MedicalResearch.com Interview with:
Dr. Tracy Wang MD MHS MSc
Assistant Dean, Continuing Medical Education
Director, Center for Educational Excellence
Fellowship Associate Program Director
Associate Professor of Medicine, Cardiology
Duke Clinical Research Institute
Medical Research: What is the background for this study? What are the main findings?
Response: Medication non-adherence is a known challenge in the management of patients with coronary artery disease. Barriers to adherence are multifactorial, attributed to patient, healthcare provider, and social determinants. However, whether patient medication adherence varies across different hospitals is unknown. In this study, we sought to determine whether inter-hospital differences exist in the degree of patient adherence to secondary prevention medications after discharge. Moreover, we assessed whether these hospital-specific variations in medication adherence, if any, correspond to downstream patient outcomes.
We observed that the majority of post-MI patients were prescribed guideline-recommended secondary prevention medications at discharge. However, among those prescribed, we see a significant decline in the use of these medications within just 90 days after discharge. Medication adherence rates varied markedly across U.S. hospitals, with the widest variation seen for post-discharge use of beta-blockers. Hospitals with high post-discharge medication adherence were associated with significantly lower risk of major adverse cardiovascular events and death or all-cause readmissions when compared with hospitals with low adherence rates, even after adjustment for differences in patient case-mix.
Medical Research: What should clinicians and patients take away from your report?
Response: This study suggests that post-MI patient outcomes vary depending on the degree of adherence to guidelines-recommended secondary prevention medications. There was remarkable variation between hospitals in the degree of medication adherence early after MI hospitalization discharge. This may be attributed to differences in transition of care practices between hospitals. This study suggests that collaborative initiatives among patients, the discharging hospital and outpatient clinic providers are needed to improve post-discharge medication adherence in order to enhance longitudinal patient outcomes.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Why are patients discharged from certain hospitals more likely to adhere to their prescribed medications than others? The extent to which hospital-specific discharge practices affect patient medication adherence remains poorly described, and our study provides a starting point towards identifying the key factors that contribute to improved patient adherence and therefore better clinical outcome in post-MI patient population.
Abstract presented at the 2015 AHA November 2015
Quality of Care and Outcomes – Session Title: Trends in Utilization of Guideline-Recommended Medications: The Times They Are A Changin’Abstract 12685: Hospital Variation in Adherence to Secondary Prevention Medications After Acute Myocardial Infarction
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Dr. Tracy Wang MD MHS MSc (2015). Medication Adherence Rates Vary Widely Across US Hospitals