A shared decision‐making intervention by pharmacy students to improve statin adherence

Abstract

Introduction: Despite the well-established value of statins in reducing cardiovascular events, nearly half of patients fail to receive maximum benefit due to nonadherence.Studies indicate that motivational interviewing (MI) by pharmacy students can improve statin adherence. The benefit of incorporating an individualized approach, including shared-decision making (SDM), is unknown, as is the student-perceived value of this activity in their professional development.Objectives: To (a) measure the effect of an individualized telephone intervention conducted by pharmacy students in improving statin adherence and (b) assess the selfreported value of intervention participation to guide continual quality improvement. Methods: A prospective, quality-improvement project was conducted among patients receiving care at a university-based healthcare system through a commercial or Medicare Advantage plan. Pharmacy claims data identified nonadherent patients based on a six-month proportion of days covered (PDC) <0.80 for statin prescriptions. A sample of these patients was randomly selected to receive the intervention from July 2019 to April 2020, while remaining patients served as controls. The intervention included 1-2 telephone calls by pharmacy students to deliver individualized evidence-based education, including SDM and MI strategies. Mean PDC change and proportion of patients converted to adherent (PDC≥0.80) were evaluated 6 months post-intervention using the intention-to-treat principle.Results: There were 58 patients in the intervention group, 52 of whom (90%) received at least one telephone call, and 82 controls. Six months post-intervention mean PDC increased significantly in the intervention vs control group (12.8% vs 0.7%, P = .004), and 66% of the intervention group were adherent compared to 41% of controls [P = .005, adjusted OR = 2.46 (1.20-5.05)]. Seven students participated in the intervention, with 83% of survey responders reporting positive professional development value during the experience. Conclusion: Pharmacy trainees may successfully deliver individualized interventions capable of improving statin adherence while positively contributing to their professional development.