TY - JOUR
T1 - Effects of a transitional care programme on medication adherence in an older cardiac population: A randomized clinical trial
T2 - A randomized clinical trial
AU - Daliri, Sara
AU - Kooij, Marcel J.
AU - Scholte op Reimer, Wilma J. M.
AU - ter Riet, Gerben
AU - Jepma, Patricia
AU - Verweij, Lotte
AU - Peters, Ron J. G.
AU - Buurman, Bianca M.
AU - Karapinar-Çarkit, Fatma
N1 - Funding Information: Further, we thank the CCB management team, including Michel Terbraak, Corine Latour, and research nurses Maaike Bangma, Marleen van Leeuwen, Anniek Leijnse, Lisa van Maanen and Sara Soldan. This study was supported by a research grant of the Netherlands Organisation for Health Research and Development (ZonMw), grant number: 520002002 and SIA RAAK MKB, grant number: RAAK.MKB08.011. The funders had no role in study design, data collection and analyses, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2021 British Pharmacological Society.
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - adherence
KW - cardiovascular
KW - elderly
KW - medication errors
UR - http://www.scopus.com/inward/record.url?scp=85117768065&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/bcp.15044
DO - https://doi.org/10.1111/bcp.15044
M3 - Article
C2 - 34410011
SN - 0306-5251
VL - 88
SP - 965
EP - 982
JO - British journal of clinical pharmacology
JF - British journal of clinical pharmacology
IS - 3
ER -