Medical Research: What is the background for this study? What are the main findings?
Dr. Mathews: Though treatment for patients with an acute myocardial infarction with evidence based therapies has increased significantly over the years, adherence to these therapies after discharge remain sub optimal. We used a validated instrument, the Morisky scale, to assess patient medication adherence. We found that in a contemporary population of 7,425 patients across 216 hospitals, about 30% of patients were not adherent to prescribed cardiovascular medications as early as 6 weeks after discharge. Patients with low adherence were more likely to report financial hardship as well as have signs of depression. In addition, we found that patients who had follow up arranged prior to discharge and those that received explanations from the provider on the specific medications, were more often adherent to therapies. There was a non significant increase in risk of death or readmission at 2 months (HR [95% CI]: 1.35 [0.98-1.87]) among low adherence patients.
Medical Research: What should clinicians and patients take away from your report?
Dr. Mathews: The reasons for medication non adherence are complex and multifactorial. Though some factors such as race and age are non modifiable, others such as health literacy, patient perception of side effects, and out of pocket expenses, can be influenced. The transition of a patient from hospital to home is an opportunity to identify patients who may be at increased risk for non adherence. The discharge process should include an assessment of possible barriers to adherence after patients leave the hospital. Once these have been identified, a patient tailored strategy can be used to address these barriers. For instance, while cost may be the main issue for some patients, access to follow up care, or an insufficient understanding of the reasons for medications, may be the primary factor for others. This is an important opportunity for clinicians and providers to potentially improve adherence as well as perhaps impacting down stream outcomes such as readmissions and other adverse cardiovascular events.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Mathews: The discharge process of a patient after an acute myocardial infarction varies between hospitals across the U.S. Therefore, the identification of specific hospital and provider level practices that positively impact short and long term medication adherence, is critical. Any effective intervention will need to be patient centered and tailored to the specific needs of the patient. Once identified, these should be disseminated as ‘best practices’ in order to provide some standardization to our discharge process.
Early Medication Nonadherence After Acute Myocardial Infarction: Insights into Actionable Opportunities From the Treatment with ADP receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome Study
MedicalResearch.com Interview with: Robin Mathews, MD, Duke Clinical Research Institute, Duke University Medical Center, & Durham, NC (2015). Improved Hospital Discharge Process May Reduce Medication Nonadherence