Ulla Hedegaard1, Lene Juel Kjeldsen2, Anton Pottegård3, Jan Erik Henriksen4, Jess Lambrechtsen5, Jørgen Hangaard5, Jesper Hallas3. 1. Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark; Clinical Pharmacy Department, Hospital Pharmacy of Funen, Odense University Hospital, Odense, Denmark. Electronic address: uhedegaard@health.sdu.dk. 2. The Danish Research Unit for Hospital Pharmacy, Copenhagen, Denmark. 3. Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark. 4. Department of Endocrinology, Odense University Hospital, Odense, Denmark. 5. Department of Internal Medicine, Odense University Hospital - Svendborg, Svendborg, Denmark.
Abstract
BACKGROUND AND PURPOSE: In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention. METHODS:Patients (n = 532) were recruited from 3 hospital outpatient clinics and randomized tousual care or a 6-month pharmacist intervention comprising collaborative care, medication review, and tailored adherence counseling including motivational interviewing and telephone follow-ups. The primary outcome was composite medication possession ratio (MPR) to antihypertensive and lipid-lowering agents, at 1-year follow-up, assessed by analyzing pharmacy records. Secondary outcomes at 12 months included persistence to medications, blood pressure, hospital admission, and a combined clinical endpoint of cardiovascular death, stroke, or acute myocardial infarction. RESULTS: At 12 months, 20.3% of the patients in the intervention group (n = 231) were nonadherent (MPR <0.80), compared with 30.2% in the control group (n = 285) (risk difference -9.8; 95% confidence interval [CI], -17.3, -2.4) and median MPR (interquartile range) was 0.93 (0.82-0.99) and 0.91 (0.76-0.98), respectively, P = .02. The combined clinical endpoint was reached by 1.3% in the intervention group and 3.1% in the control group (relative risk 0.41; 95% CI, 0.11-1.50). No significant differences were found for persistence, blood pressure, or hospital admission. CONCLUSIONS: A multifaceted pharmacist intervention in a hospital setting led to a sustained improvement in medication adherence for patients with hypertension. The intervention had no significant impact on blood pressure and secondary clinical outcomes.
RCT Entities:
BACKGROUND AND PURPOSE: In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve medication adherence in hypertensivepatients. Motivational interviewing was a key element of the intervention. METHODS:Patients (n = 532) were recruited from 3 hospital outpatient clinics and randomized to usual care or a 6-month pharmacist intervention comprising collaborative care, medication review, and tailored adherence counseling including motivational interviewing and telephone follow-ups. The primary outcome was composite medication possession ratio (MPR) to antihypertensive and lipid-lowering agents, at 1-year follow-up, assessed by analyzing pharmacy records. Secondary outcomes at 12 months included persistence to medications, blood pressure, hospital admission, and a combined clinical endpoint of cardiovascular death, stroke, or acute myocardial infarction. RESULTS: At 12 months, 20.3% of the patients in the intervention group (n = 231) were nonadherent (MPR <0.80), compared with 30.2% in the control group (n = 285) (risk difference -9.8; 95% confidence interval [CI], -17.3, -2.4) and median MPR (interquartile range) was 0.93 (0.82-0.99) and 0.91 (0.76-0.98), respectively, P = .02. The combined clinical endpoint was reached by 1.3% in the intervention group and 3.1% in the control group (relative risk 0.41; 95% CI, 0.11-1.50). No significant differences were found for persistence, blood pressure, or hospital admission. CONCLUSIONS: A multifaceted pharmacist intervention in a hospital setting led to a sustained improvement in medication adherence for patients with hypertension. The intervention had no significant impact on blood pressure and secondary clinical outcomes.
Authors: Lucas Lauder; Milan A Wolf; Sean S Scholz; Mathias Hohl; Felix Mahfoud; Michael Böhm Journal: Curr Cardiol Rep Date: 2019-07-05 Impact factor: 2.931
Authors: Niteesh K Choudhry; Thomas Isaac; Julie C Lauffenburger; Chandrasekar Gopalakrishnan; Nazleen F Khan; Marianne Lee; Amy Vachon; Tanya L Iliadis; Whitney Hollands; Scott Doheny; Sandra Elman; Jacqueline M Kraft; Samrah Naseem; Joshua J Gagne; Cynthia A Jackevicius; Michael A Fischer; Daniel H Solomon; Thomas D Sequist Journal: Am Heart J Date: 2016-08-08 Impact factor: 4.749
Authors: Niteesh K Choudhry; Thomas Isaac; Julie C Lauffenburger; Chandrasekar Gopalakrishnan; Marianne Lee; Amy Vachon; Tanya L Iliadis; Whitney Hollands; Sandra Elman; Jacqueline M Kraft; Samrah Naseem; Scott Doheny; Jessica Lee; Julie Barberio; Lajja Patel; Nazleen F Khan; Joshua J Gagne; Cynthia A Jackevicius; Michael A Fischer; Daniel H Solomon; Thomas D Sequist Journal: JAMA Intern Med Date: 2018-09-01 Impact factor: 21.873
Authors: Caitrin W McDonough; Kyle Babcock; Kristen Chucri; Dana C Crawford; Jiang Bian; François Modave; Rhonda M Cooper-DeHoff; William R Hogan Journal: Pharmacoepidemiol Drug Saf Date: 2020-08-26 Impact factor: 2.890