Pharmacist-Led Intervention to Enhance Medication Adherence in Patients With Acute Coronary Syndrome in Vietnam: A Randomized Controlled Trial

被引:18
作者
Nguyen, Thang [1 ]
Nguyen, Thao H. [2 ]
Nguyen, Phu T. [2 ]
Tran, Ha T. [2 ]
Nguyen, Ngoc, V [2 ]
Nguyen, Hoa Q. [2 ]
Ha, Ban N. [3 ]
Pham, Tam T. [4 ]
Taxis, Katja [5 ]
机构
[1] Can Tho Univ Med & Pharm, Dept Pharmacol & Clin Pharm, Can Tho, Vietnam
[2] Univ Med & Pharm, Dept Clin Pharm, Ho Chi Minh City, Vietnam
[3] Heart Inst Ho Chi Minh City, Ho Chi Minh City, Vietnam
[4] Can Tho Univ Med & Pharm, Fac Publ Hlth, Can Tho, Vietnam
[5] Univ Groningen, Groningen Res Inst Pharm, Groningen, Netherlands
关键词
acute coronary syndrome; medication adherence; pharmacist-led intervention; randomized controlled trial; Vietnam; CARDIOVASCULAR MEDICATIONS; MEDICINES QUESTIONNAIRE; IMPROVE ADHERENCE; HEART-FAILURE; DISEASE; CARE; METAANALYSIS; THERAPY; MANAGEMENT; DISCHARGE;
D O I
10.3389/fphar.2018.00656
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Background: Patient adherence to cardioprotective medications improves outcomes of acute coronary syndrome (ACS), but few adherence-enhancing interventions have been tested in low-income and middle-income countries. Objectives: We aimed to assess whether a pharmacist-led intervention enhances medication adherence in patients with ACS and reduces mortality and hospital readmission. Methods: We conducted a randomized controlled trial in Vietnam. Patients with ACS were recruited, randomized to the intervention or usual care prior to discharge, and followed 3 months after discharge. Intervention patients received educational and behavioral interventions by a pharmacist. Primary outcome was the proportion of adherent patients 1 month after discharge. Adherence was a combined measure of self-reported adherence (the 8-item Morisky Medication Adherence Scale) and obtaining repeat prescriptions on time. Secondary outcomes were (1) the proportion of patients adherent to medication; (2) rates of mortality and hospital readmission; and (3) change in quality of life from baseline assessed with the European Quality of Life Questionnaire - 5 Dimensions - 3 Levels at 3 months after discharge. Logistic regression was used to analyze data. Registration: ClinicalTrials.gov (NCT02787941). Results: Overall, 166 patients (87 control, 79 intervention) were included (mean age 61.2 years, 73% male). In the analysis excluding patients from the intervention group who did not receive the intervention and excluding all patients who withdrew, were lost to follow-up, died or were readmitted to hospital, a greater proportion of patients were adherent in the intervention compared with the control at 1 month (90.0% vs. 76.5%; adjusted OR = 2.77; 95% CI, 1.01-7.62) and at 3 months after discharge (90.2% vs. 77.0%; adjusted OR = 3.68; 95% CI, 1.14-11.88). There was no significant difference in median change of EQ-5D-3L index values between intervention and control [0.000 (0.000; 0.275) vs. 0.234 (0.000; 0.379); p = 0.081]. Rates of mortality, readmission, or both were 0.8, 10.3, or 11.1%, respectively; with no significant differences between the 2 groups. Conclusion: Pharmacist-led interventions increased patient adherence to medication regimens by over 13% in the first 3 months after ACS hospital discharge, but not quality of life, mortality and readmission. These results are promising but should be tested in other settings prior to broader dissemination.
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页数:9
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