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Improving Medication Adherence through Graphically Enhanced Interventions in Coronary Heart Disease (IMAGE-CHD): a
Sunil Kripalani1, Brian Schmotzer, Terry A Jacobson
1Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, TN 37232, USA. sunil.kripalani@vanderbilt.edu
Journal of General Internal Medicine
|July 14, 2012
Summary
Low-literacy interventions did not improve medication adherence overall. However, illustrated schedules may help patients with low self-efficacy or multiple medications adhere to their treatment plans.
Area of Science:
- Cardiovascular Disease Management
- Health Literacy
- Patient Adherence
Background:
- Up to 50% of patients do not adhere to prescribed medication regimens.
- Interventions to improve medication adherence are crucial, especially understanding which patient groups benefit most.
- Low health literacy is a significant barrier to medication adherence.
Purpose of the Study:
- To evaluate the effectiveness of two low-literacy interventions on medication adherence.
- To determine if refill reminder postcards or illustrated daily medication schedules improve adherence in patients with coronary heart disease.
Main Methods:
- A randomized controlled trial with a 2x2 factorial design was conducted.
- Participants included adults with coronary heart disease from an inner-city primary care clinic.
- Medication adherence was assessed over 1 year using the cumulative medication gap (CMG), with CMG < 0.20 indicating adherence.
Main Results:
- Overall adherence rates did not significantly differ between usual care and the intervention groups.
- Illustrated medication schedules showed a significant increase in adherence odds for patients with polypharmacy (more than eight medications) or low self-efficacy.
- A trend towards improved adherence was observed in patients reporting baseline non-adherence.
Conclusions:
- The tested low-literacy interventions did not improve overall medication adherence.
- Illustrated medication schedules may be beneficial for specific patient subgroups, including those with low self-efficacy, polypharmacy, or prior non-adherence.
- Further research is needed to confirm the efficacy of illustrated medication schedules in these subgroups.
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