Lin Chung-Ying, Yaseri Mehdi, Pakpour Amir H, Malm Dan, Broström Anders, Fridlund Bengt, Burri Andrea, Webb Thomas L
Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
Drugs Aging. 2017 Feb;34(2):143-156. doi: 10.1007/s40266-016-0429-3.
Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for extended periods, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence in this patient group is therefore important.
The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery.
Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment-as-usual (TAU; n = 144) groups using cluster randomization at center level. Medication adherence was evaluated using the Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL was evaluated using Short Form-36. Data were collected at baseline; 3, 6, and 18 months after intervention. Survival status was followed up at 18 months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses.
Compared with patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved 6 months after surgery (p < 0.01) and remained so 18 months after surgery (p < 0.01). QoL also increased among patients in the EXP group as compared with those who received TAU at 18 months post-surgery (physical component summary score p = 0.02; mental component summary score p = 0.04). HR in the EXP group compared with the TAU group was 0.38 (p = 0.04).
The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after 18 months. QoL and survival rates increased as a function of better medication adherence. ClinicalTrials.gov NCT02109523.
接受冠状动脉旁路移植术（CABG）的患者需要长期服用复杂的药物治疗方案，并且由于难以坚持该方案，他们可能会出现负面结果。因此，设计有效的干预措施以促进该患者群体的药物依从性非常重要。
本研究旨在评估多方面干预措施（心理教育、动机性访谈和短信服务）对接受CABG手术的老年患者的药物依从性、生活质量（QoL）和死亡率的长期影响。
来自12个中心的65岁以上患者在中心层面采用整群随机化方法被分配到干预组（EXP；n = 144）或常规治疗组（TAU；n = 144）。使用药物依从性评分量表（MARS）、药房再填充率和血脂谱评估药物依从性；使用简短健康调查问卷-36评估生活质量。在基线、干预后3个月、6个月和18个月收集数据。在18个月时对生存状况进行随访。采用多水平回归和风险比（HR）生存分析进行分析。
与接受常规治疗的患者相比，EXP组患者的MARS、药房再填充率和血脂谱在术后6个月有所改善（p < 0.01），并在术后18个月保持改善（p < 0.01）。与接受常规治疗的患者相比，EXP组患者在术后18个月时的生活质量也有所提高（身体成分汇总评分p = 0.02；心理成分汇总评分p = 0.04）。与TAU组相比，EXP组的HR为0.38（p = 0.04）。
研究结果表明，多方面干预措施可提高接受CABG手术的老年患者的药物依从性，且这些改善在18个月后仍得以维持。生活质量和生存率随着更好的药物依从性而提高。ClinicalTrials.gov NCT02109523。
