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Effects of a transitional care programme on medication adherence in an older cardiac population: A randomized
Sara Daliri1,2, Marcel J Kooij3, Wilma J M Scholte Op Reimer4,5
1Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands.
Insights
The Cardiac Care Bridge intervention did not improve medication adherence in older cardiac patients after hospital discharge. However, a potential benefit was observed in patients not using multidose drug dispensing systems.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Medication non-adherence is prevalent in older adults with chronic conditions post-discharge, leading to adverse health outcomes.
- Effective interventions are crucial to improve medication adherence and reduce hospital readmissions in this vulnerable population.
Purpose of the Study:
- To evaluate the impact of the Cardiac Care Bridge (CCB) intervention on medication adherence in elderly cardiac patients following hospital discharge.
- To identify factors influencing medication adherence in the post-discharge setting.
Main Methods:
- Secondary analysis of a randomized single-blind trial involving patients aged 70 years and older admitted to cardiology departments.
- The CCB intervention included medication reconciliation, identification of medication-related problems (MRPs) by community nurses, and pharmacist recommendations.
- Medication adherence was measured by the proportion of days covered (PDC) using pharmacy refill data.
Main Results:
- The CCB intervention did not significantly improve medication adherence (PDC) in the overall study population.
- A trend towards improved adherence was noted in patients not utilizing multidose drug dispensing (MDD) systems (Pinteraction = 0.085).
- A high prevalence of medication-related problems (MRPs) was observed in 77.0% of patients post-discharge.
Conclusions:
- The multi-component CCB intervention did not demonstrate a significant benefit in improving medication adherence for older cardiac patients post-discharge.
- Further research is warranted to confirm the potential adherence benefits in non-MDD users.
- Addressing medication-related problems remains critical for this patient group.
Aims:
Medication non-adherence post-discharge is common among patients, especially those suffering from chronic medical conditions, and contributes to hospital admissions and mortality. This study aimed to evaluate the effect of the Cardiac Care Bridge (CCB) intervention on medication adherence post-discharge.
Methods:
We performed a secondary analysis of the CCB randomized single-blind trial, a study in patients ≥70 years, at high risk of functional loss and admitted to cardiology departments in six hospitals. In this multi-component intervention study, community nurses performed medication reconciliation and observed medication-related problems (MRPs) during post-discharge home visits, and pharmacists provided recommendations to resolve MRPs. Adherence to high-risk medications was measured using the proportion of days covered (PDC), using pharmacy refill data. Furthermore, MRPs were assessed in the intervention group.
Results:
For 198 (64.7%) of 306 CCB patients, data were available on adherence (mean age: 82 years; 58.9% of patients used a multidose drug dispensing [MDD] system). The mean PDC before admission was 92.3% in the intervention group (n = 99) and 88.5% in the control group (n = 99), decreasing to 85.2% and 84.1% post-discharge, respectively (unadjusted difference: -2.6% (95% CI -9.8 to 4.6, P = .473); adjusted difference -3.3 (95% CI -10.3 to 3.7, P = .353)). Post-hoc analysis indicated that a modest beneficial intervention effect may be restricted to MDD non-users (Pinteraction = .085). In total, 77.0% of the patients had at least one MRP post-discharge.
Conclusions:
Our findings indicate that a multi-component intervention, including several components targeting medication adherence in older cardiac patients discharged from hospital back home, did not benefit their medication adherence levels. A modest positive effect on adherence may potentially exist in those patients not using an MDD system. This finding needs replication.
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