Smith David H, Kramer Judith M, Perrin Nancy, Platt Richard, Roblin Douglas W, Lane Kimberly, Goodman Michael, Nelson Winnie W, Yang Xiuhai, Soumerai Stephen B
Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA.
Arch Intern Med. 2008 Mar 10;168(5):477-83; discussion 483; quiz 447. doi: 10.1001/archinternmed.2007.132.
Although beta-blockers are routinely prescribed at hospital discharge after myocardial infarction (MI), patients' adherence has been shown to decline substantially over time. We sought to test the hypothesis that a simple, direct-to-patient intervention can improve adherence to beta-blocker therapy following MI.
We conducted a cluster randomized controlled trial in 4 geographically dispersed health maintenance organizations testing the hypothesis that a simple direct-to-patient intervention could improve adherence. The study was carried out from June 2004 to March 2005. The primary analyses were based on 836 post-MI patients who were dispensed a beta-blocker prescription after discharge. The intervention consisted of 2 mailings 2 months apart describing the importance of beta-blocker use. The main outcomes were proportion of days covered with beta-blocker therapy and percentage of patients with at least 80% of days covered in the 9 months after the first mailing. Analyses were adjusted for age, sex, total medications dispensed, days between MI and intervention, and intervention site.
Over the entire follow-up period, patients in the treatment arm had a mean absolute increase of 4.3% of days covered per month compared with patients in the control arm (a 5.7% relative change from baseline), representing 1.3 extra days (P = .04). Treatment patients were 17% more likely (relative risk, 1.17; 95% confidence interval, 1.02-1.29) to have 80% of days covered. For every 16 patients receiving the intervention, 1 additional patient would become adherent (80% or more days covered per month).
A low-cost, easily replicable effort to increase adherence can have a demonstrable impact on beta-blocker adherence following MI. Trial Registration clinicaltrials.gov Identifier: NCT00211172.
尽管心肌梗死（MI）患者出院时通常会常规开具β受体阻滞剂，但研究表明患者的依从性会随着时间大幅下降。我们试图验证一个假设，即一种简单的直接针对患者的干预措施可以提高心肌梗死后β受体阻滞剂治疗的依从性。
我们在4个地理位置分散的健康维护组织中进行了一项整群随机对照试验，以验证简单的直接针对患者的干预措施能否提高依从性这一假设。该研究于2004年6月至2005年3月进行。主要分析基于836例心肌梗死后出院时开具了β受体阻滞剂处方的患者。干预措施包括每隔2个月邮寄两次，说明使用β受体阻滞剂的重要性。主要结局指标为β受体阻滞剂治疗覆盖天数的比例以及在第一次邮寄后的9个月内至少80%天数得到覆盖的患者百分比。分析对年龄、性别、所开具药物总数、心肌梗死与干预之间的天数以及干预地点进行了校正。
在整个随访期内，与对照组患者相比，治疗组患者每月覆盖天数的平均绝对增加量为4.3%（相对于基线有5.7%的相对变化），相当于多了1.3天（P = 0.04）。治疗组患者有80%天数得到覆盖的可能性要高17%（相对风险为1.17；95%置信区间为1.02 - 1.29）。每16名接受干预的患者中，就会有1名额外患者变得依从（每月80%或更多天数得到覆盖）。
一项低成本、易于复制的提高依从性的措施对心肌梗死后β受体阻滞剂的依从性可产生显著影响。试验注册 clinicaltrials.gov 标识符：NCT00211172。
