Effects of a transitional care program on medication adherence in an older cardiac population: a randomized clinical trial.

Abstract

AIM\nTo evaluate the effect of the Cardiac Care Bridge (CCB) intervention on medication adherence post-discharge.\n\n\nMETHODS\nWe 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.\n\n\nRESULTS\nFor 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=0.473); adjusted difference -3.3 (95% CI -10.3 to 3.7, p = 0.353)). Post-hoc analysis indicated that a modest beneficial intervention effect may be restricted to MDD non-users (pinteraction =0.085). In total, 77.0% of the patients had at least one MRP post-discharge.\n\n\nCONCLUSIONS\nOur 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 a MDD system. This finding needs replication.