Pharmacist intervention ups heart medicine compliance
Heart-failure patients are more likely to comply with a medication regimen if they are under the continuing care of a pharmacist, according to a study from the University of North Carolina at Chapel Hill School of Pharmacy.1
The study evaluated 314 low-income patients with heart failure. One study group received typical services from a pharmacist, while the other group received care from a specially trained pharmacist who had access to customized educational materials, provided comprehensive instruction to participants, and reminded them to refill their prescriptions.
"For every $1 we spent on the intervention group, the healthcare system gained $14 in savings by decreasing emergency room visits and hospitalization," said UNC School of Pharmacy Mescal C. Ferguson Distinguished Professor Michael Murray, PharmD, the study's lead author.
Compared to patients in the control group, those who received special intervention took their medications 16% more consistently, visited the emergency room and were hospitalized 19% less, and had direct annual healthcare costs nearly $3,000 lower per patient. "The key to the success of our intervention was taking time with patients to create a regular schedule for taking their medicines that fit their lifestyle," said James Young, PharmD, the intervention pharmacist involved in the study at Wishard Health Services in Indianapolis. "We made sure that patients understood how their medications worked and why taking them consistently was so important."
The study investigators created special heart-specific materials designed to help patients with lower levels of health literacy. Thus, heart patients taking an ACE inhibitor received their pills in a bottle marked with an ace of hearts sticker. A corresponding user-friendly information sheet also was marked with the ace of hearts.
Researchers say that five million people in the U.S. have heart failure, with total healthcare costs more than $29 billion, largely from expensive exacerbations that require emergency visits and hospitalizations. Regularly administered cardiovascular medications may preserve cardiac function, improve quality of life, and reduce risk for costly exacerbations.
Researchers also have estimated that some 50% of patients with chronic illnesses do not take their medications as prescribed. Reasons for non-adherence include lack of patient knowledge, skills, and support to appropriately self-manage complicated medication regimens.
Few studies on interventions
While there are many chronic disease management programs, few studies have rigorously tested interventions aimed at improving patient adherence to prescribed medications and their effect on health outcomes.
In this study, the researchers hypothesized that the pharmacist intervention would improve adherence to heart failure medications, reduce exacerbations requiring emergency department visits or hospitalization, improve disease-specific quality of life, increase patient satisfaction, and reduce healthcare costs.
The primary study outcomes were medication adherence tracked by using electronic monitors and clinical exacerbations that required visits to the emergency department or hospitalization.
The study reports that the pharmacist intervention improved adherence to cardiovascular medications, including the proportion of medications taken, the reliability of scheduling these medications, and the amounts of medications refilled.
However, it said, the effects of the intervention on taking and scheduling adherence observed during the nine-month active intervention period dissipated in the three-month post-intervention period. Patients in the intervention group had fewer exacerbations requiring emergency room visits and hospital care and reported greater satisfaction with pharmacist services than did patients receiving usual care.
Costs of care were lower and improvements in disease-specific quality of life were greater in the intervention group but were not statistically significant.
With respect to costs, as more patients receive the intervention, the intervention development costs become negligible and the overall cost savings per patient approaches $3,000. "Indeed," the researchers said, "the return on investment in our study is $14 for every dollar spent on the intervention, which contrasts greatly from the return on investment of $6.50 for every dollar spent in a recent meta-analysis of more intensive post-discharge interventions in older adults with heart failure.
- Murray MD, Young J, Hoke S. Pharmacist Intervention to Improve Medication Adherence in Heart Failure A Randomized Trial Ann Intern Med 2007; 146: 714-725.