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Papus M, Dima AL, Viprey M, Schott AM, Schneider MP, Novais T. Motivational interviewing to support medication adherence in adults with chronic conditions: Systematic review of randomized controlled trials. PATIENT EDUCATION AND COUNSELING 2022; 105:3186-3203. [PMID: 35779984 DOI: 10.1016/j.pec.2022.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To systematically review published randomized controlled trials (RCTs) assessing the efficacy of MI to support medication adherence in adults with chronic conditions. METHODS A systematic review (PROSPERO-CRD42020025374) was performed by searching in Pubmed/MEDLINE, PsycINFO, The Cochrane Library and Web of Science. Studies were included for the following: RCTs assessing the impact of MI on medication adherence among adults with chronic diseases. Two reviewers conducted independent screening of records and full-text articles published until July 2020. Quality was assessed with the Risk of Bias 2 tool for RCTs. RESULTS From 1262 records identified, 54 RCTs were included. The MI interventions were delivered alone or in combination with other interventions, and varied in mode of delivery (e.g. face-to-face, phone), exposure level (duration, number of sessions), and provider characteristics (profession, training). Most interventions were developed in infectious diseases (n = 16), cardiology (n = 14), psychiatry (n = 8), and endocrinology (n = 7). Medication adherence showed significant improvement in 23 RCTs, and other clinical outcomes were improved in 19 RCTs (e.g. risky behaviors, disease symptoms). CONCLUSIONS MI is an approach to medication adherence support with an increasing evidence base in several clinical domains and further potential for adaptation to different settings. PRACTICE IMPLICATIONS In further studies, particular attention should focus on methodological issues such as the populations of patients to include - patients with suboptimal adherence, the evaluation of fidelity to the MI spirit and components, and a sound measurement of medication adherence and clinical outcomes.
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Affiliation(s)
- Marlène Papus
- Pharmaceutical Unit, Charpennes Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alexandra L Dima
- Claude Bernard Lyon 1 University, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Marie Viprey
- Claude Bernard Lyon 1 University, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Public Health department, Hospices Civils de Lyon, Lyon, France
| | - Anne-Marie Schott
- Claude Bernard Lyon 1 University, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Public Health department, Hospices Civils de Lyon, Lyon, France
| | - Marie Paule Schneider
- Chair of Medication Adherence and Interprofesionality, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Switzerland
| | - Teddy Novais
- Pharmaceutical Unit, Charpennes Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.
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Shi W, Ghisi GLM, Zhang L, Hyun K, Pakosh M, Gallagher R. Systematic review, meta‐analysis and meta‐regression to determine the effects of patient education on health behaviour change in adults diagnosed with coronary heart disease. J Clin Nurs 2022. [DOI: 10.1111/jocn.16519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Wendan Shi
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Gabriela L. M. Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
| | - Ling Zhang
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
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Cross AJ, Elliott RA, Petrie K, Kuruvilla L, George J. Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Database Syst Rev 2020; 5:CD012419. [PMID: 32383493 PMCID: PMC7207012 DOI: 10.1002/14651858.cd012419.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Older people taking multiple medications represent a large and growing proportion of the population. Managing multiple medications can be challenging, and this is especially the case for older people, who have higher rates of comorbidity and physical and cognitive impairment than younger adults. Good medication-taking ability and medication adherence are necessary to ensure safe and effective use of medications. OBJECTIVES To evaluate the effectiveness of interventions designed to improve medication-taking ability and/or medication adherence in older community-dwelling adults prescribed multiple long-term medications. SEARCH METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL Plus, and International Pharmaceutical Abstracts from inception until June 2019. We also searched grey literature, online trial registries, and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. Eligible studies tested interventions aimed at improving medication-taking ability and/or medication adherence among people aged ≥ 65 years (or of mean/median age > 65 years), living in the community or being discharged from hospital back into the community, and taking four or more regular prescription medications (or with group mean/median of more than four medications). Interventions targeting carers of older people who met these criteria were also included. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data, and assessed risk of bias of included studies. We conducted meta-analyses when possible and used a random-effects model to yield summary estimates of effect, risk ratios (RRs) for dichotomous outcomes, and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, along with 95% confidence intervals (CIs). Narrative synthesis was performed when meta-analysis was not possible. We assessed overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were medication-taking ability and medication adherence. Secondary outcomes included health-related quality of life (HRQoL), emergency department (ED)/hospital admissions, and mortality. MAIN RESULTS We identified 50 studies (14,269 participants) comprising 40 RCTs, six cluster-RCTs, and four quasi-RCTs. All included studies evaluated interventions versus usual care; six studies also reported a comparison between two interventions as part of a three-arm RCT design. Interventions were grouped on the basis of their educational and/or behavioural components: 14 involved educational components only, 7 used behavioural strategies only, and 29 provided mixed educational and behavioural interventions. Overall, our confidence in results regarding the effectiveness of interventions was low to very low due to a high degree of heterogeneity of included studies and high or unclear risk of bias across multiple domains in most studies. Five studies evaluated interventions for improving medication-taking ability, and 48 evaluated interventions for improving medication adherence (three studies evaluated both outcomes). No studies involved educational or behavioural interventions alone for improving medication-taking ability. Low-quality evidence from five studies, each using a different measure of medication-taking ability, meant that we were unable to determine the effects of mixed interventions on medication-taking ability. Low-quality evidence suggests that behavioural only interventions (RR 1.22, 95% CI 1.07 to 1.38; 4 studies) and mixed interventions (RR 1.22, 95% CI 1.08 to 1.37; 12 studies) may increase the proportions of people who are adherent compared with usual care. We could not include in the meta-analysis results from two studies involving mixed interventions: one had a positive effect on adherence, and the other had little or no effect. Very low-quality evidence means that we are uncertain of the effects of educational only interventions (5 studies) on the proportions of people who are adherent. Low-quality evidence suggests that educational only interventions (SMD 0.16, 95% CI -0.12 to 0.43; 5 studies) and mixed interventions (SMD 0.47, 95% CI -0.08 to 1.02; 7 studies) may have little or no impact on medication adherence assessed through continuous measures of adherence. We excluded 10 studies (4 educational only and 6 mixed interventions) from the meta-analysis including four studies with unclear or no available results. Very low-quality evidence means that we are uncertain of the effects of behavioural only interventions (3 studies) on medication adherence when assessed through continuous outcomes. Low-quality evidence suggests that mixed interventions may reduce the number of ED/hospital admissions (RR 0.67, 95% CI 0.50 to 0.90; 11 studies) compared with usual care, although results from six further studies that we were unable to include in meta-analyses indicate that the intervention may have a smaller, or even no, effect on these outcomes. Similarly, low-quality evidence suggests that mixed interventions may lead to little or no change in HRQoL (7 studies), and very low-quality evidence means that we are uncertain of the effects on mortality (RR 0.93, 95% CI 0.67 to 1.30; 7 studies). Moderate-quality evidence shows that educational interventions alone probably have little or no effect on HRQoL (6 studies) or on ED/hospital admissions (4 studies) when compared with usual care. Very low-quality evidence means that we are uncertain of the effects of behavioural interventions on HRQoL (1 study) or on ED/hospital admissions (2 studies). We identified no studies evaluating effects of educational or behavioural interventions alone on mortality. Six studies reported a comparison between two interventions; however due to the limited number of studies assessing the same types of interventions and comparisons, we are unable to draw firm conclusions for any outcomes. AUTHORS' CONCLUSIONS Behavioural only or mixed educational and behavioural interventions may improve the proportion of people who satisfactorily adhere to their prescribed medications, but we are uncertain of the effects of educational only interventions. No type of intervention was found to improve adherence when it was measured as a continuous variable, with educational only and mixed interventions having little or no impact and evidence of insufficient quality to determine the effects of behavioural only interventions. We were unable to determine the impact of interventions on medication-taking ability. The quality of evidence for these findings is low due to heterogeneity and methodological limitations of studies included in the review. Further well-designed RCTs are needed to investigate the effects of interventions for improving medication-taking ability and medication adherence in older adults prescribed multiple medications.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Rohan A Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Austin Health, Heidelberg, Australia
| | - Kate Petrie
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Lisha Kuruvilla
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Barwon Health, North Geelong, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
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Crawshaw J, Weinman J, McRobbie D, Auyeung V. Initial evaluation of a brief pharmacy-led intervention to modify beliefs about medicines and facilitate adherence among patients hospitalised with acute coronary syndrome. Eur J Hosp Pharm 2019; 29:18-25. [PMID: 34930790 PMCID: PMC8717792 DOI: 10.1136/ejhpharm-2019-002041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/30/2019] [Accepted: 10/28/2019] [Indexed: 11/06/2022] Open
Abstract
Objectives Medication non-adherence is common among patients with acute coronary syndrome (ACS) and is associated with poor clinical outcomes. To date, pharmacists have been underutilised in the delivery of adherence interventions. Across two studies, we assessed the feasibility, acceptability and effectiveness of a novel pharmacy-led intervention for patients hospitalised with ACS. Methods The theory-based intervention was comprised of two personalised sessions addressing perceptual (negative/erroneous treatment beliefs) and practical (suboptimal action planning) barriers to adherence. Study 1: A single-arm, feasibility and acceptability study was conducted to determine proof-of-concept. Pre–post-comparisons using the Beliefs about Medicines Questionnaire-Specific (BMQ-S) were made. Study 2: A non-randomised controlled before–after pilot study was conducted with the intervention delivered by a team of clinical pharmacists. Follow-up data were collected at 6 and 12 weeks post-discharge. Primary outcome measures included the BMQ-S and the Medication Adherence Report Scale 5. Results Study 1: 15 patients received the intervention and reported higher BMQ-S necessity scores post-intervention. The intervention was deemed highly acceptable to patients; therefore, further testing was sought. Study 2: A total of 56 patients were recruited: control (n=29) versus treatment (n=27). At 6-week follow-up, the treatment group had higher BMQ-S necessity scores (M=21.8, SD=3.1) compared with control (M=19.8, SD=2.7; p=0.045), although this effect was not maintained at 12 weeks. No differences were reported in the other outcome measures. Conclusions Although the intervention was acceptable to patients, poor fidelity in delivery raises questions about its feasibility in practice. Furthermore, there was some impact on patients’ beliefs about medications but no effect on adherence. These findings demonstrate the importance of conducting feasibility and acceptability studies when developing adherence innovations in clinical care. Future studies should consider enhancing the training process to ameliorate fidelity issues.
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Affiliation(s)
- Jacob Crawshaw
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - John Weinman
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Duncan McRobbie
- Department of Pharmacy, Guy's and St Thomas' NHS Foundation Truts, London, UK
| | - Vivian Auyeung
- Institute of Pharmaceutical Science, King's College London, London, UK
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Östbring MJ, Eriksson T, Petersson G, Hellström L. Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Intervention Development and Protocol for the Process Evaluation. JMIR Res Protoc 2018; 7:e21. [PMID: 29382630 PMCID: PMC5811650 DOI: 10.2196/resprot.8660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/24/2017] [Accepted: 11/24/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Trials of complex interventions are often criticized for being difficult to interpret because the effects of apparently similar interventions vary across studies dependent on context, targeted groups, and the delivery of the intervention. The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a randomized controlled trial (RCT) of an intervention aimed at improving pharmacological secondary prevention. Guidelines for the development and evaluation of complex interventions have recently highlighted the need for better reporting of the development of interventions, including descriptions of how the intervention is assumed to work, how this theory informed the process evaluation, and how the process evaluation relates to the outcome evaluation. OBJECTIVE This paper aims to describe how the intervention was designed and developed. The aim of the process evaluation is to better understand how and why the intervention in the MIMeRiC trial was effective or not effective. METHODS The research questions for evaluating the process are based on the conceptual model of change processes assumed in the intervention and will be analyzed by qualitative and quantitative methods. Quantitative data are used to evaluate the medication review in terms of drug-related problems, to describe how patients' beliefs about medicines are affected by the intervention, and to evaluate the quality of motivational interviewing. Qualitative data will be used to analyze whether patients experienced the intervention as intended, how cardiologists experienced the collaboration and intervention, and how the intervention affected patients' overall experience of care after coronary heart disease. RESULTS The development and piloting of the intervention are described in relation to the theoretical framework. Data for the process evaluation will be collected until March 2018. Some process evaluation questions will be analyzed before, and others will be analyzed after the outcomes of the MIMeRiC RCT are known. CONCLUSIONS This paper describes the framework for the design of the intervention tested in the MIMeRiC trial, development of the intervention from the pilot stage to the complete trial intervention, and the framework and methods for the process evaluation. Providing the protocol of the process evaluation allows prespecification of the processes that will be evaluated, because we hypothesize that they will determine the outcomes of the MIMeRiC trial. This protocol also constitutes a contribution to the new field of process evaluations as made explicit in health services research and clinical trials of complex interventions.
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Affiliation(s)
- Malin Johansson Östbring
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden.,eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science, Malmö University, Malmö, Sweden.,Department of Clinical and Molecular Medicine, Norwegian University of Sciences and Technology, Trondheim, Norway
| | - Göran Petersson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Lina Hellström
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden
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El Hajj MS, Jaam MJ, Awaisu A. Effect of pharmacist care on medication adherence and cardiovascular outcomes among patients post-acute coronary syndrome: A systematic review. Res Social Adm Pharm 2017. [PMID: 28641999 DOI: 10.1016/j.sapharm.2017.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The impact of collaborative and multidisciplinary health care on the outcomes of care in patients with acute coronary syndromes (ACS) is well-established in the literature. However, there is lack of high quality evidence on the role of pharmacist care in this setting. OBJECTIVE This systematic review aimed to evaluate the impact of pharmacist care on patient outcomes (readmission, mortality, emergency visits, and medication adherence) in patients with ACS at or post-discharge. METHODS The following electronic databases and search engines were searched from their inception to September 2016: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science, Scopus, Campbell Library, Database of Abstracts of Reviews of Effects (DARE), Health System Evidence, Global Health Database, Joanna Briggs Institute Evidence-Based Practice Database, Academic Search Complete, ProQuest, PROSPERO, and Google Scholar. Studies were included if they evaluated the impact of pharmacist's care (compared with no pharmacist's care or usual care) on the outcomes of rehospitalization, mortality, and medication adherence in patients post-ACS discharge. Comparison of the outcomes with relevant statistics was summarized and reported. RESULTS A total of 17 studies [13 randomized controlled trials (RCTs) and four non-randomized clinical studies] involving 8391 patients were included in the review. The studies were of variable quality (poor to good quality) or risk of bias (moderate to critical risk). The nature and intensity of pharmacist interventions varied among the studies including medication reconciliation, medication therapy management, discharge medication counseling, motivational interviewing, and post-discharge face-to-face or telephone follow-up. Pharmacist-delivered interventions significantly improved medication adherence in four out of 12 studies. However, these did not translate to significant improvements in the rates of readmissions, hospitalizations, emergency visits, and mortality among ACS patients. CONCLUSIONS Pharmacist care of patients discharged after ACS admission was not associated with significant improvement in medication adherence or reductions in readmissions, emergency visits, and mortality. Future studies should use well-designed RCTs to assess the short- and long-terms effects of pharmacist interventions in ACS patients.
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Affiliation(s)
| | | | - Ahmed Awaisu
- College of Pharmacy, Qatar University, P.O. Box 2713, Doha, Qatar.
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Santo K, Kirkendall S, Laba TL, Thakkar J, Webster R, Chalmers J, Chow CK, Redfern J. Interventions to improve medication adherence in coronary disease patients: A systematic review and meta-analysis of randomised controlled trials. Eur J Prev Cardiol 2016; 23:1065-76. [DOI: 10.1177/2047487316638501] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/22/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Karla Santo
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | | | - Tracey-Lea Laba
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Jay Thakkar
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
- Cardiology Department, Westmead Hospital, Australia
| | - Ruth Webster
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - John Chalmers
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Clara K Chow
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
- Cardiology Department, Westmead Hospital, Australia
| | - Julie Redfern
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
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M A Jalal ZS, Smith F, Taylor D, Finlay K, Patel H, Antoniou S. Impact of pharmacy care upon adherence to cardiovascular medicines: a feasibility pilot controlled trial. Eur J Hosp Pharm 2016; 23:250-256. [PMID: 31156861 DOI: 10.1136/ejhpharm-2015-000790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/10/2015] [Accepted: 12/15/2015] [Indexed: 11/04/2022] Open
Abstract
Objective To investigate the feasibility and potential impact of a pharmacy care intervention, involving motivational interviews among patients with acute coronary syndrome, on adherence to medication and on health outcomes. Methods This article reports a prospective, interventional, controlled feasibility/pilot study. Seventy one patients discharged from a London Heart Attack Centre following acute treatment for a coronary event were enrolled and followed up for 6 months. Thirty two pharmacies from six London boroughs were allocated into intervention or control sites. The intervention was delivered by community pharmacists face-to-face in the pharmacy, or by telephone. Consultations were delivered as part of the New Medicine Service or a Medication Usage Review. They involved a 15-20 min motivational interview aimed at improving protective cardiovascular medicine taking. Results At 3 months, there was a statistically significant difference in adherence between the intervention group (M=7.7, SD=0.56) and the control group (M=7.0, SD=1.85), p=0.026. At 6 months, the equivalent figures were for the intervention group M=7.5, SD=1.47 and for the controls M=6.1, SD=2.09 (p=0.004). In addition, there was a statistically significant relationship between the level of adherence at 3 months and beliefs regarding medicines (p=0.028). Patients who reported better adherence expressed positive beliefs regarding the necessity of taking their medicines. However, given the small sample size, no statistically significant outcome difference in terms of recorded blood pressure and low density lipoprotein-cholesterol was observed over the 6 months of the study. Conclusions The feasibility, acceptability and potentially positive clinical outcome of the intervention were demonstrated, long with a high level of patient acceptability. It had a significant impact on cardiovascular medicine taking adherence. But these findings must be interpreted with caution. The intervention should be tested in a larger trial to ascertain its full clinical utility. Trial registration number ClinicalTrials.gov identifier: NCT01920009.
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Affiliation(s)
- Zahraa S M A Jalal
- Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Felicity Smith
- Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - David Taylor
- Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Katherine Finlay
- Department of Psychology, The University of Buckingham, Buckingham, UK
| | - Hemant Patel
- North-East London Local Pharmaceutical Committee, London, UK
| | - Sotiris Antoniou
- Pharmacy Department, Barts Heart Centre, Barts Health NHS Trust, London, UK
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