Researchers led by David H. Smith, RPh, PhD, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, found that a low-cost, easily replicable direct-to-patient intervention may improve adherence to [beta]-blocker therapy among persons who have had a myocardial infarction (MI). Study results were published in the March issue of Archives of Internal Medicine.
Smith and colleagues conducted a cluster randomized controlled trial in 4 geographically dispersed HMOs (in Boston, Minneapolis, Atlanta, and Portland, Oregon) from June 2004 to March 2005. The team studied 836 post-MI patients (67% men; average age, 65 years; average time from MI to randomization, approximately 136 days) who were given a [beta]-blocker after discharge. The participants received 2 mailings--the first at randomization and the second 2 months later. The communications contained nearly identical information, stressing the importance of lifetime use of [beta]-blockers following MI and of remembering to refill their prescription, reminding patients that adverse effects of the drugs can be managed. The mailings also briefly mentioned other therapies, including statins, angiotensin-converting enzyme (ACE) inhibitors, and aspirin.
After adjusting for age, sex, total number of medications dispensed, days between MI and intervention, and intervention site, the team found that patients who received the mailings had a mean absolute increase of 4.3% in days of [beta]-blocker coverage per month (1.3 days per month; P = .04) compared with those who did not receive the mailings. Mailing recipients were also 17% (RR, 1.17; 95% CI, 1.02 to 1.29) more likely than nonrecipients to have at least 80% of days covered. For every 16 patients receiving the intervention, 1 additional patient would become adherent (80% or more days covered per month).
The researchers also found that the use of ACE inhibitors, angiotensin receptor blockers, and statins did not decrease in the intervention group. The estimated cost of the intervention was between $5 and $10 per patient, depending on the size of the HMO.
"Interventions may improve post-MI adherence to [beta]-blockers." Drug Benefit Trends 20.4 (2008): 134. Academic OneFile. Web. 5 Dec. 2009.
Gale Document Number:A189052439
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