Multiple methods for detecting non-adherence exist but are imperfect, and, despite emerging technology, a gold standard remains elusive. Non-adherence to medication is dynamic and often has multiple causes, particularly in the context of cardiovascular disease, which tends to require lifelong medication to control symptoms and risk factors in order to prevent disease progression. In this Review, we identify the causes of medication non-adherence and summarize interventions that have been proven in randomized clinical trials to be effective in improving adherence. Practical solutions and areas for future research are also proposed.
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Affiliation(s)
- Adam J Nelson
- Victorian Heart Institute, Melbourne, Victoria, Australia
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | - Hayden B Bosworth
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.
- Population Health Sciences, Duke University, Durham, NC, USA.
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Tolu-Akinnawo O, Ezekwueme F, Awoyemi T. Telemedicine in Cardiology: Enhancing Access to Care and Improving Patient Outcomes. Cureus 2024; 16:e62852. [PMID: 38912070 PMCID: PMC11192510 DOI: 10.7759/cureus.62852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 06/25/2024] Open
Abstract
Telemedicine has gained significant recognition, particularly since the COVID-19 pandemic. However, its roots date back to its significant role during major epidemic outbreaks such as severe acute respiratory syndrome (SARS), H1N1 and H7N9 influenza, and Middle East respiratory syndrome (MERS), where alternate means of accessing healthcare were adopted to combat the outbreak while limiting the spread of the virus. In Sub-Saharan Africa, telemedicine has supported healthcare delivery, patient and professional health education, disease prevention, and surveillance, starting with its first adoption in Ethiopia in 1980. In the United States, telemedicine has significantly impacted cardiology, particularly at-home monitoring programs, which have proven highly effective for patients with abnormal heart rhythms. Devices such as Holter monitors, blood pressure monitors, and implantable cardioverter-defibrillators have reduced mortality rates and hospital readmissions while improving healthcare efficiency by saving healthcare costs. However, the COVID-19 pandemic accelerated the adoption of telemedicine, as evidenced by a dramatic increase in telemedicine visits at institutions like New York University (NYU) Langone Health during and post-COVID-19 pandemic. In addition, telemedicine has also facilitated cardiac rehabilitation and improved access to specialized cardiology care in rural and underserved areas, reducing disparities in cardiovascular health outcomes. As technology advances, telemedicine is poised to play an increasingly significant role in cardiology and healthcare at large, enhancing patient management, healthcare efficiency, and cost reduction. This review underscores the significance of telemedicine in cardiology, its challenges, and future directions.
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Affiliation(s)
| | - Francis Ezekwueme
- Internal Medicine, University of Pittsburgh Medical Center, Pittsburg, USA
| | - Toluwalase Awoyemi
- Internal Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, GBR
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5
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Campos Cervera LV, Sabouret P, Bernardi M, Spadafora L, Banach M, Muñoz F, Viruel M, Zaidel EJ, Bonorino J, Perez G, Arbucci R, Costabel JP. Treatment adherence in patients without ST-elevation acute coronary syndrome. Minerva Cardiol Angiol 2024; 72:134-140. [PMID: 37405714 DOI: 10.23736/s2724-5683.23.06345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Despite progress during the last decades, patients with coronary artery disease (CAD) remain with a high residual risk due to multiple reasons. Optimal medical treatment (OMT) provides a decrease of recurrent ischemic events after acute coronary syndrome (ACS). Therefore, treatment adherence results crucial to reduce further outcomes after the index event. No recent data are available in Argentinian population; the main objective of our study was to evaluate the adherence at 6 and 15 months in post non-ST elevation acute coronary syndrome (NST-ACS) consecutive patients. Secondary objective was to evaluate the relationship of adherence with 15-month events. METHODS A prespecified sub-analysis in the prospective registry Buenos Aires I was performed. The adherence was evaluated using the modified Morisky-Green Scale. RESULTS A number of 872 patients had information about adherence profile. Of them 76.4% were classified as adherents at month 6 and 83.6% at 15 (P=0.06). We did not find any difference in baseline characteristic between the adherent and non-adherent patients at 6 months. The adjusted analysis showed that non-adherent patients had a rate of ischemic events at 15th month of 20% (27/135) vs. 11.5% (52/452) in adherent patients (P=0.001). The bleeding events defined were of 3.6% in the non-adherent group vs. 5% in the adherent group without a statistical difference (P=0.238). CONCLUSIONS Adherence to treatment is still a major issue as almost 25% of patients should be considered as non-adherent to OMT. No clinical predictor of this phenomenon was identified but our criteria were not exhaustive. Good adherence to treatment was highly associated to a reduction of ischemic events, whereas no impact on bleeding events was found. These data support a better network and collaboration with shared decision between healthcare professionals with patients and family members to improve acceptance and adherence to optimal medical strategies.
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Affiliation(s)
- Lucía V Campos Cervera
- Unit of Cardiology, Department of Cardiology, Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina
| | - Pierre Sabouret
- Heart Institute and Action Group, Pitié-Salpétrière, Sorbonne University, Paris, France
| | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University od Lodz, Lodz, Poland
| | - Florencia Muñoz
- Unit of Cardiology, Department of Cardiology, Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina
| | - Marcos Viruel
- Unit of Cardiology, Department of Cardiology, Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina
| | | | - José Bonorino
- Department of Cardiology, Hospital Austral, Buenos Aires, Argentina
| | - Gonzalo Perez
- Department of Cardiology, Clinica Olivos, Buenos Aires, Argentina
| | - Rosina Arbucci
- Unit of Cardiology, Department of Cardiology, Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina
| | - Juan P Costabel
- Unit of Cardiology, Department of Cardiology, Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina -
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Aboyans V, Boutaleb AM. Cardiology off the map: the impact of remoteness on secondary prevention after myocardial infarction. Eur J Prev Cardiol 2024:zwae091. [PMID: 38527225 DOI: 10.1093/eurjpc/zwae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Martin Luther King Ave., Limoges 87042, France
- EpiMaCT, Inserm 1094 & IRD 270, 2, Rue du Dr Marcland, Limoges University, Limoges, France
| | - Amine Mamoun Boutaleb
- Department of Cardiology, Dupuytren-2 University Hospital, Martin Luther King Ave., Limoges 87042, France
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7
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Gebremichael LG, Champion S, Nesbitt K, Pearson V, Bulamu NB, Dafny HA, Sajeev S, Pinero de Plaza MA, Ramos JS, Suebkinorn O, Gulyani A, Bulto LN, Beleigoli A, Hendriks JM, Hines S, Clark RA. Effectiveness of cardiac rehabilitation programs on medication adherence in patients with cardiovascular disease: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 20:200229. [PMID: 38188637 PMCID: PMC10770721 DOI: 10.1016/j.ijcrp.2023.200229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/20/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024]
Abstract
Background Education to improve medication adherence is one of the core components of cardiac rehabilitation (CR) programs. However, the evidence on the effectiveness of CR programs on medication adherence is conflicting. Therefore, we aimed to summarize the effectiveness of CR programs versus standard care on medication adherence in patients with cardiovascular disease. Methods A systematic review and meta-analysis was conducted. Seven databases and clinical trial registries were searched for published and unpublished articles from database inception to 09 Feb 2022. Only randomised controlled trials and quasi-experimental studies were included. Two independent reviewers conducted the screening, extraction, and appraisal. The JBI methodology for effectiveness reviews and PRISMA 2020 guidelines were followed. A statistical meta-analysis of included studies was pooled using RevMan version 5.4.1. Results In total 33 studies were included with 16,677 participants. CR programs increased medication adherence by 14 % (RR = 1.14; 95 % CI: 1.07 to 1.22; p = 0.0002) with low degree of evidence certainty. CR also lowered the risk of dying by 17 % (RR = 0.83; 95 % CI: 0.69 to 1.00; p = 0.05); primary care and emergency department visit by mean difference of 0.19 (SMD = -0.19; 95 % CI: -0.30 to -0.08; p = 0.0008); and improved quality of life by 0.93 (SMD = 0.93; 95 % CI: 0.38 to 1.49; p = 0.0010). But no significant difference was observed in lipid profiles, except with total cholesterol (SMD = -0.26; 95 % CI: -0.44 to -0.07; p = 0.006) and blood pressure levels. Conclusions CR improves medication adherence with a low degree of evidence certainty and non-significant changes in lipid and blood pressure levels. This result requires further investigation.
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Affiliation(s)
- Lemlem Gebremedhin Gebremichael
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Australia
| | - Stephanie Champion
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Australia
| | - Katie Nesbitt
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Australia
| | - Vincent Pearson
- JBI, School of Public Health, The University of Adelaide, Australia
| | - Norma B. Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Hila A. Dafny
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Australia
| | - Shelda Sajeev
- Centre for Artificial Intelligence Research and Optimisation (AIRO), Torrens University, Adelaide, South Australia, Australia
- College of Science and Engineering, Flinders University, Adelaide, SA, Australia
| | - Maria Alejandra Pinero de Plaza
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Australia
- National Health and Medical Research Council, Transdisciplinary Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
| | - Joyce S. Ramos
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Orathai Suebkinorn
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Aarti Gulyani
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Lemma N. Bulto
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Australia
| | - Alline Beleigoli
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Australia
| | - Jeroen M. Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sonia Hines
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Australia
- Flinders Rural and Remote Health, NT. College of Medicine and Public Health, Flinders University, Australia
| | - Robyn A. Clark
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Australia
| | - On behalf of the NHMRC CHAP Project Team
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Australia
- JBI, School of Public Health, The University of Adelaide, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Centre for Artificial Intelligence Research and Optimisation (AIRO), Torrens University, Adelaide, South Australia, Australia
- College of Science and Engineering, Flinders University, Adelaide, SA, Australia
- National Health and Medical Research Council, Transdisciplinary Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA, Australia
- Flinders Rural and Remote Health, NT. College of Medicine and Public Health, Flinders University, Australia
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Sim HW, Koh KWL, Poh SC, Chan SP, Marchesseau S, Singh D, Han Y, Ng F, Lim E, Prabath JF, Lee CH, Chen R, Carvalho L, Tan SH, Loh JPY, Tan JWC, Kuwelker K, Amanullah RM, Chin CT, Yip JWL, Lee CY, Gan J, Lo CY, Ho HH, Hausenloy DJ, Tai BC, Richards AM, Chan MY. Remote intensive management to improve antiplatelet adherence in acute myocardial infarction: a secondary analysis of the randomized controlled IMMACULATE trial. J Thromb Thrombolysis 2024; 57:408-417. [PMID: 38300500 DOI: 10.1007/s11239-023-02931-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 02/02/2024]
Abstract
This study aim to investigate if remote intensive coaching for the first 6 months post-AMI will improve adherence to the twice-a-day antiplatelet medication, ticagrelor. Between July 8, 2015, to March 29, 2019, AMI patients were randomly assigned to remote intensive management (RIM) or standard care (SC). RIM participants underwent 6 months of weekly then two-weekly consultations to review medication side effects and medication adherence coaching by a centralized nurse practitioner team, whereas SC participants received usual cardiologist face-to-face consultations. Adherence to ticagrelor were determined using pill counting and serial platelet reactivity measurements for 12 months. A total of 149 (49.5%) of participants were randomized to RIM and 152 (50.5%) to SC. Adherence to ticagrelor was similar between RIM and SC group at 1 month (94.4 ± 0.7% vs. 93.6±14.7%, p = 0.537), 6 months (91.0±14.6% vs. 90.6±14.8%, p = 0.832) and 12 months (87.4±17.0% vs. 89.8±12.5%, p = 0.688). There was also no significant difference in platelet reactivity between the RIM and SC groups at 1 month (251AU*min [212-328] vs. 267AU*min [208-351], p = 0.399), 6 months (239AU*min [165-308] vs. 235AU*min [171-346], p = 0.610) and 12 months (249AU*min [177-432] vs. 259AU*min [182-360], p = 0.678). Sensitivity analysis did not demonstrate any association of ticagrelor adherence with bleeding events and major adverse cardiovascular events. RIM, comprising 6 months of intensive coaching by nurse practitioners, did not improve adherence to the twice-a-day medication ticagrelor compared with SC among patients with AMI. A gradual decline in ticagrelor adherence over 12 months was observed despite 6 months of intensive coaching.
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Affiliation(s)
- Hui Wen Sim
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.
- Department of Medicine, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore.
| | - Karen W L Koh
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Sock-Cheng Poh
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Siew Pang Chan
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Stephanie Marchesseau
- Clinical Imaging Research Centre, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Devinder Singh
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Yiying Han
- Clinical Imaging Research Centre, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
| | - Faclin Ng
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Eleanor Lim
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Joseph F Prabath
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Ruth Chen
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Leonardo Carvalho
- Universidade Federal de São Paulo, R. Sena Madureira, 1500 - Vila Clementino, São Paulo, SP, 04021-001, Brazil
| | - Sock-Hwee Tan
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Joshua P Y Loh
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Jack W C Tan
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
| | - Karishma Kuwelker
- Betanien Hospital, Bjørnstjerne Bjørnsons gate 6, Skien, 3722, Norway
| | - R M Amanullah
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
| | - Chee-Tang Chin
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
| | - James W L Yip
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Choy-Yee Lee
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Juvena Gan
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Chew-Yong Lo
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Hee-Hwa Ho
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Derek J Hausenloy
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Bee-Choo Tai
- Saw Swee Hock School of Public Health, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - A Mark Richards
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Christchurch Heart Institute, University of Otago, 362 Leith Street, Dunedin North, Dunedin, 9016, New Zealand
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
- Department of Medicine, Yong Loo-Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.
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9
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Graham J, Voyce SJ, Hayden JR, Chopra A, Tinsley J, Singh N, Eslami A, Grassi S, Zook A, Lauver B, Eckel S, Hayduk VA, Kern MS, Agarwal S, Wright EA. Evaluation of pharmacist-led transition of care program in patients with acute coronary syndrome. J Am Pharm Assoc (2003) 2024:102023. [PMID: 38309415 DOI: 10.1016/j.japh.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Guideline-directed medical therapies (GDMTs), initiated in-hospital and continued during the transition to outpatient care, are paramount to successful outcomes for patients with acute coronary syndrome (ACS). Incomplete discharge medication prescribing and delayed follow-up lead to worse cardiovascular outcomes. OBJECTIVES We investigated a system of care using inpatient and outpatient clinical pharmacists to close GDMT gaps, ensure seamless transition to outpatient care, improve patient education, and optimize therapies. METHODS We conducted a pre-post cohort analysis of patients with ACS pre- versus post-intervention to compare process metrics and key outcomes using electronic health record data. RESULTS There were 181 and 135 patients in the pre- and post-intervention cohorts, respectively. Patients post-intervention were significantly more likely to have appropriately-timed follow-up visits scheduled with cardiology (79% vs. 51%, P < 0.0001) and primary care (57% vs. 43%, P = 0.01), to be discharged with prescriptions for P2Y12 inhibitors (87% vs. 64%, P < 0.0001), high dose statins (86% vs. 70%, P = 0.001), and beta blockers (87% vs. 76%, P = 0.01), and significantly less likely to have 30-day all-cause hospital readmissions (4% vs. 12%, P = 0.02) and emergency department (ED) visits (10% vs. 18%, P = 0.04). CONCLUSIONS The integration of advanced practicing pharmacists into a cardiology team at transition and post-hospitalization resulted in improved rates of posthospital follow-up visits, optimization of GDMT medications, and significantly lower 30-day hospital readmission and ED utilization.
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Yang Q, He J, Yuan F. Improvement of proportion of days covered for denosumab under implementation of clinical pharmacist adherence management system: normal and COVID-19 period. Osteoporos Int 2024; 35:309-316. [PMID: 37801081 PMCID: PMC10837216 DOI: 10.1007/s00198-023-06933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
We established a clinical pharmacist adherence management system (CPAMS) led by clinical pharmacists to examine whether denosumab adherence could be improved. The results showed that CPAMS could effectively improve adherence to denosumab and the treatment of osteoporosis. However, this effect weakened during the spread of infectious diseases such as COVID-19. PURPOSE Denosumab is currently one of the drugs that can effectively reduce the risk of clinical fracture. However, as a drug requiring long-term subcutaneous injection, patient adherence to denosumab is the most important factor affecting its therapeutic efficacy. Therefore, we established a clinical pharmacist adherence management system (CPAMS) led by clinical pharmacists and examined whether denosumab adherence could be improved. METHODS Data were collected from patients receiving denosumab in our hospital between March 2021 and May 2022. The patients who participated in the CPAMS were in the intervention group, and the rest were in the control group. We analysed the proportion of days covered (PDC) value of denosumab, distribution of subsequent visits, and proportion of patients who continued participating during the normal and coronavirus (COVID-19) periods. RESULTS Eighty-five patients were enrolled in this retrospective study: 32 in the intervention group and 53 in the control group. The PDC values were significantly higher in the intervention group (0.9875, 0.9025-1) than in the control group (0.5, 0.5-0.5) after 1 year. The subsequent visit rate in the intervention group was 93.80%. However, none of the patients in the control group returned. In the intervention group, the ratio of timely to delayed subsequent visits was 11:19. After the COVID-19 pandemic, the PDC value of the intervention group (0.957, 0.5-1) was lower than that before COVID-19, and the ratio of timely to delayed subsequent visits was 9:13. CONCLUSIONS Clinical pharmacist-led CPAMS could effectively improve adherence to denosumab and the treatment of osteoporosis.
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Affiliation(s)
- Qiong Yang
- Department of Pharmacy, Ningbo No. 6 Hospital, Ningbo, China
| | - Junhong He
- Department of Pharmacy, Ningbo No. 6 Hospital, Ningbo, China
| | - Fangfang Yuan
- Department of Rheumatism and Immunology, Ningbo No. 6 Hospital, Ningbo, China.
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11
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Abera SM, O’Donnell C, Salahuddin T, Prabhu K, Simons CE, Ho PM, Waldo SW, Doll JA. Assessment of Medication Adherence Using Pharmacy Data Before and After Percutaneous Coronary Intervention. Patient Prefer Adherence 2023; 17:2789-2795. [PMID: 37942121 PMCID: PMC10629403 DOI: 10.2147/ppa.s431183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/29/2023] [Indexed: 11/10/2023] Open
Abstract
Objective Adherence to anti-platelet medications is critical following coronary stenting, but prior studies indicate that clinician assessment and patient self-assessment of adherence are poorly correlated with future medication-taking behavior. We therefore sought to determine if integrated pharmacy data can be used to identify patients at high risk of non-adherence after percutaneous coronary interventions (PCI). Methods Using Veteran Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) data linked with pharmacy records, we assessed adherence to cardiovascular medications from 2012 to 2018. Adherence was defined as the proportion of days covered (PDC) ≥ 0.80. We assessed the association of pre-PCI adherence with post-PCI adherence to P2Y12 inhibitors and clinical outcomes using logistic regression and Cox proportional hazard models, respectively. Results Among 56,357 patients, 66.0% filled at least 1 cardiovascular medication within VA for the year prior to PCI and were evaluable for adherence. Pre-PCI non-adherence was 20.7%, and non-adherent patients were more likely to be younger and present non-electively. Non-adherent patients were less likely to adhere to P2Y12 inhibitor therapy after PCI (Adjusted OR 0.45 C.I. 0.41-0.46), compared with adherent patients, and had a higher adjusted risk of mortality (HR 1.17 C.I. 1.03-1.33). Conclusion Adherence to cardiovascular medications prior to PCI can be assessed for most patients using pharmacy data, and past adherence is associated with future adherence and mortality after PCI. Use of integrated pharmacy data to identify high-risk patients could improve outcomes and cost-effectiveness of adherence interventions.
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Affiliation(s)
- Seifu M Abera
- Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Colin O’Donnell
- Department of Veterans Affairs Clinical Assessment, Reporting, and Tracking Program, VHA Office of Quality and Patient Safety, Washington, DC, USA
| | - Taufiq Salahuddin
- Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Carol E Simons
- Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA, USA
| | - P Michael Ho
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stephen W Waldo
- Department of Veterans Affairs Clinical Assessment, Reporting, and Tracking Program, VHA Office of Quality and Patient Safety, Washington, DC, USA
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jacob A Doll
- Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Veterans Affairs Clinical Assessment, Reporting, and Tracking Program, VHA Office of Quality and Patient Safety, Washington, DC, USA
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12
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Bahit MC, Korjian S, Daaboul Y, Baron S, Bhatt DL, Kalayci A, Chi G, Nara P, Shaunik A, Gibson CM. Patient Adherence to Secondary Prevention Therapies After an Acute Coronary Syndrome: A Scoping Review. Clin Ther 2023; 45:1119-1126. [PMID: 37690915 DOI: 10.1016/j.clinthera.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/05/2023] [Accepted: 08/16/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE Adherence to guideline-recommended, long-term secondary preventative therapies among patients with acute coronary syndrome (ACS) is fundamental to improving long-term outcomes. The purpose of this scoping review was to provide a broad synopsis of pertinent studies in a structured and comprehensive way regarding factors that influence patient adherence to medical therapy after ACS. METHODS Relevant articles focusing on adherence to medical therapy after ACS were retrieved from the EMBASE and MEDLINE databases (search date, September 7, 2021). Studies were independently screened, and relevant information was extracted. FINDINGS A total of 58 studies were identified by using the EMBASE and MEDLINE databases. Adherence to secondary prevention was moderate to low and steadily decreased over time. Nearly 30% of patients discontinued one or more medications within 90 days of their primary ACS, and adherence decreased to 50% to 60% at 1 year postdischarge. There were no major differences in adherence between drug classes. Factors influencing patient adherence can be broadly divided into 3 categories: patient related, health care system related, and disease related. Patients managed with percutaneous coronary interventions were more adherent to follow-up treatment than medically managed patients. Depression was reported as a major psychological factor that negatively affected adherence. Improved adherence was observed when higher levels of patient education and provider engagement were delivered during postdischarge follow-up, particularly when scheduled early. Notably, the incidence of major adverse cardiovascular events was lower in hospitals with high 90-day medication adherence than those with moderate or low adherence. IMPLICATIONS Patient nonadherence to guideline-recommended long-term pharmacologic secondary preventative therapies after ACS is multifactorial. A comprehensive multifaceted approach should be implemented to improve adherence and clinical outcomes. This approach should include key interventions such as early follow-up visits, high medication adherence at 90 days, patient engagement and education, and development of novel interventions that support the 3 broad categories influencing patient adherence as discussed in this review.
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Affiliation(s)
| | - Serge Korjian
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Yazan Daaboul
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne Baron
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Deepak L Bhatt
- Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Arzu Kalayci
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerald Chi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Nara
- CSL Behring, King of Prussia, Pennsylvania, USA
| | | | - C Michael Gibson
- PERFUSE Study Group, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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13
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Costello J, Barras M, Foot H, Cottrell N. The impact of hospital-based post-discharge pharmacist medication review on patient clinical outcomes: A systematic review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100305. [PMID: 37655116 PMCID: PMC10466898 DOI: 10.1016/j.rcsop.2023.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 06/20/2023] [Accepted: 07/08/2023] [Indexed: 09/02/2023] Open
Abstract
Background Clinical pharmacists have been shown to identify and resolve medication related problems post-discharge, however the impact on patient clinical outcomes is unclear. Aims To undertake a systematic review to identify, critically appraise and present the evidence on post-discharge hospital clinics that provide clinical pharmacist medication review; report the patient clinical outcomes measured; and describe the activities of the clinical pharmacist. Methods Published studies evaluating a patient clinical outcome following a post-discharge hospital clinic pharmacy service were included. All studies needed a comparative design (intervention vs control or comparator). Pubmed, Embase, CINAHL, PsycnINFO, Web of Science, IPA and APAIS-Health databases were searched to identify studies. The type of clinic and the clinical pharmacist activities were linked to patient clinical outcomes. Results Fifty-seven studies were included in the final analysis, 14 randomised controlled trials and 43 non-randomised studies. Three key clinic types were identified: post-discharge pharmacist review alone, inpatient care plus post-discharge review and post-discharge collaborative clinics. The three main outcome metrics identified were hospital readmission and/or representation, adverse events and improved disease state metrics. There was often a mix of these outcomes reported as primary and secondary outcomes. High heterogeneity of interventions and clinical pharmacist activities reported meant it was difficult to link clinical pharmacist activities with the outcomes reported. Conclusions A post-discharge clinic pharmacist may improve patient clinical outcomes such as hospital readmission and representation rates. Future research needs to provide a clearer description of the clinical pharmacist activities provided in both arms of comparative studies.
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Affiliation(s)
- Jaclyn Costello
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Redcliffe Hospital, Metro North Health, Brisbane, QLD, Australia
| | - Michael Barras
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
| | - Holly Foot
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Neil Cottrell
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
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Gao L, Han Y, Jia Z, Wang P, Zhang M, Ma T, Yan S, Liu H. Impact of continuous pharmaceutical care led by clinical pharmacists during transitions of care on medication adherence and clinical outcomes for patients with coronary heart disease: a prospective cohort study. Front Pharmacol 2023; 14:1249636. [PMID: 37693909 PMCID: PMC10484794 DOI: 10.3389/fphar.2023.1249636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives: The study aimed to explore the impact of a continuous pharmaceutical care (CPC) program during care transitions on medication adherence and clinical outcomes for patients with coronary heart disease (CHD). Methods: A prospective cohort study was conducted from April 2020 to February 2021. Patients diagnosed with CHD were selected and divided into intervention (CPC) and usual care (UC) groups by nurses at equal intervals based on admission time. The intervention group received CPC services provided by clinical pharmacists (including medication reconciliation, disease education, medication guidance, lifestyle counseling, and follow-up services) and usual care. The UC group received only routine medical care. The study compared medication adherence, clinical indicators (low-density lipoprotein cholesterol [LDL-C], blood pressure [BP], glycated hemoglobin [HbA1c] control rates), the incidence of adverse drug reactions (ADRs), and readmission rates (overall, major adverse cardiovascular events [MACEs]-related, and CHD risk factors-related) at admission and 1, 3, and 6 months after discharge between the two groups. Results: A total of 228 patients with CHD completed the study, including 113 patients in the CPC group and 115 patients in the UC group. There were no significant differences (p > 0.05) in both groups in demographic and clinical characteristics at baseline. A total of 101 drug-related problems were identified in the CPC group (an average of 0.89 per person). The CPC group showed significantly higher medication adherence at 1, 3, and 6 months after discharge than the UC group (p < 0.05). At 3 and 6 months after discharge, the intervention group had significantly higher control rates of LDL-C (61.11% vs. 44.64% at 3 months, 78.18% vs. 51.43% at 6 months), and BP (91.15% vs. 77.39% at 3 months, 88.50% vs. 77.19% at 6 months). The CPC group had higher HbA1c control rates (53.85% vs. 34.21% at 3 months, 54.05% vs. 38.46% at 6 months) than the UC group. However, the differences were not statistically significant. The incidence of ADRs 6 months after discharge was significantly lower in the CPC group than in the UC group (5.13% vs. 12.17%, p < 0.05). The CPC group had a lower overall readmission rate (13.27% vs. 20.00%), MACE-related readmission rate (5.31% vs. 12.17%), and readmission rate related to CHD risk factors (0.88% vs. 2.61%) 6 months after discharge compared to the UC group. However, these differences were not statistically significant (p > 0.05). Conclusion: CPC led by clinical pharmacists during care transitions effectively improved medication adherence, safety, and risk factor control in patients with CHD.
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Affiliation(s)
- Lingyan Gao
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Yalei Han
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Zhankun Jia
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Pengfei Wang
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Meijing Zhang
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Teng Ma
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Suying Yan
- Department of Pharmacy, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Hua Liu
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
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15
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Weeda E, Gilbert RE, Kolo SJ, Haney JS, Hazard LT, Taber DJ, Axon RN. Impact of Pharmacist-Driven Transitions of Care Interventions on Post-hospital Outcomes Among Patients With Coronary Artery Disease: A Systematic Review. J Pharm Pract 2023; 36:668-678. [PMID: 34962844 PMCID: PMC9427131 DOI: 10.1177/08971900211064155] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Transitions of care (ToC) aim to provide continuity while preventing loss of information that may result in poor outcomes such as hospital readmission. Readmissions not only burden patients, they also increase costs. Given the high prevalence of coronary artery diseases (CAD) in the United States (US), patients with CAD often make up a significant portion of hospital readmissions. Objective: To conduct a systematic review evaluating the impact of pharmacist-driven ToC interventions on post-hospital outcomes for patients with CAD. Methods: MEDLINE, Scopus, and CINAHL were searched from database inception through 03/2020 using key words for CAD and pharmacists. Studies were included if they: (1) identified adults with CAD at US hospitals, (2) evaluated pharmacist-driven ToC interventions, and (3) assessed post-discharge outcomes. Outcomes were summarized qualitatively. Results: Of the 1612 citations identified, 11 met criteria for inclusion. Pharmacist-driven ToC interventions were multifaceted and frequently included medication reconciliation, medication counseling, post-discharge follow-up and initiatives to improve medication adherence. Hospital readmission and emergency room visits were numerically lower among patients receiving vs not receiving pharmacist-driven interventions, with statistically significant differences observed in 1 study. Secondary prevention measures and adherence tended to be more favorable in the pharmacist-driven intervention groups. Conclusion: Eleven studies of multifaceted, ToC interventions led by pharmacists were identified. Readmissions were numerically lower and secondary prevention measures and adherence were more favorable among patients receiving pharmacist-driven interventions. However, sufficiently powered studies are still required to confirm these benefits.
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Affiliation(s)
- Erin Weeda
- Charleston Patient Safety Center of Inquiry, Ralph H Johnson VAMC, Charleston, SC, USA
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H Johnson VAMC, Charleston, SC, USA
- College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Rachael E Gilbert
- Charleston Patient Safety Center of Inquiry, Ralph H Johnson VAMC, Charleston, SC, USA
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H Johnson VAMC, Charleston, SC, USA
| | - Shelby J Kolo
- Charleston Patient Safety Center of Inquiry, Ralph H Johnson VAMC, Charleston, SC, USA
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H Johnson VAMC, Charleston, SC, USA
| | - Jason S Haney
- Charleston Patient Safety Center of Inquiry, Ralph H Johnson VAMC, Charleston, SC, USA
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H Johnson VAMC, Charleston, SC, USA
- College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Linh Tran Hazard
- College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - David J Taber
- Charleston Patient Safety Center of Inquiry, Ralph H Johnson VAMC, Charleston, SC, USA
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H Johnson VAMC, Charleston, SC, USA
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Robert Neal Axon
- Charleston Patient Safety Center of Inquiry, Ralph H Johnson VAMC, Charleston, SC, USA
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H Johnson VAMC, Charleston, SC, USA
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Béjot Y, Soilly AL, Bardou M, Duloquin G, Pommier T, Laurent G, Cottin Y, Vadot L, Adam H, Boulin M, Giroud M. Efficiency and effectiveness of intensive multidisciplinary follow-up of patients with stroke/TIA or myocardial infarction compared to usual monitoring: protocol of a pragmatic randomised clinical trial. DiVa (Dijon vascular) study. BMJ Open 2023; 13:e070197. [PMID: 37185649 PMCID: PMC10151851 DOI: 10.1136/bmjopen-2022-070197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION The ongoing ageing population is associated with an increase in the number of patients suffering a stroke, transient ischaemic attack (TIA) or myocardial infarction (MI). In these patients, implementing secondary prevention is a critical challenge and new strategies need to be developed to close the gap between clinical practice and evidence-based recommendations. We describe the protocol of a randomised clinical trial that aims to evaluate the efficiency and effectiveness of an intensive multidisciplinary follow-up of patients compared with standard care. METHODS AND ANALYSIS The DiVa study is a randomised, prospective, controlled, multicentre trial including patients >18 years old with a first or recurrent stroke (ischaemic or haemorrhagic) or TIA, or a type I or II MI, managed in one of the participating hospitals of the study area, with a survival expectancy >12 months. Patients will be randomised with an allocation ratio of 1:1 in two parallel groups: one group assigned to a multidisciplinary, nurse-based and pharmacist-based 2-year follow-up in association with general practitioners, neurologists and cardiologists versus one group with usual follow-up. In each group for each disease (stroke/TIA or MI), 430 patients will be enrolled (total of 1720 patients) over 3 years. The primary outcome will be the incremental cost-utility ratio at 24 months between intensive and standard follow-up in a society perspective. Secondary outcomes will include the incremental cost-utility ratio at 6 and 12 months, the incremental cost-effectiveness ratio at 24 months, reduction at 6, 12 and 24 months of the rates of death, unscheduled rehospitalisation and iatrogenic complications, changes in quality of life, net budgetary impact at 5 years of the intensive follow-up on the national health insurance perspective and analysis of factors having positive or negative effects on the implementation of the project in the study area. ETHICS AND DISSEMINATION Ethical approval was obtained and all patients receive information about the study and give their consent to participate before randomisation. Results of the main trial and each of the secondary analyses will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT04188457. Registered on 6 December 2019.
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Affiliation(s)
- Yannick Béjot
- Neurology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Anne-Laure Soilly
- Department of Clinical Research and Innovation, Clinical Research Unit-Methodological Support Network (USMR), University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Marc Bardou
- Gastroenterology, University Hospital Centre Dijon Bourgogne, Dijon, France
- CIC-Inserm 1432, University of Burgundy, Dijon, France
| | - Gauthier Duloquin
- Neurology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Thibaut Pommier
- Cardiology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Gabriel Laurent
- Cardiology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Yves Cottin
- Cardiology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Lucie Vadot
- Pharmacy, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Héloïse Adam
- Pharmacy, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Mathieu Boulin
- Pharmacy, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Maurice Giroud
- Neurology, University Hospital Centre Dijon Bourgogne, Dijon, France
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Roos A, Sedin E, Edgren G. Management and outcomes of patients with chest pain and psychiatric disorders in the era of high-sensitivity cardiac troponins. J Intern Med 2023; 293:481-493. [PMID: 36511632 DOI: 10.1111/joim.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The management of patients with psychiatric disease and chest pain in the emergency department (ED) in the era of high-sensitivity cardiac troponin assays is unexplored. OBJECTIVES To investigate differences in management and outcomes comparing patients with versus without psychiatric disorders who present with chest pain in the ED. METHODS All visits to seven different EDs in Sweden from 9 December 2010 to 31 December 2016 by patients with chest pain were included. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to estimate differences in clinical management. Hazard ratios with 95% CIs were used for comparisons of all-cause mortality and risk of cardiovascular events. RESULTS Altogether, 216,653 visits were identified, of which 40,054 (18%) occurred in patients with psychiatric disorders. The risk of a myocardial infarction (MI) was reduced almost by half in patients with an affective (OR 0.63; 95% CI: 0.59-0.68) or psychotic disorder (OR 0.57; 95% CI: 0.47-0.70). These patients were less likely to be treated with any cardiovascular medication or to undergo percutaneous coronary intervention. Contrastingly, patients with psychiatric disease had a 1.8- to 2.6-fold increased risk of being diagnosed with an MI registered after the index visit but within 30 days. CONCLUSIONS Patients with psychiatric disease and chest pain undergo less intense investigation and are less likely to receive cardiovascular medications compared with patients without psychiatric disease, even in the presence of myocardial injury. In addition, they experience a higher risk of being diagnosed with an MI within 30 days after a visit with no MI.
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Affiliation(s)
- Andreas Roos
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Solna, Stockholm, Sweden.,Department of Emergency and Reparative Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Eva Sedin
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Gustaf Edgren
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Solna, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Stockholm, Sweden
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18
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Arshed M, Mahmud AB, Minhat HS, Ying LP, Umer MF. Effectiveness of mHealth Interventions in Medication Adherence among Patients with Cardiovascular Diseases: A Systematic Review. Diseases 2023; 11:diseases11010041. [PMID: 36975590 PMCID: PMC10047328 DOI: 10.3390/diseases11010041] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/30/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
mHealth interventions have been reported to improve adherence to long-term therapies in chronic conditions. Therefore, this study aimed at determining the effectiveness of mHealth interventions in medication adherence among patients with cardiovascular diseases (CVDs), a leading cause of mortality globally. Relying on our inclusion criteria and the PRISMA recommendations, a literature search was carried out in the PubMed, Medline, and ProQuest databases for primary studies that investigated the impact of mHealth on medication adherence for cardiovascular disease (CVD) between 2000–2021. A total of 23 randomized controlled trials with 34,915 participants matched the selection criteria. The mHealth interventions used included text messages, mobile phone applications, and voice calls, which were used either as a single intervention or combined. Additionally, studies on enhancing drug adherence had contradictory findings: most of the studies elaborated positive results; however, six studies were unable to reveal any significant effect. Finally, a risk bias analysis revealed varying outcomes across all studies. This review, as a whole, supported the notion that mHealth interventions can be effective in improving adherence to CVD medication even though they could not improve adherence to all CVD medications when compared with controls. Further trials with more refined designs integrated with comprehensive interventions are needed to produce better health outcomes.
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Affiliation(s)
- Muhammad Arshed
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor Darul Ehsan, Malaysia
| | - Aidalina Binti Mahmud
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor Darul Ehsan, Malaysia
| | - Halimatus Sakdiah Minhat
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor Darul Ehsan, Malaysia
| | - Lim Poh Ying
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor Darul Ehsan, Malaysia
| | - Muhammad Farooq Umer
- Department of Dental Public Health, College of Dentistry, King Faisal University, Hofuf 31982, Saudi Arabia
- Correspondence: ; Tel.: +966-590536962
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19
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Effectiveness of a structured pharmacist-delivered intervention for patients post-acute coronary syndromes on all-cause hospitalizations and cardiac-related hospital readmissions: a prospective quasi-experimental study. Int J Clin Pharm 2023:10.1007/s11096-023-01538-4. [PMID: 36795303 DOI: 10.1007/s11096-023-01538-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/05/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity in Qatar and globally. AIM The primary objective of the study was to evaluate the effectiveness of a structured clinical pharmacist-delivered intervention on all-cause hospitalizations and cardiac-related readmissions in patients with ACS. METHOD A prospective quasi-experimental study was conducted at Heart Hospital in Qatar. Discharged ACS patients were allocated to one of three study arms: (1) an intervention group (received a structured clinical pharmacist-delivered medication reconciliation and counselling at discharge, and two follow-up sessions at 4 weeks and 8 weeks post-discharge), (2) a usual care group (received the general usual care at discharge by clinical pharmacists) or, (3) a control group (discharged during weekends or after clinical pharmacists' working hours). Follow-up sessions for the intervention group were designed to re-educate and counsel patients about their medications, remind them about the importance of medication adherence, and answer any questions they may have. At the hospital, patients were allocated into one of the three groups based on intrinsic and natural allocation procedures. Recruitment of patients took place between March 2016 and December 2017. Data were analyzed based on intention-to-treat principles. RESULTS Three hundred seventy-three patients were enrolled in the study (intervention = 111, usual care = 120, control = 142). Unadjusted results showed that the odds of 6-month all-cause hospitalizations were significantly higher among the usual care (OR 2.034; 95% CI: 1.103-3.748, p = 0.023) and the control arms (OR 2.704; 95% CI: 1.456-5.022, p = 0.002) when compared to the intervention arm. Similarly, patients in the usual care arm (OR 2.304; 95% CI: 1.122-4.730, p = 0.023) and the control arm (OR 3.678; 95% CI: 1.802-7.506, p ≤ 0.001) had greater likelihood of cardiac-related readmissions at 6 months. After adjustment, these reductions were only significant for cardiac-related readmissions between control and intervention groups (OR 2.428; 95% CI: 1.116-5.282, p = 0.025). CONCLUSION This study demonstrated the impact of a structured intervention by clinical pharmacists on cardiac-related readmissions at 6 months post-discharge in patients post-ACS. The impact of the intervention on all-cause hospitalization was not significant after adjustment for potential confounders. Large cost-effective studies are required to determine the sustained impact of structured clinical pharmacist-provided interventions in ACS setting. TRIAL REGISTRATION Clinical Trials: NCT02648243 Registration date: January 7, 2016.
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20
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Patel K, Maestas CM, Petrechko O, Boja H, Blankenship JC. Failure of Guidelines and Consensus Statements to Recommend Follow-up for Chronic Cardiovascular Conditions. Heart Lung 2023; 59:128-138. [PMID: 36801547 DOI: 10.1016/j.hrtlng.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Many cardiac conditions require long-term clinical follow-up to monitor progression of disease and tolerance and adherence to therapies. Providers are often unsure as to the frequency of clinical follow-up and who should provide the follow-up. In the absence of formal guidance, patients may be seen more frequently than necessary - thereby limiting clinic space for other patients, or not frequently enough, potentially leading to undetected progression of disease. OBJECTIVES To determine the extent to which guidelines (GL)/consensus statements (CS) provide guidance about appropriate follow-up for common cardiovascular conditions. METHODS We identified 31 chronic cardiovascular disease conditions for which long-term (beyond 1 year) follow-up is indicated and used PubMed and professional society websites to identify all relevant GL/CS (n = 33) regarding these chronic cardiac conditions. RESULTS Of the 31 cardiac conditions reviewed, GL/CS contained no recommendation or vague recommendation for long-term follow-up for 7 of the conditions. Of the 24 conditions with recommendations for follow-up, 3 had recommendations for imaging follow-up only without mention of clinical follow-up. Of the 33 GL/CS reviewed, 17 made any recommendations about long-term follow-up. When recommendations were made regarding follow-up, they were often vague, using terminology such as "as needed". CONCLUSIONS Half of GL/CS fail to provide recommendations for clinical follow-up of common cardiovascular conditions. Writing groups for GL/CS should adopt a standard of routinely including recommendations for follow-up including specific advice about level of expertise needed (eg, primary care physician, cardiologist), need for imaging or testing, and frequency of follow-up.
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Affiliation(s)
- Krishna Patel
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Camila M Maestas
- University of Virginia Health Science Center, Charlottesville, VA
| | - Oksana Petrechko
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
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21
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Bagyawantha NMY, Coombes ID, Gawarammana I, Fahim M. Impact of a clinical pharmacist on optimising the quality use of medicines according to the acute coronary syndrome (ACS) secondary prevention guidelines and medication adherence following discharge in patients with ACS in Sri Lanka: a prospective non-randomised controlled trial study protocol. BMJ Open 2023; 13:e059413. [PMID: 36759028 PMCID: PMC9923319 DOI: 10.1136/bmjopen-2021-059413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES Ensuring quality use of medicines (QUM) through clinical pharmacy services can improve therapeutic outcomes of patients diagnosed with acute coronary syndrome (ACS). The major objective of this study is to demonstrate the added value of a clinical pharmacist to the medical and nursing team providing care to patients with ACS on the continuation of quality use of the patients' medicine after discharge. STUDY DESIGN This protocol outlines a prospective, non-blinded, non-randomised, controlled interventional study. STUDY SETTING The study will be conducted at the professorial medical wards of a tertiary care teaching hospital in Sri Lanka. PARTICIPANTS Sample size will be 746 patients in both control and intervention arms. Patients diagnosed with ACS who are 18 years old or above and expected to visit the hospital for their routine clinic follow-ups after discharge will be recruited and randomised 1:1 to either the intervention group or the control group. Patients who are diagnosed and suffering from psychological disorders will be excluded from this study. INTERVENTIONS The planned interventions that will be delivered at discharge include review and optimisation of medications, assessing patient adherence and providing discharge medication counselling. Data will be collected at recruitment, 1 month, 3 months and 6 months' time intervals in both groups. Improvement of patients' medication adherence, reduction of hospital readmissions, reduction of drug-related problems, the attitude of doctors and nurses towards clinical pharmacy services and the cost-effectiveness of the clinical pharmacy services will be the major outcomes of this study. ETHICS AND DISSEMINATION Ethical approval for this study has been obtained from the ethics review committee, Faculty of Medicine, University of Peradeniya (2019/EC/26) and the trial is registered at the Sri Lanka Clinical Trials Registry. The results of this study will be disseminated via conference proceedings, journal publications and thesis presentations. TRIAL REGISTRATION NUMBER SLCTR/2019/039.
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Affiliation(s)
- Nanayakkara Muhandiramalaya Yasakalum Bagyawantha
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Central, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ian D Coombes
- School of Pharmacy, The University of Queensland, Saint Lucia, Queensland, Australia
- Collaboration of Australians and Sri Lankans for Pharmacy Practice, Education and Research (CASPPER), Brisbane, Queensland, Australia
| | - Indika Gawarammana
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Central, Sri Lanka
| | - Mohamed Fahim
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
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22
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Amritphale A, Fonarow GC, Amritphale N, Omar B, Crook ED. All-cause unplanned readmissions in the United States: insights from the Nationwide Readmission Database. Intern Med J 2023; 53:262-270. [PMID: 34633136 DOI: 10.1111/imj.15581] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are few studies looking into adult, all-cause and age-group-specific unplanned readmissions. The predictors of such unplanned readmissions for all inpatient encounters remain obscure. AIMS To describe the incidence and factors associated with unplanned readmissions in all inpatient encounters in the United States. METHODS The US Nationwide Readmission Database (NRD) is a representative sample of hospitalisations in the United States (from approximately 28 states) accounting for approximately 60% of the US population. All inpatient encounters during January-November 2017 in the NRD were evaluated for the rates, predictors and costs of unplanned 30 days readmissions for age groups 18-44 years, 45-64 years, 65-75 years and ≥75 years. Elective readmissions and those patients who died on their index hospitalisations were excluded. Weighted analysis was performed to obtain nationally representative data. RESULTS We identified 28 942 224 inpatient encounters with a total of 3 051 189 (10.5%) unplanned readmissions within 30 days. The age groups 18-44 years, 45-64 years, 65-74 years and ≥75 years had 7.0%, 12.0%, 11.7% and 12.3% readmissions respectively. Female gender, private insurance and elective admissions were negative predictors for readmissions. For the group aged 18-44 years, schizophrenia and diabetes mellitus complications were the most frequent primary diagnosis for readmissions, while in all older age groups septicaemia and heart failure were the most frequent primary diagnosis for readmissions. CONCLUSIONS Thirty-day unplanned readmissions are common in patients over age 45 years, leading to significant morbidity. Effective strategies for reducing unplanned readmission may help to improve quality of care, outcomes and higher value care.
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Affiliation(s)
- Amod Amritphale
- Department of Internal Medicine, University Hospital, University of South Alabama, Mobile, Alabama, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA
| | - Nupur Amritphale
- Children and Women's Hospital, University of South Alabama, Mobile, Alabama, USA
| | - Bassam Omar
- Department of Internal Medicine, University Hospital, University of South Alabama, Mobile, Alabama, USA
| | - Errol D Crook
- Department of Internal Medicine, University Hospital, University of South Alabama, Mobile, Alabama, USA
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23
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Raparelli V, Wright CX, Corica B, Sharma G, Lindley K, Brackett A, Pilote L, Wood MJ, Dreyer RP. Interventions Targeted to Address Social Determinants of Health in Ischemic Heart Disease: A Sex- and Gender-Oriented Scoping Review. Can J Cardiol 2022; 38:1881-1892. [PMID: 35809812 DOI: 10.1016/j.cjca.2022.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 12/14/2022] Open
Abstract
The burden of ischemic heart disease (IHD) is a major health problem worldwide. The detrimental effect of gendered (ie, unevenly distributed between female and male) socioeconomic determinants of health (SDOH) on outcomes has been demonstrated, more so in female individuals. Therefore, addressing SDOH is a priority for the care implementation of patients with IHD. We conducted a scoping review to identify the types of SDOH-tailored interventions tested in randomised controlled trials (RCTs) among IHD patients, and whether the reporting of findings was sex-unbiased. We identified 8 SDOH domains: education, physical environment, health care system, economic stability, social support, sexual orientation, culture/language, and systemic racism. A total of 28 RCTs (2 ongoing) were evaluated. Since the 1990s, 26 RCTs have been conducted, mainly in the Middle East and Asia, and addressed only education, physical environment, health care system, and social support. The 77% of studies focused on patient-education interventions, and around 80% on SDOH-based interventions achieved positive effects on a variety of primary outcome(s). Among the limitations of the conducted RCTs, the most relevant were an overall low participation of female and racial/ethnical minority participants, a lack of sex-stratified analyses, and a missing opportunity of tailoring some SDOH interventions relevant for health. The SDOH-tailored interventions tested so far in RCTs, enrolling predominantly male patients and mainly targeting education and health literacy, were effective in improving outcomes among patients with IHD. Future studies should focus on a wider range of SDOH with an adequate representation of female and minority patients who would most benefit from such interventions.
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Affiliation(s)
- Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; University Centre for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy; Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine X Wright
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bernadette Corica
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathryn Lindley
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri, USA
| | - Alexandria Brackett
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Louise Pilote
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montréal, Québec, Canada; Divisions of Clinical Epidemiology and General Internal Medicine, McGill University Health Centre Research Institute, Montréal, Québec, Canada
| | - Malissa J Wood
- Massachusetts General Hospital Corrigan Minehan Heart Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, Connecticut, USA.
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24
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Gebremichael LG, Beleigoli A, Champion S, Nesbitt K, Bulto LN, Pinero de Plaza MA, Pearson V, Noonan S, Hendriks JM, Hines S, Clark RA. Effectiveness of cardiac rehabilitation programs in improving medication adherence in patients with cardiovascular disease: a systematic review protocol. JBI Evid Synth 2022; 20:2986-2994. [PMID: 36081378 DOI: 10.11124/jbies-21-00457] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review is to measure the effectiveness of cardiac rehabilitation programs versus standard care on medication adherence in patients with cardiovascular disease. INTRODUCTION Poor adherence to long-term medications increases the risk of morbidity and mortality, and decreases quality of life in patients with cardiovascular diseases. Several strategies have been trialed to improve medication adherence, one of which is cardiac rehabilitation programs. Although evidence has indicated that such programs increase medication adherence, the extent of their effectiveness and translation into clinical practice is not well documented. Our systematic review will collect and analyze the available evidence for clinical practice implementation. INCLUSION CRITERIA The search will aim to locate randomized controlled trials. Where randomized controlled trials are not available, quasi-experimental studies, case-control studies, observational studies, and other study designs will be included. Studies that measure effectiveness of cardiac rehabilitation programs compared with standard care on medication adherence in cardiovascular disease patients will be included. METHODS Databases, including MEDLINE (Ovid), Emcare (Ovid), Embase (Ovid), Cochrane CENTRAL, Scopus, CINAHL (EBSCO), and unpublished sources will be searched. Articles in English and non-English-language articles with an English abstract, published from database inception to the present, will be included. Articles will be screened and reviewed by 2 independent reviewers for inclusion. Critical appraisal tools will be applied to the included studies. Data will be extracted using the appropriate extraction tools and synthesized for the objectives of the study. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021284705.
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Affiliation(s)
- Lemlem G Gebremichael
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Alline Beleigoli
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Stephanie Champion
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Katie Nesbitt
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Lemma N Bulto
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Maria Alejandra Pinero de Plaza
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia.,National Health and Medical Research Council, Transdisciplinary Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
| | - Vincent Pearson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Sara Noonan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia.,Centre for Heart Rhythm Disorders, University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sonia Hines
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia.,Flinders Rural and Remote Health, NT, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Robyn A Clark
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
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25
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A Study on Types of Medication Adherence in Hypertension among Older Patients and Influencing Factors. Healthcare (Basel) 2022; 10:healthcare10112322. [DOI: 10.3390/healthcare10112322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Hypertension has the characteristic that the risk of complications can be reduced through appropriate medication in daily life. Hence, it is important to consider practical measures to increase medication adherence, particularly among older patients. Methods: This study used the Korea Health Panel 2020 data (Version 2.0.1), jointly conducted by Korea Institute for Health and Social Affairs and National Health Insurance. A total of 2300 patients with high blood pressure over 65 years of age were selected. In order to identify types of medication adherence in older hypertensive patients, and examine factors that influence the types, the Latent Profile Analysis (LPA) and logistic regression were performed. Results: The types of adherence groups were classified into two groups: an ‘adherence group’ (87.1%) and a ‘non-adherence group’ (12.9%). Furthermore, age, living alone, and depressive symptoms were identified as determinants of medication adherence type among older hypertensive patients. Conclusion: The significant impact of sociodemographic status (age, living alone, and depressive symptoms) on medication adherence among older hypertensive patients indicates the need to establish more specific empirical interventions based on each type’s characteristics. It is expected that this study will provide an in-depth understanding of factors associated with medication adherence among older patients with hypertension, which can support interventions tailored to the specific needs of those who are non-adherent.
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26
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Al-Qahtani S, Jalal Z, Paudyal V, Mahmood S, Mason J. The Role of Pharmacists in Providing Pharmaceutical Care in Primary and Secondary Prevention of Stroke: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:2315. [PMID: 36421639 PMCID: PMC9691113 DOI: 10.3390/healthcare10112315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/05/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022] Open
Abstract
Pharmacists deliver pharmaceutical care in many different healthcare settings and are well-placed to support the prevention of stroke. However, their role and impact in this area is ill-defined. This systematic review aims to explore the pharmacists’ role in stroke prevention. Nine databases were searched for studies reporting pharmacist interventions in the management of primary and secondary ischaemic stroke prevention. Study quality was evaluated through Cochrane Risk of Bias and Joanna Briggs Institute (JBI) appraisal tools where possible. A narrative review was conducted and meta-analysis performed for studies with comparable outcomes. Of the 834 initial articles, 31 met inclusion criteria. Study designs were varied and included controlled trials, observational studies, audit reports and conference abstracts. Seven studies addressed the pharmacists’ role in primary prevention and 24 in secondary prevention. Pharmacist interventions reported were diverse and often multifactorial. Overall, 20 studies reported significant improvement in outcomes. Meta-analysis showed pharmacist interventions in emergency care significantly improved the odds of achieving thrombolytic therapy door to needle (DTN) times ≤45 min, odds ratio: 2.69 (95% confidence interval (CI): 1.95−3.72); p < 0.001. The pharmacists’ role is varied and spans the stroke treatment pathway, with the potential for a positive impact on a range of health-related outcomes.
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Affiliation(s)
- Saeed Al-Qahtani
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
- School of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
| | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Vibhu Paudyal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Sajid Mahmood
- Department of Pharmacy, Quaid-i-Azam University, Islamabad 45320, Pakistan
| | - Julie Mason
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Yahya F, Nazar H, Hadi MA. Role of primary care pharmacists in the post-hospital discharge care of patients: a scoping review protocol. J Pharm Policy Pract 2022; 15:75. [PMID: 36309737 PMCID: PMC9617399 DOI: 10.1186/s40545-022-00473-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence has shown that there is a significant problem with medication safety when patients are transferred between settings. The role of community pharmacists and hospital pharmacists in facilitating transition of care has been well-researched. However, with the developing role of pharmacists in general practice as part of a multi-disciplinary team, little is known about their role in improving transition of care when patients move from secondary to primary care. The key objective of this scoping review is to understand the nature and extent of the role of primary care pharmacists for patients recently discharged from secondary care. METHODS This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping review underpinned by the Arksey and O'Malley methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews (PRISMA-ScR) guidelines. The following electronic databases will be systematically searched: MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and NICE Evidence. Reference lists of included full texts will be searched for relevant papers, in addition to grey literature which includes websites of relevant professional organisations. Primary studies, published in the English language that involved a primary care pharmacist-led intervention post-hospital discharge will be included. Two independent reviewers will screen studies against eligibility criteria and use a piloted data extraction form to extract data related to the review questions. The data will be presented in tabular form and assessed for key themes to identify gaps and inform future research. DISCUSSION This scoping review will map current evidence surrounding the role of primary care pharmacists in the post-hospital discharge care of patients. Findings will inform ongoing research to support safer transfer-of-care post-hospital discharge and identify ways in which collaboration between healthcare professionals can be improved. This review anticipates guiding the inclusion of patient and public involvement (PPI) at the consultation stage to validate and build on the findings.
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Affiliation(s)
- Faiza Yahya
- Our Health Partnership, First Floor, 1856 Pershore Road, Cotteridge, Birmingham, B30 3AS UK
| | - Hamde Nazar
- School of Pharmacy, Newcastle University, King George VI Building, Newcastle-Upon-Tyne, NE1 7RU UK
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Ismail FF, Md Redzuan A, Wen CW. Patient-centered education in dyslipidemia management: a systematic review. ASIAN BIOMED 2022; 16:214-236. [PMID: 37551316 PMCID: PMC10321189 DOI: 10.2478/abm-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Background Dyslipidemia management is crucial to reduce mortality and morbidity from cardiovascular diseases (CVDs). Patients must be educated and empowered to enable them to manage their own diseases. Various methods of patient education, such as patient-centered education (PCE) or non-PCE (such as didactic education or any traditional form of education), have been implemented. Objective To review and determine the effectiveness of PCE for dyslipidemia management compared with usual care. The primary outcome chosen was cholesterol level. Other measures, such as psychosocial or cognitive, behavioral, and other relevant outcomes, were also extracted. Additionally, underlying theories and other contributing factors that may have led to the success of the intervention were also reviewed and discussed. Methods We conducted searches in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Google Scholar from inception until April 2021. All studies involving randomized controlled trials were included. Study quality was assessed using the Critical Appraisal Skills Program (CASP) checklist specifically for randomized controlled trials. Results The search identified 8,847 records. Of these, 20 studies were eligible for inclusion. Interventions using a PCE approach were largely successful. Contributing factors extracted from the included studies were underlying theories, instant reward system, dietary education, collaborative care, duration of intervention with systematic follow-ups, social support, adherence assessment method, and usage of e-health. Conclusions PCE is successful in achieving the desired outcomes in dyslipidemia management. Future studies may incorporate the elements of PCE to improve the management of dyslipidemia in hospital or community settings where appropriate.
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Affiliation(s)
- Farhana Fakhira Ismail
- Centre for Quality Management of Medicine, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur50300, Malaysia
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor42300, Malaysia
| | - Adyani Md Redzuan
- Centre for Quality Management of Medicine, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur50300, Malaysia
| | - Chong Wei Wen
- Centre for Quality Management of Medicine, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur50300, Malaysia
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29
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de Carvalho Costa IMNB, Silva DGD, Oliveira JLM, Silva JRS, Pereira LMC, Alves LVS, de Andrade FA, Góes Jorge JD, Oliveira LMSMD, Almeida RRD, Oliveira VB, Martins LS, Costa JO, de Souza MFC, Voci SM, Almeida-Santos MA, Abreu VV, Aidar FJ, Baumworcel L, Sousa ACS. Adherence to secondary prevention measures after acute coronary syndrome in patients associated exclusively with the public and private healthcare systems in Brazil. Prev Med Rep 2022; 29:101973. [PMID: 36161134 PMCID: PMC9502285 DOI: 10.1016/j.pmedr.2022.101973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/28/2022] [Accepted: 08/27/2022] [Indexed: 11/24/2022] Open
Abstract
Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity.
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Affiliation(s)
| | - Danielle Góes da Silva
- Program of Post-Graduation in Nutrition Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Joselina Luzia Meneses Oliveira
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- São Lucas Clinic and Hospital / Rede D Or São Luiz, Aracaju, Sergipe, Brazil
- Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - José Rodrigo Santos Silva
- Department of Statistics and Actuarial Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Luciana Vieira Sousa Alves
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Juliana de Góes Jorge
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Department of Physiotherapy, Tiradentes University, Aracaju, Sergipe, Brazil
| | | | - Rebeca Rocha de Almeida
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Victor Batista Oliveira
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Larissa Santos Martins
- Program of Post-Graduation in Nutrition Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Jamille Oliveira Costa
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Silvia Maria Voci
- Program of Post-Graduation in Nutrition Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Marcos Antonio Almeida-Santos
- São Lucas Clinic and Hospital / Rede D Or São Luiz, Aracaju, Sergipe, Brazil
- Postgraduate Program in Health and Environment, Tiradentes University, Aracaju, Sergipe, Brazil
| | - Victoria Vieira Abreu
- Program of Post-Graduation in Nutrition Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Felipe J. Aidar
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports – GEPEPS, Federal University of Sergipe (UFS), São Cristóvão, Sergipe, Brazil
| | - Leonardo Baumworcel
- São Lucas Clinic and Hospital / Rede D Or São Luiz, Aracaju, Sergipe, Brazil
| | - Antônio Carlos Sobral Sousa
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- São Lucas Clinic and Hospital / Rede D Or São Luiz, Aracaju, Sergipe, Brazil
- Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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30
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Haile ST, Joelsson-Alm E, Johansson UB, Lööf H, Palmer-Kazen U, Gillgren P, Linné A. Effects of a person-centred, nurse-led follow-up programme on adherence to prescribed medication among patients surgically treated for intermittent claudication: randomized clinical trial. Br J Surg 2022; 109:846-856. [PMID: 35848783 PMCID: PMC10364713 DOI: 10.1093/bjs/znac241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/05/2022] [Accepted: 06/22/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Management of intermittent claudication should include secondary prevention to reduce the risk of cardiocerebrovascular disease. Patient adherence to secondary prevention is a challenge. The aim of this study was to investigate whether a person-centred, nurse-led follow-up programme could improve adherence to medication compared with standard care. METHODS A non-blinded RCT was conducted at two vascular surgery centres in Sweden. Patients with intermittent claudication and scheduled for revascularization were randomized to the intervention or control (standard care) follow-up programme. The primary outcome, adherence to prescribed secondary preventive medication, was based on registry data on dispensed medication and self-reported intake of medication. Secondary outcomes were risk factors for cardiocerebrovascular disease according to the Framingham risk score. RESULTS Some 214 patients were randomized and analysed on an intention-to-treat basis. The mean proportion of days covered (PDC) at 1 year for lipid-modifying agents was 79 per cent in the intervention and 82 per cent in the control group, whereas it was 92 versus 91 per cent for antiplatelet and/or anticoagulant agents. The groups did not differ in mean PDC (lipid-modifying P = 0.464; antiplatelets and/or anticoagulants P = 0.700) or in change in adherence over time. Self-reported adherence to prescribed medication was higher than registry-based adherence regardless of allocation or medication group (minimum P < 0.001, maximum P = 0.034). There was no difference in median Framingham risk score at 1 year between the groups. CONCLUSION Compared with the standard follow-up programme, a person-centred, nurse-led follow-up programme did not improve adherence to secondary preventive medication. Adherence was overestimated when self-reported compared with registry-reported.
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Affiliation(s)
- Sara T Haile
- Correspondence to: Sara T. Haile, Department of Surgery, Södersjukhuset, SE-118 83 Stockholm, Sweden (e-mail: )
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Unn Britt Johansson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promoting Science Sophiahemmet University, Stockholm, Sweden
| | - Helena Lööf
- Department of Health Promoting Science Sophiahemmet University, Stockholm, Sweden
- Division of Caring Sciences, School of Healthcare and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Ulrika Palmer-Kazen
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Gillgren
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Section of Vascular Surgery, Södersjukhuset, Stockholm, Sweden
| | - Anneli Linné
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Section of Vascular Surgery, Södersjukhuset, Stockholm, Sweden
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31
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David F, Philipp J, Henrike AB, Nikolaos PP, Christine PH, Martin C, Oliver PR, Benjamin S. Impact of the Educational Level on Non-Fatal Health Outcomes following Myocardial Infarction. Curr Probl Cardiol 2022; 47:101340. [DOI: 10.1016/j.cpcardiol.2022.101340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 11/03/2022]
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32
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Ho PM, O’Donnell CI, McCreight M, Bavry AA, Bosworth HB, Girotra S, Grossman PM, Helfrich C, Latif F, Lu D, Matheny M, Mavromatis K, Ortiz J, Parashar A, Ratliff DM, Grunwald GK, Gillette M, Jneid H. Multifaceted Intervention to Improve P2Y12 Inhibitor Adherence After Percutaneous Coronary Intervention: A Stepped Wedge Trial. J Am Heart Assoc 2022; 11:e024342. [PMID: 35766258 PMCID: PMC9333389 DOI: 10.1161/jaha.121.024342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background P2Y12 inhibitor medications are critical following percutaneous coronary intervention (PCI); however, adherence remains suboptimal. Our objective was to assess the effectiveness of a multifaceted intervention to improve P2Y12 inhibitor adherence following PCI. Methods and Results This was a modified stepped wedge trial of 52 eligible hospitals, of which 15 were randomly selected and agreed to participate (29 hospitals declined, and 8 eligible hospitals were not contacted). At each intervention hospital, patient recruitment occurred for 6 months and enrolled patients were followed up for 1 year after PCI. Three control groups were used: patients at intervention hospitals undergoing PCI (1) before the intervention period (preintervention); (2) after the intervention period (postintervention); or (3) at the 8 hospitals not contacted (concurrent controls). The intervention consisted of 4 components: (1) P2Y12 inhibitor delivered to patients' bedside after PCI; (2) education on importance of P2Y12 inhibitors; (3) automated reminder telephone calls to refill medication; and (4) outreach to patients if they delayed refilling P2Y12 inhibitor. The primary outcomes were as follows: (1) proportion of patients with delays filling P2Y12 inhibitor at hospital discharge and (2) proportion of patients who were adherent in the year after PCI using pharmacy refill data. Primary analysis compared intervention with preintervention control patients. There were 1377 (intent-to-treat) potentially eligible patients, of whom 803 (per protocol) were approached at intervention sites versus 5910 preintervention, 2807 postintervention, and 4736 concurrent control patients. In the intent-to-treat analysis, intervention patients were less likely to delay filling P2Y12 at hospital discharge (-3.4%; 98.3% CI, -1.2% to -5.6%) and more likely to be adherent to P2Y12 (4.1%; 98.3% CI, 1.0%-7.1%) at 1 year, but had more clinical events (3.2%; 98.3% CI, 2.3%-4.1%) driven by repeated PCI compared with preintervention patients. In post hoc analysis looking at myocardial infarction, stroke, and death, intervention patients had lower event rates compared with preintervention patients (-1.7%; 98.3% CI, -2.3% to -1.1%). Conclusions A 4-component intervention targeting P2Y12 inhibitor adherence was difficult to implement. The intervention produced mixed results. It improved P2Y12 adherence, but there was also an increase in repeat PCI. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01609842.
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Affiliation(s)
- P. Michael Ho
- Cardiology SectionRocky Mountain Regional VA Medical CenterAuroraCO,Department of MedicineUniversity of Colorado School of MedicineAuroraCO,Denver‐Seattle Center of Innovation for Veteran Centered and Value Driven CareRocky Mountain Regional VA Medical CenterAuroraCO
| | | | - Marina McCreight
- Denver‐Seattle Center of Innovation for Veteran Centered and Value Driven CareRocky Mountain Regional VA Medical CenterAuroraCO
| | | | - Hayden B. Bosworth
- Departments of Population Health Science, Medicine, Psychiatry, School of NursingDuke University School of MedicineDurhamNC,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)Durham VAMCDurhamNC
| | - Saket Girotra
- University of Iowa Carver College of MedicineIowa CityIA,Iowa City Veterans Affairs Medical CenterIowa CityIA
| | | | - Christian Helfrich
- Seattle‐Denver Center of Innovation for Veteran Centered and Value Driven CarePuget Sound Health Care SystemSeattleWA
| | - Faisal Latif
- Oklahoma City VA Health Care SystemOklahoma CityOK,University of Oklahoma Health Sciences CenterOklahoma CityOK
| | - David Lu
- Washington DC VA Medical CenterWashingtonDC
| | - Michael Matheny
- Geriatric ResearchEducation, and Clinical Care CenterTennessee Valley Healthcare System VANashvilleTN,Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTN
| | | | - Jose Ortiz
- VA Northeast Ohio Healthcare SystemClevelandOH
| | - Amitabh Parashar
- Virginia Tech Carilion School of MedicineRoanokeVA,Salem VA Medical CenterSalemVA
| | | | - Gary K. Grunwald
- Denver‐Seattle Center of Innovation for Veteran Centered and Value Driven CareRocky Mountain Regional VA Medical CenterAuroraCO,University of Colorado School of Public HealthAuroraCO
| | - Michael Gillette
- Baylor College of MedicineHoustonTX,Michael E. DeBakey VA Medical CenterHoustonTX
| | - Hani Jneid
- Baylor College of MedicineHoustonTX,Michael E. DeBakey VA Medical CenterHoustonTX
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Toma MM, Bungau SG, Tit DM, Moisi MI, Bustea C, Vesa CM, Behl T, Stoicescu M, Brisc CM, Purza LA, Gitea D, Diaconu CC. Use of anticoagulant drugs in patients with atrial fibrillation. Does adherence to therapy have a prognostic impact? Biomed Pharmacother 2022; 150:113002. [PMID: 35462339 DOI: 10.1016/j.biopha.2022.113002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/10/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022] Open
Abstract
Anticoagulant therapy represents a pivotal element that strongly influences the thromboembolic risk of non-valvular atrial fibrillation (NVAF) subjects. The main purpose of this review was to identify issues and suggest strategies to improve the oral anticoagulants (OACs) treatment adherence, which is the most important predictor of NVAF outcome. Advantages, efficacy, and impact of these drugs on patients' prognosis were revealed in important clinical trials on large cohorts of patients and are often prescribed nowadays. A real-life data registry, the Global Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD-AF) analyzed the profile and outcome of patients diagnosed with NVAF receiving oral antithrombotic treatment. The observations gathered in the registry were crucial for identifying relevant elements that clinicians must improve, such as adherence strategies and predisposing factors that correlated with stroke. Adherence to OACs in AF patients is essential from the viewpoint of clinical efficacy and safety. Major adverse events and negative outcome are correlated with a weak anticoagulation control caused by an ineffective treatment adherence strategy. Solving the issue of oral anticoagulation adherence is possible using new technologies, but future directions should be explored. Mobile phone applications centered on patients' needs, telemedicine programs that evaluate patients' evolution and detect adverse reactions or events, encouraging an adequate management of the event without interruption of OACs, represent perspectives with a major impact on treatment adherence.
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Affiliation(s)
- Mirela Marioara Toma
- Doctoral School of Biomedical Sciences, University of Oradea, Oradea 410087, Romania.
| | - Simona Gabriela Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, Oradea 410087, Romania; Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania.
| | - Delia Mirela Tit
- Doctoral School of Biomedical Sciences, University of Oradea, Oradea 410087, Romania; Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania.
| | - Madalina Ioana Moisi
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania.
| | - Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania.
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania.
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, 140401 Punjab, India.
| | - Manuela Stoicescu
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.
| | - Cristina Mihaela Brisc
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.
| | - Lavinia Anamaria Purza
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania.
| | - Daniela Gitea
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania.
| | - Camelia Cristina Diaconu
- Department 5, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania; Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania.
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Chidester J, Bennett D, Mathew C, Denkins T, Vigen R, Addo T, Das S. Telephone-based reminder to improve safety after percutaneous coronary intervention. Sci Rep 2022; 12:8597. [PMID: 35597853 PMCID: PMC9124185 DOI: 10.1038/s41598-022-12722-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 05/12/2022] [Indexed: 11/25/2022] Open
Abstract
Dual antiplatelet therapy (DAPT) is a class I guideline indication after percutaneous coronary intervention (PCI). Our population is high-risk for low medication adherence. With a multidisciplinary team we developed a telephone-based intervention to improve DAPT adherence post-PCI. Patients undergoing PCI at our center were contacted by nursing staff via telephone at 1 week, 30 days, and 60 days post-procedure. Calls included a reminder of the importance of DAPT and elicited any patient concerns. Concerns were relayed to the team who could take appropriate action. For patients filling their medications at any pharmacies within our closed system the proportion of days covered (PDC) was calculated. These were compared to data for patients undergoing PCI in the seven months prior to program initiation. Information on interventions performed as a result of calls was also collected. During the study period, 452 patients underwent PCI. Of these, 70% were contacted and 244 filled their prescription at our system pharmacies. Twelve-month median PDC was 74%, with 45% of patients having PDC > 80%. There was no significant difference when compared to the group prior to the intervention, median PDC 79% and 50% of patients having PDC > 80%. In 26 patients calls led to interventions, removing barriers that would have otherwise prevented continued adherence. A telephone-based reminder system led to directed interventions in nearly 1 in 10 patients contacted. It was not able to significantly improve PDC when compared to a contemporary sample. This highlights the difficulty in using PDC to detect barriers to adherence.
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Affiliation(s)
- Jeffrey Chidester
- University of Texas Southwestern, 6939 Patricia Avenue, Dallas, TX, 75223, USA.
| | - Daniel Bennett
- University of Texas Southwestern, 6939 Patricia Avenue, Dallas, TX, 75223, USA.,Revere Health, Provo, USA
| | - Chris Mathew
- Parkland Health and Hospital System, Dallas, USA
| | | | - Rebecca Vigen
- University of Texas Southwestern, 6939 Patricia Avenue, Dallas, TX, 75223, USA
| | - Tayo Addo
- University of Texas Southwestern, 6939 Patricia Avenue, Dallas, TX, 75223, USA
| | - Sandeep Das
- University of Texas Southwestern, 6939 Patricia Avenue, Dallas, TX, 75223, USA
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Dalli LL, Kilkenny MF, Arnet I, Sanfilippo FM, Cummings DM, Kapral MK, Kim J, Cameron J, Yap KY, Greenland M, Cadilhac DA. Towards better reporting of the Proportion of Days Covered method in cardiovascular medication adherence: A scoping review and new tool TEN-SPIDERS. Br J Clin Pharmacol 2022; 88:4427-4442. [PMID: 35524398 PMCID: PMC9546055 DOI: 10.1111/bcp.15391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022] Open
Abstract
Although medication adherence is commonly measured in electronic datasets using the proportion of days covered (PDC), no standardized approach is used to calculate and report this measure. We conducted a scoping review to understand the approaches taken to calculate and report the PDC for cardiovascular medicines to develop improved guidance for researchers using this measure. After prespecifying methods in a registered protocol, we searched Ovid Medline, Embase, Scopus, CINAHL Plus and grey literature (1 July 2012 to 14 December 2020) for articles containing the terms “proportion of days covered” and “cardiovascular medicine”, or synonyms and subject headings. Of the 523 articles identified, 316 were reviewed in full and 76 were included (93% observational studies; 47% from the USA; 2 grey literature articles). In 45 articles (59%), the PDC was measured from the first dispensing/claim date. Good adherence was defined as 80% PDC in 61 articles, 56% of which contained a rationale for selecting this threshold. The following parameters, important for deriving the PDC, were often not reported/unclear: switching (53%), early refills (45%), in‐hospital supplies (45%), presupply (28%) and survival (7%). Of the 46 articles where dosing information was unavailable, 59% reported how doses were imputed. To improve the transparent and systematic reporting of the PDC, we propose the TEN‐SPIDERS tool, covering the following PDC parameters: Threshold, Eligibility criteria, Numerator and denominator, Survival, Presupply, In‐hospital supplies, Dosing, Early Refills, and Switching. Use of this tool will standardize reporting of the PDC to facilitate reliable comparisons of medication adherence estimates between studies.
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Affiliation(s)
- Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
| | - Isabelle Arnet
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Western Australia, Australia
| | - Doyle M Cummings
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA.,Centre for Health Disparities, East Carolina University, Greenville, North Carolina, USA
| | - Moira K Kapral
- ICES, Toronto, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
| | - Jan Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,School of Nursing and Midwifery, Monash University, Victoria, Australia.,Australian Centre for Heart Health, Victoria, Australia
| | - Kevin Y Yap
- Department of Pharmacy, Singapore General Hospital, Singapore.,School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Melanie Greenland
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, UK.,Nuffield Department of Population Health, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
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36
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Jabali MS, Sadeghi M, Nabovati E, Sarrafzadegan N, Farzandipour M. Determination of Characteristics and Data Elements requirements in National Acute Coronary Syndrome Registries for Post-discharge Follow-up. Curr Probl Cardiol 2022:101244. [DOI: 10.1016/j.cpcardiol.2022.101244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/03/2022]
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37
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Team-based strategies to prevent heart failure. Curr Opin Cardiol 2022; 37:294-301. [PMID: 35271509 DOI: 10.1097/hco.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The burden of heart failure (HF) in the United States and worldwide is projected to rise. Prevention of HF can curb the burden of this chronic syndrome, but current approaches are limited. This review discusses team-based strategies aimed to prevent HF. RECENT FINDINGS Individuals at high risk for developing HF can be identified using HF risk scores, biomarkers, and cardiac imaging. Electronic medical records (EMR) can integrate clinical data to estimate HF risk and identify individuals who may benefit most from preventive therapies. Team-based interventions can lead to enhanced adherence to medications, optimization of medical management, and control of risk factors. Multifaceted interventions involve EMR-based strategies, pharmacist- and nurse-led initiatives, involvement of community personnel, polypills, and digital solutions. SUMMARY Team-based strategies aimed to prevent HF incorporate a broad group of personnel and tools. Despite implementation challenges, existing resources can be efficiently utilized to facilitate team-based approaches to potentially reduce the burden of HF.
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38
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Liu ES, Hung CC, Chiang CH, Tsai YC, Fu YJ, Ko YL, Wang CL, Lai WY, Tsai FT, Kuo FY, Huang WC. Quality care in ST-segment elevation myocardial infarction. J Chin Med Assoc 2022; 85:268-275. [PMID: 34999635 DOI: 10.1097/jcma.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Over the past decades, the treatment of ST-segment elevation myocardial infarction (STEMI) has been redefined with the incorporation of evidence from multiple clinical trials. Recommendations from guidelines are updated regularly to reduce morbidity and mortality. However, heterogeneous care systems, physician perspectives, and patient behavior still lead to a disparity between evidence and clinical practice. The quality of care has been established and become an integral part of modern healthcare in order to increase the likelihood of desired health outcomes and adhere to professional knowledge. For patients with STEMI, measuring the quality of care is a multifactorial and multidimensional process that cannot be estimated solely based on patients' clinical outcomes. The care of STEMI is similar to the concept of "the chain of survival" that emphasizes the importance of seamless integration of five links: early recognition and diagnosis, timely reperfusion, evidence-based medications, control of cholesterol, and cardiac rehabilitation. Serial quality indicators, reflecting the full spectrum of care, have become a widely used tool for assessing performance. Comprehension of every aspect of quality assessment and indicators might be too demanding for a physician. However, it is worthwhile to understand the concepts involved in quality improvement since every physician wants to provide better care for their patients. This article reviews a fundamental approach to quality care in STEMI.
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Affiliation(s)
- En-Shao Liu
- Department of critical care medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Cheng Chung Hung
- Department of critical care medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Cheng-Hung Chiang
- Department of critical care medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Yi-Ching Tsai
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yun-Ju Fu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Lin Ko
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Lin Wang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wei-Yi Lai
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fu-Ting Tsai
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Feng-You Kuo
- Department of critical care medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Wei-Chun Huang
- Department of critical care medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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OUP accepted manuscript. Eur Heart J 2022; 43:2303-2313. [DOI: 10.1093/eurheartj/ehac116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/31/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
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Habibzadeh H, Bagherzadi A, Didarloo A, Khalkhali H. The effect of patient education based on health belief model on hospital readmission preventive behaviors and readmission rate in patients with a primary diagnosis of acute coronary syndrome: a quasi-experimental study. BMC Cardiovasc Disord 2021; 21:595. [PMID: 34915850 PMCID: PMC8674864 DOI: 10.1186/s12872-021-02413-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The health belief model is one of the applicable methods of training health preventive behaviors, especially in patients with cardiovascular diseases. Therefore, this study aimed to determine the effect of patient education based on the health belief model on readmission preventive behaviors and readmission rate in patients with a primary diagnosis of acute coronary syndrome. METHODS The present quasi-experimental study was conducted in 2020 on patients with a primary diagnosis of acute coronary syndrome who were discharging from Seyed Al-Shohada Hospital, Urmia, Iran. In this study, a total of 70 samples were recruited using convenience sampling and then randomly assigned to two groups of intervention and control (n = 35 in each group). A total of 7 face-to-face group training sessions were held with the participation of the patients and one of their family members during 14 days after hospital discharge. These sessions were conducted along with concentration on the structures of the health belief model. Data were collected at three time points of immediately before, one month, and three months after the intervention using a demographic questionnaire, a researcher-made questionnaire of readmission preventive behaviors in cardiovascular diseases, and a checklist of hospital readmission. Data were analyzed using SPSS Statistics for Windows, version 17.0 (SPSS Inc., Chicago, Ill., USA). RESULTS The results showed that there was a statistically significant difference in the mean score of preventive behaviors between the two groups at time points of one month and three months after the intervention (p < .05). However, there was no statistically significant difference in the readmission rate between the two groups after the intervention (p > .05). CONCLUSION Health belief model-based education was shown to be effective on readmission preventive behaviors in patients with acute coronary syndrome, although this model had no effect on the readmission rate in these patients. Other factors affecting the readmission rate are recommended to be investigated.
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Affiliation(s)
- Hossein Habibzadeh
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Nursing and Midwifery Faculty, Urmia University of Medical Sciences, Campus Nazlu, 11 KM Road Seru, 575611-5111 Urmia, West Azerbaijan Iran
| | - Aynaz Bagherzadi
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Nursing and Midwifery Faculty, Urmia University of Medical Sciences, Campus Nazlu, 11 KM Road Seru, 575611-5111 Urmia, West Azerbaijan Iran
| | - Alireza Didarloo
- Department of Public Health, Faculty of Health Sciences, Urmia University of Medical Sciences, Campus Nazlu, 11 KM Road Seru, 575611-5111 Urmia, West Azerbaijan Iran
| | - Hamidreza Khalkhali
- Department of Biostatistics and Epidemiology, School of Medicine, Nursing and Midwifery Faculty, Urmia University of Medical Sciences, Campus Nazlu, 11 KM Road Seru, 575611-5111 Urmia, West Azerbaijan Iran
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Waughtal J, Luong P, Sandy L, Chavez C, Ho PM, Bull S. Nudge me: tailoring text messages for prescription adherence through N-of-1 interviews. Transl Behav Med 2021; 11:1832-1838. [PMID: 34080636 PMCID: PMC8686108 DOI: 10.1093/tbm/ibab056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Almost 50% of patients with cardiovascular diseases face challenges in taking medications and increased morbidity and mortality. Text messaging may impact medication refill behavior and can be delivered at scale to patients by texting mobile phones. To obtain feedback from persons with chronic conditions on the design of interactive text messages and determine language of message for making messages that can motivate patients to refill medications on time. We purposively sampled 35 English and Spanish speaking patients with at least one chronic condition from three large healthcare delivery systems to participate in N-of-1 video-based synchronous interviews. Research assistants shared ideas for theory-informed text messages with content intended to persuade patients to refill their medication. We transcribed recorded interviews and conducted a content analysis to identify strategies to employ generating a dynamic interactive text message library intended to increase medication refill. Those interviewed were of diverse age and race/ethnicity and typical of persons with multiple chronic conditions. Several participants emphasized that personally tailored and positively framed messages would be more persuasive than generic and/or negative messages. Some patients appreciated humor and messages that could evoke a sense of social support from their providers and rejected the use of emojis. Messages to remind patients to refill medications may facilitate improvements in adherence, which in turn can improve chronic care. Designing messages that are persuasive and can prompt action is feasible and should be considered given the ease with which such messages can be delivered automatically at scale.
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Affiliation(s)
- Joy Waughtal
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
| | - Phat Luong
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
| | - Lisa Sandy
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
| | - Catia Chavez
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
| | - P Michael Ho
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
- Veteran Affairs Eastern Colorado Health Care System,
Aurora, CO, USA
| | - Sheana Bull
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
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Neville HL, Mann K, Killen J, Callaghan M. Pharmacist Intervention to Improve Medication Adherence in Patients with Acute Coronary Syndrome: The PRIMA-ACS Study. Can J Hosp Pharm 2021; 74:350-360. [PMID: 34602623 DOI: 10.4212/cjhp.v74i4.3198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Despite ample evidence of benefit, adherence to secondary prevention medication therapy after acute coronary syndrome (ACS) is often suboptimal. Hospital pharmacists are uniquely positioned to improve adherence by providing medication education at discharge. Objective To determine whether a standardized counselling intervention at hospital discharge significantly improved patients' adherence to cardiovascular medications following ACS. Methods This single-centre, prospective, nonrandomized comparative study enrolled patients with a primary diagnosis of ACS (January 2014 to July 2015). Patients who received standardized discharge counselling from a clinical pharmacist were compared with patients who did not receive counselling. At 30 days and 1 year after discharge, follow-up patient surveys were conducted and community pharmacy refill data were obtained. Adherence was assessed using pharmacy refill data and patient self-reporting for 5 targeted medications: acetylsalicylic acid, P2Y purinoceptor 12 (P2Y12) inhibitors, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, β-blockers, and statins. Thirty-day and 1-year medication utilization, cardiovascular readmission rates, and all-cause mortality were also assessed. Results Of the 259 patients enrolled, 88 (34.0%) received discharge counselling. Medication data were obtained for 253 patients (97.7%) at 30 days and 242 patients (93.4%) at 1 year. At 1 year after discharge, there were no statistically significant differences between patients who did and did not receive counselling in terms of rates of nonadherence (11.9% versus 18.4%, p = 0.19), cardiovascular readmission (17.6% versus 22.3%, p = 0.42), and all-cause mortality (3.4% versus 4.2%, p > 0.99). Overall medication nonadherence was 2.8% (7/253) at 30 days and 16.1% (39/242) at 1 year. Conclusions Discharge medication counselling provided by hospital pharmacists after ACS was not associated with significantly better medication adherence at 1 year. Higher-quality evidence is needed to determine the most effective and practical interventions to ensure that patients adhere to their medication regimens and achieve positive outcomes after ACS.
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Affiliation(s)
- Heather L Neville
- , BScPharm, MSc, FCSHP, is with Nova Scotia Health, Halifax, Nova Scotia
| | - Kelsey Mann
- , BScPharm, was, at the time of this study, with Nova Scotia Health, Halifax, Nova Scotia
| | - Jessica Killen
- , BScPharm, ACPR, is with Nova Scotia Health, Halifax, Nova Scotia
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Bond Z, Scanlon T, Judah G. Systematic Review of RCTs Assessing the Effectiveness of mHealth Interventions to Improve Statin Medication Adherence: Using the Behaviour-Change Technique Taxonomy to Identify the Techniques That Improve Adherence. Healthcare (Basel) 2021; 9:1282. [PMID: 34682962 PMCID: PMC8535703 DOI: 10.3390/healthcare9101282] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Statin non-adherence is a common problem in the management of cardiovascular disease (CVD), increasing patient morbidity and mortality. Mobile health (mHealth) interventions may be a scalable way to improve medication adherence. The objectives of this review were to assess the literature testing mHealth interventions for statin adherence and to identify the Behaviour-Change Techniques (BCTs) employed by effective and ineffective interventions. A systematic search was conducted of randomised controlled trials (RCTs) measuring the effectiveness of mHealth interventions to improve statin adherence against standard of care in those who had been prescribed statins for the primary or secondary prevention of CVD, published in English (1 January 2000-17 July 2020). For included studies, relevant data were extracted, the BCTs used in the trial arms were coded, and a quality assessment made using the Risk of Bias 2 (RoB2) questionnaire. The search identified 17 relevant studies. Twelve studies demonstrated a significant improvement in adherence in the mHealth intervention trial arm, and five reported no impact on adherence. Automated phone messages were the mHealth delivery method most frequently used in effective interventions. Studies including more BCTs were more effective. The BCTs most frequently associated with effective interventions were "Goal setting (behaviour)", "Instruction on how to perform a behaviour", and "Credible source". Other effective techniques were "Information about health consequences", "Feedback on behaviour", and "Social support (unspecified)". This review found moderate, positive evidence of the effect of mHealth interventions on statin adherence. There are four primary recommendations for practitioners using mHealth interventions to improve statin adherence: use multifaceted interventions using multiple BCTs, consider automated messages as a digital delivery method from a credible source, provide instructions on taking statins, and set adherence goals with patients. Further research should assess the optimal frequency of intervention delivery and investigate the generalisability of these interventions across settings and demographics.
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Affiliation(s)
| | | | - Gaby Judah
- Department of Surgery & Cancer, Institute of Global Health Innovation, Imperial College London, London W2 1NY, UK; (Z.B.); (T.S.)
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Soldati S, Di Martino M, Rosa AC, Fusco D, Davoli M, Mureddu GF. The impact of in-hospital cardiac rehabilitation program on medication adherence and clinical outcomes in patients with acute myocardial infarction in the Lazio region of Italy. BMC Cardiovasc Disord 2021; 21:466. [PMID: 34565326 PMCID: PMC8474767 DOI: 10.1186/s12872-021-02261-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background Medication adherence is a recognized key factor of secondary cardiovascular disease prevention. Cardiac rehabilitation increases medication adherence and adherence to lifestyle changes. This study aimed to evaluate the impact of in-hospital cardiac rehabilitation (IH-CR) on medication adherence as well as other cardiovascular outcomes, following an acute myocardial infarction (AMI). Methods This is a population-based study. Data were obtained from the Health Information Systems of the Lazio Region, Italy (5 million inhabitants). Hospitalized patients aged ≥ 18 years with an incident AMI in 2013–2015 were investigated. We divided the whole cohort into 4 groups of patients: ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI) who underwent or not percutaneous coronary intervention (PCI) during the hospitalization. Primary outcome was medication adherence. Adherence to chronic poly-therapy, based on prescription claims for both 6- and 12-month follow-up, was defined as Medication Possession Ratio (MPR) ≥ 75% to at least 3 of the following medications: antiplatelets, β-blockers, ACEI/ARBs, statins. Secondary outcomes were all-cause mortality, hospital readmission for cardiovascular and cerebrovascular event (MACCE), and admission to the emergency department (ED) occurring within a 3-year follow-up period. Results A total of 13.540 patients were enrolled. The median age was 67 years, 4.552 (34%) patients were female. Among the entire cohort, 1.101 (8%) patients attended IH-CR at 33 regional sites. Relevant differences were observed among the 4 groups previously identified (from 3 to 17%). A strong association between the IH-CR participation and medication adherence was observed among AMI patients who did not undergo PCI, for both 6- and 12-month follow-up. Moreover, NSTEMI-NO-PCI participants had lower risk of all-cause mortality (adjusted IRR 0.76; 95% CI 0.60–0.95), hospital readmission due to MACCE (IRR 0.78; 95% CI 0.65–0.94) and admission to the ED (IRR 0.80; 95% CI 0.70–0.91). Conclusions Our findings highlight the benefits of IH-CR and support clinical guidelines that consider CR an integral part in the treatment of coronary artery disease. However, IH-CR participation was extremely low, suggesting the need to identify and correct the barriers to CR participation for this higher-risk group of patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02261-6.
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Affiliation(s)
- Salvatore Soldati
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Mirko Di Martino
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
| | | | - Danilo Fusco
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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Hassan TA, Sáenz JE, Ducinskiene D, Cook JP, Imperato JS, Zou KH. New Strategies to Improve Patient Adherence to Medications for Noncommunicable Diseases During and After the COVID-19 Era Identified via a Literature Review. J Multidiscip Healthc 2021; 14:2453-2465. [PMID: 34522102 PMCID: PMC8434910 DOI: 10.2147/jmdh.s313626] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/28/2021] [Indexed: 12/21/2022] Open
Abstract
Noncommunicable diseases (NCDs) place a huge burden on healthcare systems and society as a whole. Relatively early in the coronavirus disease 2019 (COVID-19) pandemic, clinicians became aware that in individuals infected with COVID-19, those with preexisting NCDs such as diabetes mellitus and cardiovascular disease (CVD) were at a greater risk of poor outcomes and mortality than those without. The importance of adherence to medications and lifestyle changes to control and prevent NCDs has been a major focus for many years, but with limited success - the proportion of patients adherent and persistent to their medications remains very low. There are many facets to adherence and persistence. Recent evidence suggests that a patient-centric approach is important, and ensuring that a patient is both motivated and empowered is critical to improving adherence/persistence. The COVID-19 pandemic has brought many changes to the way in which patients with NCDs are managed, with telemedicine and ehealth becoming more common. Changes have also occurred in the way in which patients can gain access to medications during the pandemic. The potential for these changes forms the basis of improving the management of patients with NCDs both during and after the pandemic. Over the coming months, a huge amount of work will be put into initiatives to promote adherence to COVID-19 vaccination programs. Those at highest risk of severe COVID-19, such as people aged 80 years and older, are likely to receive the vaccine first in some parts of world. Finally, social determinants of health are critical elements that can impact not just the likelihood of having an NCD or becoming infected with COVID-19, but also access to healthcare, and a patient's adherence and persistence with their treatments.
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Affiliation(s)
- Tarek A Hassan
- Global Medical and Clinical, Viatris, Canonsburg, PA, USA
| | | | | | - Joseph P Cook
- Global Medical and Clinical, Viatris, Canonsburg, PA, USA
| | | | - Kelly H Zou
- Global Medical and Clinical, Viatris, Canonsburg, PA, USA
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Pedrosa RBDS, Gallani MCBJ, Rodrigues RCM. Impact of a Theory-based Intervention to Promote Medication Adherence in Patients With a History of Myocardial Infarction. J Cardiovasc Nurs 2021; 37:E1-E10. [PMID: 34483292 DOI: 10.1097/jcn.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient discontinuation of cardioprotective medications after a cardiac ischemic event commonly occurs early after hospital discharge. Theory-based interventions could be effective in promoting better patient self-regulation of health-related behaviors and positive intentions to adhere to the recommended medical regimen. OBJECTIVE The aim of this study was to evaluate the potential efficacy and feasibility of a theory-based intervention to promote adherence to cardioprotective medications. METHODS In this mixed-methods quasi-experimental study with 3 time points, we recruited 45 participants with a positive intention to adhere and a history of myocardial infarction. They were recruited in primary care units in Brazil. Data collection occurred in 2 waves (Tb and T60). The intervention consisted of developing action and coping plans, delivered in a 30-minute face-to-face session, with face-to-face reinforcement at a 30-day interval. Quantitative data were submitted to descriptive, Wilcoxon, and McNemar analyses; qualitative data were submitted to content analysis. RESULTS An increase in the proportion of patients adhering to medications at the end of follow-up was found (T60 - Tb, +60.0%; P < .001). In addition, a significant reduction was found for blood pressure (T60 - Tb, -8.6 mm Hg; P < .001), heart rate (T60 - Tb, -6.6 bpm; P < .001), and low-density lipoprotein (T60 - Tb, -6.2 mg/dL; P < .05). Qualitative results revealed that the intervention was feasible, with an attrition rate of zero. The intervention was found to be easy to apply to patients' daily lives, and there was adequate time for implementation. CONCLUSIONS Our data confirm the potential efficacy of a theory-based intervention on the promotion of adherence to cardioprotective medications and on the related clinical end points, as well as its feasibility in the clinical context (Universal Trial Number: U1111-1189-9967).
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Affiliation(s)
- Rafaela Batista Dos Santos Pedrosa
- Rafaela Batista dos Santos Pedrosa, RN, PhD Professor Doctor, School of Nursing, Universidade Estadual de Campinas, São Paulo, Brazil. Maria Cecília Bueno Jayme Gallani, RN, PhD Professor Titular, Faculté des Sciences Infirmières, Université Laval, Québec City, Québec, Canada. Roberta Cunha Matheus Rodrigues, RN, PhD Professor Titular, School of Nursing, Universidade Estadual de Campinas, São Paulo, Brazil
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Al-Qerem W, Jarab AS, Badinjki M, Hyassat D, Qarqaz R. Exploring variables associated with medication non-adherence in patients with type 2 diabetes mellitus. PLoS One 2021; 16:e0256666. [PMID: 34424940 PMCID: PMC8382191 DOI: 10.1371/journal.pone.0256666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/11/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aims to assess medication adherence and explore its predictors in outpatients with type 2 diabetes. METHOD This cross-sectional study collected socio-demographics, disease-related information, and different biomedical variables for type 2 diabetes patients attending a Jordanian Diabetes center. The four-item medication adherence scale (4-IMAS) and the beliefs about medications questionnaire (BMQ) which includes necessity and concerns were used. Stepwise backward quartile regression models were conducted to evaluate variables associated with the Necessity and Concerns scores. Stepwise ordinal regression was conducted to evaluate variables associated with adherence. RESULTS 287 diabetic patients participated in the study. Almost half of the participants (46.5%) reported moderate adherence and 12.2% reported low adherence. Significant predictors of the adherence were necessity score (OR = 14.86, p <0.01), concern score (OR = 0.36, p <0.05), and frequency of medication administration (OR = 0.88, p- <0.01). Education was a significant predictor of Necessity and Concerns scores (β = 0.48, -0.2, respectively). CONCLUSION Simplifying the medication regimen, emphasizing medication necessity and overcoming medication concerns should be targeted in future diabetes intervention programs to improve medication adherence and hence glycemic control among diabetic patients.
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Affiliation(s)
- Walid Al-Qerem
- Department of pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Anan S. Jarab
- Faculty of Pharmacy, Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Badinjki
- Department of pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Dana Hyassat
- National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan
| | - Raghda Qarqaz
- Department of pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
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Daliri S, Kooij MJ, Scholte Op Reimer WJM, Ter Riet G, Jepma P, Verweij L, Peters RJG, Buurman BM, Karapinar-Çarkit F. Effects of a transitional care programme on medication adherence in an older cardiac population: A randomized clinical trial. Br J Clin Pharmacol 2021; 88:965-982. [PMID: 34410011 DOI: 10.1111/bcp.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/21/2021] [Accepted: 07/31/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS Medication non-adherence post-discharge is common among patients, especially those suffering from chronic medical conditions, and contributes to hospital admissions and mortality. This study aimed to evaluate the effect of the Cardiac Care Bridge (CCB) intervention on medication adherence post-discharge. METHODS We performed a secondary analysis of the CCB randomized single-blind trial, a study in patients ≥70 years, at high risk of functional loss and admitted to cardiology departments in six hospitals. In this multi-component intervention study, community nurses performed medication reconciliation and observed medication-related problems (MRPs) during post-discharge home visits, and pharmacists provided recommendations to resolve MRPs. Adherence to high-risk medications was measured using the proportion of days covered (PDC), using pharmacy refill data. Furthermore, MRPs were assessed in the intervention group. RESULTS For 198 (64.7%) of 306 CCB patients, data were available on adherence (mean age: 82 years; 58.9% of patients used a multidose drug dispensing [MDD] system). The mean PDC before admission was 92.3% in the intervention group (n = 99) and 88.5% in the control group (n = 99), decreasing to 85.2% and 84.1% post-discharge, respectively (unadjusted difference: -2.6% (95% CI -9.8 to 4.6, P = .473); adjusted difference -3.3 (95% CI -10.3 to 3.7, P = .353)). Post-hoc analysis indicated that a modest beneficial intervention effect may be restricted to MDD non-users (Pinteraction = .085). In total, 77.0% of the patients had at least one MRP post-discharge. CONCLUSIONS Our findings indicate that a multi-component intervention, including several components targeting medication adherence in older cardiac patients discharged from hospital back home, did not benefit their medication adherence levels. A modest positive effect on adherence may potentially exist in those patients not using an MDD system. This finding needs replication.
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Affiliation(s)
- Sara Daliri
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands.,Department of Internal Medicine, section of Geriatric Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marcel J Kooij
- Community pharmacy, Service Apotheek Koning, Amsterdam, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.,University of Applied Sciences Utrecht, Research Group Chronic Diseases, Utrecht, The Netherlands
| | - Gerben Ter Riet
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Patricia Jepma
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lotte Verweij
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, section of Geriatric Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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Abstract
Cardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.
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Affiliation(s)
- Steven T Simon
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Vinay Kini
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew E Levy
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, Denver Health Medical Center, Denver, CO, USA
| | - P Michael Ho
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Cardiology Section, VA Eastern Colorado Health Care System, Aurora, CO, USA
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50
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Östbring MJ, Eriksson T, Petersson G, Hellström L. Effects of a pharmaceutical care intervention on clinical outcomes and patient adherence in coronary heart disease: the MIMeRiC randomized controlled trial. BMC Cardiovasc Disord 2021; 21:367. [PMID: 34334142 PMCID: PMC8327441 DOI: 10.1186/s12872-021-02178-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/23/2021] [Indexed: 01/22/2023] Open
Abstract
Background In the treatment of coronary heart disease, secondary prevention goals are still often unmet and poor adherence to prescribed drugs has been suggested as one of the reasons. We aimed to investigate whether pharmaceutical care by a pharmacist at the cardiology clinic trained in motivational interviewing improves clinical outcomes and patient adherence. Methods This was a prospective, randomized, controlled, outcomes-blinded trial designed to compare pharmaceutical care follow-up with standard care. After standard follow-up at the cardiology clinic, patients in the intervention group were seen by a clinical pharmacist two to five times as required over seven months. Pharmacists were trained to use motivational interviewing in the consultations and they tailored their support to each patient’s clinical needs and beliefs about medicines. The primary study end-point was the proportion of patients who reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. The key secondary outcome was patient adherence to lipid-lowering therapy at 15 months after discharge, and other secondary outcomes were the effects on patient adherence to other preventive drugs, systolic blood pressure, disease-specific quality of life, and healthcare use. Results 316 patients were included. The proportion of patients who reached the target for low-density lipoprotein cholesterol were 37.0% in the intervention group and 44.2% in the control group (P = .263). More intervention than control patients were adherent to cholesterol-lowering drugs (88 vs 77%; P = .033) and aspirin (97 vs 91%; P = .036) but not to beta-blocking agents or renin–angiotensin–aldosterone system inhibitors. Conclusions Our intervention had no positive effects on risk factors for CHD, but it increased patient adherence. Further investigation of the intervention process is needed to explore the difference in results between patient adherence and medication effects. Longer follow-up of healthcare use and mortality will determine if the increased adherence per se eventually will have a meaningful effect on patient health. Trial registration: ClinicalTrials.gov NCT02102503, 03/04/2014 retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02178-0.
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Affiliation(s)
- Malin Johansson Östbring
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden. .,Pharmaceutical Department, Region Kalmar County, Building 2, floor 2, County Council Hospital, 391 85, Kalmar, Sweden.
| | - Tommy Eriksson
- Department of Biomedical Science, and Biofilm - Research Center for Biointerfaces, Malmö University, Malmö, Sweden
| | - Göran Petersson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Lina Hellström
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.,Pharmaceutical Department, Region Kalmar County, Building 2, floor 2, County Council Hospital, 391 85, Kalmar, Sweden
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