Durham Veterans Affairs Medical Center, 411 W Chapel Hill St, Ste 600, Durham, NC 27701. E-mail:
Am J Manag Care. 2017 Sep 1;23(9):e280-e286.
Elevated low-density lipoprotein cholesterol (LDL-C) is a major modifiable risk factor for cardiovascular disease, a leading cause of death in the United States. Our goal was to evaluate a simple, scalable, and affordable medication packaging method for improving cholesterol medication adherence and subsequently lowering LDL-C levels.
Mixed-method study.
This mixed-method study involved US military veterans with LDL-C levels greater than 130 mg/dL and/or less than 80% refill adherence of cholesterol-lowering medication in the last 12 months; they were randomized to an education-only (control) group or an adherence packaging intervention group. Adherence packaging group participants' statin medication was provided in special blister packaging labeled for daily use that included written reminder prompts. Outcomes included 12-month cholesterol medication possession ratio (MPR) for medication refills; baseline, 6-, and 12-month self-reported cholesterol medication use; LDL-C and high-density lipoprotein cholesterol (HDL-C) levels; and total cholesterol changes over 12 months. Qualitative evaluation of the intervention is presented as well.
We enrolled 240 individuals (120 intervention, 120 control). Overall, 54.2% of the adherence packaging intervention group was adherent per MPR over 12 months compared with 46.6% of the education-only group (difference = 7.6%; 95% confidence interval, -5% to 20%; P ≤.24). Both arms reported improvements in self-reported cholesterol adherence at 12 months, and decreases in LDL-C, HDL-C, and total cholesterol were observed, but differences in change between arms were not statistically significant. Qualitatively, patients reported high levels of satisfaction with the blister package.
In a sample of US veterans, prefilled calendared blister packaging provided an inexpensive method for improving cholesterol medication adherence.
升高的低密度脂蛋白胆固醇（LDL-C）是心血管疾病的主要可调节风险因素，也是美国的主要死亡原因。我们的目标是评估一种简单、可扩展且经济实惠的药物包装方法，以提高胆固醇药物的依从性，从而降低 LDL-C 水平。
混合方法研究。
这项混合方法研究纳入了 LDL-C 水平大于 130mg/dL 和/或过去 12 个月中降脂药物的依从性不足 80%的美国退伍军人；他们被随机分配到教育仅组（对照组）或依从性包装干预组。依从性包装组参与者的他汀类药物采用特殊的泡罩包装提供，标签上注明了每日使用，并包括书面提醒提示。结果包括 12 个月的胆固醇药物补充药物持有率（MPR）；基线、6 个月和 12 个月的自我报告胆固醇药物使用情况；LDL-C 和高密度脂蛋白胆固醇（HDL-C）水平；以及 12 个月内的总胆固醇变化。还介绍了干预措施的定性评估。
我们共纳入了 240 名参与者（120 名干预组，120 名对照组）。总体而言，依从性包装干预组在 12 个月内的 MPR 为 54.2%，而教育仅组为 46.6%（差异=7.6%；95%置信区间，-5%至 20%；P≤.24）。两个组在 12 个月时均报告胆固醇依从性有所改善，并且 LDL-C、HDL-C 和总胆固醇均有所下降，但两组之间的变化差异无统计学意义。定性研究表明，患者对泡罩包装非常满意。
在一组美国退伍军人中，预填充的日历式泡罩包装为提高胆固醇药物的依从性提供了一种廉价的方法。
