Improve adherence to beta-blockers

Better physician/patient communication needed

The message that the long-term use of beta-blockers following a heart attack can decrease the risk of another heart attack and death from cardiovascular disease is not being delivered to patients.

A study conducted by the Council for Affordable Quality Healthcare (CAQH) based in Washington, DC, found that only 69% of the patients prescribed beta-blockers following a heart attack regularly took the medication during the first 30 days after their hospital discharge. Over the six-month period after the heart attack 52% of the patients regularly took beta-blockers. The first year after a heart attack, 45% of heart attack survivors continued taking the medication regularly.

Further investigation revealed that there were significant gaps between the patients’ perception about why they were taking the medication and the physicians’ knowledge about the value of beta-blockers. The medications are prescription drugs that work by controlling certain nerve impulses that reduce the heart’s workload. This protects the heart by decreasing its demand for blood and oxygen.

Information was gathered on patients through seven focus groups in three markets — Atlanta, Los Angeles, and Baltimore, says Richard L. Snyder, MD, vice president of Quality Management at Independence Blue Cross and chair of heartBBEAT for life (Beta-Blocker Education and Treatment), which is a public education campaign developed by CAQH. In addition, 20 physicians were interviewed to determine their perspective on the importance of beta-blockers and how they encouraged patients to remain on the drug following a heart attack.

The focus groups revealed that patients did not understand why they were taking beta-blockers or the benefit of staying on them. They often felt that lifestyle changes were more important and harder to do than staying on the medications. On the other hand, physicians thought that complying with lifestyle changes was something that patients couldn’t do, even though patients thought they could.

Patients were often fearful of staying on beta-blockers for a long time; however, they were very willing to take aspirin for a long time. Physicians were not educating patients about the value of staying on beta-blockers for the rest of their life. Often they did not explain why patients were taking the medications or provide them with reasonable instructions about taking them, relying instead on the pharmacist providing information.

"In general, there were some major gaps in communication between the health care delivery system and the patients that we felt they could do something about," says Snyder.

To help close the gap in communication CAQH recommends that hospitals participate in either the Bethesda, MD, based American College of Cardiology GAP Program (www.acc.org) or the Dallas-based American Heart Association "Get With the Guidelines Program" (www.americanheart.org). Both programs emphasize standardization of patient education during hospitalization and at the time of discharge, says Snyder. Also, they emphasize documentation of education on medications and providing patients with written materials that explain the importance of staying on the medications.

Under these programs, patients are verbally taught the importance of a beta-blocker and how it protects them from subsequent heart attacks and or sudden death.

"Patients take the medication during the hospitalization, and 95% go home on it; but the biggest drop-off is within the first 30 days. At the time that care is transitioning from the inpatient setting to the outpatient setting, the message isn’t following the patient, so we wanted the stronger message to be delivered in the hospital setting," says Snyder.

To reinforce the message following discharge, a series of short informational items were prepared that can be delivered to patients via e-mail, postcard, letter, or by their physician. The messages sent to patients early on focus on side effects and what they should do if they experience them. Later messages focus on issues such as the cost of medication and communicating with their physician on long-term use of beta-blockers.

These messages also are available through pharmacists so they can be distributed with the prescription.

To educate physicians, a major vendor is creating three one-hour continuing medical education programs that are being promoted by health plans and the vendor. In addition, CAQH is preparing a set of presentations that health plans can give in meetings.

To measure the outcomes of the educational efforts, adherence to beta-blockers was made a measure of performance for the Health Employer Data Information Set, which is a measure of performance at the health plan level for many factors, says Snyder.

The same methods used to improve adherence to beta-blockers can be used to improve adherence to other medications such as those used in cholesterol management, says Snyder.

Sources

For more information about the study conducted by CAQH on beta-blocker adherence and its educational campaign heartBBEAT for life, contact:

Julia Gusakova, Group Manager, Weber Shandwick, 640 Fifth Ave., New York, NY 10019. Telephone: (212) 445 8242. E-mail: jgusakova@webershandwick.com

Council for Affordable Quality Healthcare, 601 Pennsylvania Ave., N.W., South Building, Suite 500, Washington DC 20004. Telephone: (202) 861-1492. Web site: www.caqh.org