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Pharmacist-Led Management Model and Medication Adherence Among Patients With Chronic Heart Failure: A Randomized
Lingjiao Wang1, Yuanyuan Zhao2,3, Liping Han4
1Department of Clinical Pharmacy, The First Hospital of Hebei Medical University, Hebei, China.
Insights
A pharmacist-led management model improved medication adherence in Chinese patients with chronic heart failure (CHF). This intervention, using social media, showed modest but significant gains in medication adherence over usual care.
Area of Science:
- Cardiology
- Pharmacology
- Digital Health
Background:
- Poor medication adherence is a significant issue in chronic heart failure (CHF) management, leading to increased morbidity and mortality, especially in China.
- Effective strategies are needed to improve adherence rates in this vulnerable patient population.
Purpose of the Study:
- To evaluate the impact of a pharmacist-led management model, integrated with a social media platform, on medication adherence in patients with CHF.
- To compare this intervention against usual care in a randomized clinical trial setting.
Main Methods:
- A prospective, multicenter randomized clinical trial involving 445 patients with CHF in China.
- Participants were randomized to either a pharmacist-led intervention group (including WeChat communication) or a usual care control group.
- The primary outcome measured was the proportion of days covered (PDC) by medication over 52 weeks.
Main Results:
- The intervention group demonstrated a significantly higher PDC for heart failure medication at 52 weeks (8.1% increase; P < .001).
- A greater proportion of patients in the intervention group achieved an 80% or greater PDC compared to the control group (OR, 0.34; P < .001).
Conclusions:
- A pharmacist-led management model incorporating social media offers a modest but significant improvement in medication adherence for patients with CHF.
- This approach holds promise for enhancing chronic disease management in China and potentially other regions.
Importance:
Poor medication adherence is associated with high morbidity and mortality among patients with chronic heart failure (CHF), which is particularly concerning in China.
Objective:
To assess the effect of a pharmacist-led management model incorporating a social media platform vs usual care on medication adherence in patients with CHF.
Design, Setting, And Participants:
This prospective, multicenter randomized clinical trial was conducted from March 2021 to May 2023, with a follow-up duration of 52 weeks. The trial was conducted in the cardiology wards of 5 hospitals in China. Participants were 18 years or older, had a CHF diagnosis, and were receiving stable medication. They were randomly assigned to either the intervention group (pharmacist-led management) or the control group (usual care) in a 1:1 ratio using a computer-generated random number table with concealed allocation via opaque envelopes. Intention-to-treat data analysis was performed from June 2023 to July 2024.
Intervention:
The intervention group received a multimodal pharmaceutical intervention, including WeChat application-based communication and education, and a standardized follow-up visit from a pharmacist every month. The control group received the standardized follow-up visit from nurses every month.
Main Outcomes And Measures:
The primary outcome was the proportion of days covered (PDC) by heart failure medication at 52 weeks.
Results:
Among the 445 participants analyzed, 223 were assigned to the intervention group and 222 to the control group. These patients had a mean (SD) age of 63.2 (13.3) years and included 263 males (59.1%). A total of 333 patients (74.8%) had a New York Heart Association class III or IV heart failure, indicating severe limitations in physical activity. At 52 weeks, the intervention group had a significantly higher PDC for heart failure medication (8.1%; 95% CI, 5.5%-10.7%; P < .001) and a greater proportion of patients with PDC of 80% or greater (odds ratio, 0.34; 95% CI, 0.21-0.54; P < .001) compared with the control group.
Conclusions And Relevance:
This randomized clinical trial found a modest improvement in medication adherence among patients with CHF who received the pharmacist-led management intervention vs usual care.
Trial Registration:
Chinese Clinical Trial Registry Identifier: ChiCTR2000040232.
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