Pharmacist-Led Intervention to Enhance Medication Adherence in Patients With Acute Coronary Syndrome in Vietnam: A Randomized Controlled Trial

Abstract

Background: Patient adherence to cardioprotective medications improves outcomes of acute coronary syndrome (ACS), but few adherence-enhancing interventions have been tested in low-income and middle-income countries.Objectives: We aimed to assess whether a pharmacist-led intervention enhances medication adherence in patients with ACS and reduces mortality and hospital readmission.Methods: We conducted a randomized controlled trial in Vietnam. Patients with ACS were recruited, randomized to the intervention or usual care prior to discharge, and followed 3 months after discharge. Intervention patients received educational and behavioral interventions by a pharmacist. Primary outcome was the proportion of adherent patients 1 month after discharge. Adherence was a combined measure of self-reported adherence (the 8–item Morisky Medication Adherence Scale) and obtaining repeat prescriptions on time. Secondary outcomes were (1) the proportion of patients adherent to medication; (2) rates of mortality and hospital readmission; and (3) change in quality of life from baseline assessed with the European Quality of Life Questionnaire – 5 Dimensions – 3 Levels at 3 months after discharge. Logistic regression was used to analyze data. Registration: ClinicalTrials.gov (NCT02787941).Results: Overall, 166 patients (87 control, 79 intervention) were included (mean age 61.2 years, 73% male). In the analysis excluding patients from the intervention group who did not receive the intervention and excluding all patients who withdrew, were lost to follow-up, died or were readmitted to hospital, a greater proportion of patients were adherent in the intervention compared with the control at 1 month (90.0% vs. 76.5%; adjusted OR = 2.77; 95% CI, 1.01–7.62) and at 3 months after discharge (90.2% vs. 77.0%; adjusted OR = 3.68; 95% CI, 1.14–11.88). There was no significant difference in median change of EQ-5D-3L index values between intervention and control [0.000 (0.000; 0.275) vs. 0.234 (0.000; 0.379); p = 0.081]. Rates of mortality, readmission, or both were 0.8, 10.3, or 11.1%, respectively; with no significant differences between the 2 groups.Conclusion: Pharmacist-led interventions increased patient adherence to medication regimens by over 13% in the first 3 months after ACS hospital discharge, but not quality of life, mortality and readmission. These results are promising but should be tested in other settings prior to broader dissemination.

Pharmacist Role in Enhancement of Medication Adherence and Clinical Outcomes in Acute Coronary Syndrome Paitents

“…The current study has shown that pharmacist led intervention through patient education and follow up has considerable impact on optimizing patient' medication adherence as evidenced by the finding that 63.3% of the patients in intervention group had high level of adherence compared to only 21.1% of controls. This finding is in accordance with a randomized controlled trial done in Vietnam which revealed that pharmacist interventional program via patient education caused remarkable enhancement in adherence to ACS discharge medications [26] . In United States, a randomized controlled trial revealed that pharmacist multifaceted intervention consisting of patient education and follow up by phone calls and voice messages increased medication adherence markedly among patients with ACS [35] .…”

Vietnamese version of the coronary artery disease education questionnaire—Short version: Translation, adaptation and validation

“…Because of the intervention, content in randomized clinical trials was focused on counselling on medications use and the importance of adherence to medication. 15 These contents were little or not relevant to the surveyed knowledge in our questionnaire. Otherwise, the patients of the intervention group were consulted on using medications whereas our questionnaire asked about the mechanism of medications (for example, question 11 asked about the mechanism action of statins).…”

Impacts of Clinical Pharmacist Intervention on the Secondary Prevention of Coronary Heart Disease: A Randomized Controlled Clinical Study

“…This study raises questions about the effectiveness of pharmacist intervention in the management of CHD. While some studies have shown positive effects of pharmacist intervention on medication adherence and lipid management in CHD patients (Faulkner et al, 2000; Straka et al, 2005; Ho et al, 2014; Nguyen et al, 2018), there is heterogeneity in the results (Community Pharmacy Medicines Management Project Evaluation Team, 2007; Calvert et al, 2012; Schwalm et al, 2015). So far, the number of studies evaluating the contribution from pharmacists in the management of CHD is small, and most of these studies included a limited number of participants; it is necessary to conduct further studies to confirm the role of pharmacists in the secondary prevention of CHD.…”