Key result
A structured clinical pharmacist intervention significantly increased the proportion of patients with high medication adherence to 63.3% compared to 21.2% with usual care at 3 months.
Why the study?
Patients often fail to adhere to secondary prevention medications long-term after acute coronary syndrome, leading to disease deterioration, death, and financial burden.
Does a structured clinical pharmacist intervention at discharge improve medication adherence and clinical outcomes in patients with acute coronary syndrome?
RCT (n=70)
Randomly assigned
No
Does a structured clinical pharmacist intervention at discharge improve medication adherence and clinical outcomes in patients with acute coronary syndrome?
Absolute Event Rate: 63.3% vs 21.2%
p-value: p=<0.001
A structured pharmacist intervention at discharge significantly improves medication adherence, blood pressure, and lipid profiles in patients with acute coronary syndrome, though it did not reduce 30-day readmissions.
May support pharmacist-led adherence efforts; leaves open confirmation of clinical benefit in randomized trials.
Background: Patients who experience acute coronary syndrome (ACS) are at high risk of having further events in the future. One month after the attack, the average readmission rate was estimated to be approximately 20%. As a result, patients must receive secondary preven-tion medications to avoid reoccurrence of these cardiovascular events. To get the entire benefit, patients must adhere to the prescribed regimen. However, many studies demonstrated that patients do not adhere to the prescribed medications upon the long term, and this leads to substantial deterioration of disease and consequently death, as well as significant financial burden. This study has the objective of assessing the impact of pharmacist intervention on increasing patients' adherence to ACS medications. Method: a prospective interventional study was performed from January to October 2018. A total of 70 patients were selected randomly and were divided into those who received the usual care processes offered by pharmacists at discharge, and those who received well-structured clinical pharmacist intervention about the discharge medications and disease. Heart rate (HR), blood pressure (BP) and lipid profile were measured at baseline and after 3 months. Also, patients' level of adherence to the discharge medications was assessed after 3 months. Furthermore, 30 day hospital readmission rate was evaluated. Results: Regarding patients' medication adherence, 63.3% of the patients in intervention group had high level of adherence compared to only 21.1% of controls. After 3 months of follow up significant reduction in mean scores of outcomes were noticed in intervention group compared to control, where HR (73.6 vs. 80), SBP (129.5 vs. 141), DBP (81.2 vs. 87.5). Also serum cholesterol, triglycerides, and LDL were reduced and HDL increased significantly in the intervention group (P <0.05), while no such changes seen in controls. Moreover, no considerable difference was observed in hospital readmission between the intervention and control group. Conclusion: This study showed that pharmacist intervention caused notable enhancement in patient' medication adherence with subsequent improvement of heart rate, blood pressure, and lipid profile, but with no improvement in hospital readmission.
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Jabri et al. (2019) conducted an RCT in Acute Coronary Syndrome (n=70). Pharmacist intervention vs. Usual care was evaluated on High level of medication adherence (MMAS-8 score of 8) (p=<0.001). A structured clinical pharmacist intervention significantly increased the proportion of patients with high medication adherence to 63.3% compared to 21.2% with usual care at 3 months.
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