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Improving anti-platelet therapy adherence in the Veterans Health Administration: A randomized multi-site hybrid

Marina S McCreight1, Anne Lambert-Kerzner2, Colin I O'Donnell1

  • 1VHA Eastern Colorado Health Care System, Denver, CO, United States.

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Improving adherence to P2Y12 inhibitors after stenting is crucial for Veterans. A multi-faceted intervention was tested to enhance medication adherence and PCI outcomes, with a focus on implementation science.

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Area of Science:

  • Cardiovascular Medicine
  • Implementation Science
  • Health Services Research

Background:

  • P2Y12 inhibitors are vital post-percutaneous coronary intervention (PCI) with stent placement to prevent stent thrombosis and myocardial infarction.
  • Non-adherence to P2Y12 inhibitor therapy is a significant challenge among Veterans.
  • Optimizing medication adherence is critical for improving cardiovascular outcomes in this population.

Purpose of the Study:

  • To evaluate the effectiveness of a multi-faceted intervention designed to improve P2Y12 inhibitor adherence in Veterans undergoing PCI.
  • To assess the impact of the intervention on key PCI outcomes, including stent thrombosis and myocardial infarction.
  • To formatively evaluate and refine the intervention's implementation process within the Veterans Health Administration (VA) system.

Main Methods:

  • A multi-site randomized stepped wedge trial design was employed.
  • Patients were enrolled at VA PCI sites and followed for 12 months post-PCI.
  • Primary outcomes included prescription fill rates at discharge and pharmacy refill data for adherence over one year. Secondary outcomes included bleeding, MI, stroke, mortality, and cost-effectiveness. Qualitative data were collected to understand implementation barriers and facilitators.

Main Results:

  • (Results not yet available as this is a study description)

Conclusions:

  • The study aims to enhance knowledge on improving medication adherence in patients receiving PCI with stent implantation.
  • It will provide valuable insights into the implementation process and contribute to the field of implementation science.
  • Findings are expected to inform strategies for better management of Veterans undergoing PCI.