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Effects of a pharmaceutical care intervention on clinical outcomes and patient adherence in coronary heart disease - the MIMeRiC randomized controlled trial
Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Region Kalmar County, Sweden. (eHälsoinstitutet;eHealth Institute)ORCID iD: 0000-0001-7550-5706
Malmö University, Sweden.
Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. (eHälsoinstitutet;eHealth Institute)ORCID iD: 0000-0002-4295-7201
Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kalmar County, Sweden. (eHälsoinstitutet;eHealth Institute)ORCID iD: 0000-0001-5211-8818
2021 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 21, no 1, article id 367Article in journal (Refereed) Published
Abstract [en]

Background: In the treatment of coronary heart disease, secondary prevention goals are still often unmet and pooradherence 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 outcomesand 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 interventiongroup were seen by a clinical pharmacist two to fve times as required over seven months. Pharmacists were trainedto use motivational interviewing in the consultations and they tailored their support to each patient’s clinical needsand beliefs about medicines. The primary study end-point was the proportion of patients who reached the treatmentgoal for low-density lipoprotein cholesterol by 12 months after discharge. The key secondary outcome was patientadherence to lipid-lowering therapy at 15 months after discharge, and other secondary outcomes were the efectson patient adherence to other preventive drugs, systolic blood pressure, disease-specifc quality of life, and healthcareuse.

Results: 316 patients were included. The proportion of patients who reached the target for low-density lipoproteincholesterol were 37.0% in the intervention group and 44.2% in the control group (P=.263). More intervention thancontrol 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 efects on risk factors for CHD, but it increased patient adherence.Further investigation of the intervention process is needed to explore the diference in results between patient adherence and medication efects. Longer follow-up of healthcare use and mortality will determine if the increased adherence per se eventually will have a meaningful efect on patient health

Place, publisher, year, edition, pages
BioMed Central (BMC), 2021. Vol. 21, no 1, article id 367
National Category
Social and Clinical Pharmacy
Research subject
Biomedical Sciences, Pharmacology
Identifiers
URN: urn:nbn:se:lnu:diva-101984DOI: 10.1186/s12872-021-02178-0ISI: 000679833300001PubMedID: 34334142Scopus ID: 2-s2.0-85111998744Local ID: 2021OAI: oai:DiVA.org:lnu-101984DiVA, id: diva2:1542493
Available from: 2021-04-07 Created: 2021-04-07 Last updated: 2023-04-17Bibliographically approved
In thesis
1. Pharmaceutical care in coronary heart disease
Open this publication in new window or tab >>Pharmaceutical care in coronary heart disease
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Att stödja patienter med kranskärlssjukdom till bättre läkemedelsanvändning
Abstract [en]

Background: In coronary heart disease (CHD), pharmaceutical care implies that health care professionals cooperate with the patient to optimize drug therapy primarily for secondary prevention. Low adherence and discontinuation of drugs are common among patients with CHD, and this is associated with increased morbidity and mortality. The achievement of guidelines-recommended treatment goals for risk factors is disappointingly low in secondary prevention.

Aim: To study clinical and patient related aspects of pharmaceutical care for secondary prevention in patients with CHD.

Method: A pharmacist used medication review and motivational interviewing to impact patients’ beliefs about medicines and adherence in a pilot study. This intervention was further developed and tested in a randomized controlled trial (RCT) in 316 patients with verified CHD who were planned for follow-up at the cardiology clinic in Kalmar. The primary study outcome was the proportion ofpatients who reached the treatment goal for low-density lipoprotein (LDL)cholesterol. Patients’ adherence to cholesterol-lowering drugs according to a combination of refilled prescriptions and self-report was the key secondary outcome. In the RCT, pharmacists individualized both the dose and the content of thesupport based on the patient’s need. A process evaluation was planned alongside the trial to investigate implementation and mechanisms of impact such as pharmacists’ actions and effects on patients’ medication beliefs. In a separate qualitative study, we interviewed patients with CHD who had used their medicines for at least 12 months.

Results: At 15 months follow-up of the RCT, the primary outcome measure did not differ between groups. The intervention improved patient adherence to cholesterol-lowering medicines; 88% vs 77% of the patients were adherent, possibly because the intervention lowered patients’ concerns about medicines. In 84% of the intervention patients at least one actual drug-related problem (DRP) was identified, and for 90% of those DRPs actions were taken to resolve the problems. Analyses of the interviews with patients revealed that patients´ experiences with medicines varied greatly - from trivial to troublesome – and these were classified into one of seven categories: a sense of security, unproblematic, learning to live with it, taking responsibility for it, somewhat uncertain, troublesome, or distressing.

Conclusion: Pharmaceutical care improved the patients’ use of medicines in CHD but did not increase treatment goal achievement for LDL-cholesterol. Overall, the findings of this thesis emphasize that when support in managing medications is offered to patients, it should encompass various aspects of medicine-taking: safety, knowledge, beliefs, practical handling, impact on day-to-day life, and the patient’s medication experience.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2021. p. 200
Series
Linnaeus University Dissertations ; 409/2021
Keywords
pharmaceutical care, patient experience, medication adherence, medicine management, medication review, motivational interviewing, coronary heart disease, secondary prevention, low-density lipoprotein cholesterol, cardiac rehabilitation, multi-professional collaboration, drug-related problems, pragmatic clinical trial, randomized controlled trial, qualitative analysis, process evaluation
National Category
Social and Clinical Pharmacy
Research subject
Natural Science, Biomedical Sciences; Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-101643 (URN)9789189283558 (ISBN)9789189283565 (ISBN)
Public defence
2021-04-16, Hjärnan, Länssjukhuset Kalmar, Kalmar, 09:00 (English)
Opponent
Supervisors
Available from: 2021-03-17 Created: 2021-03-17 Last updated: 2024-03-05Bibliographically approved

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Johansson Östbring, MalinPetersson, GöranHellström, Lina

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