Population Health Research Institute, McMaster University and Hamilton Health Sciences, DBCVSRI, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
BMC Med. 2022 Jun 21;20(1):213. doi: 10.1186/s12916-022-02401-5.
Preliminary evidence suggests that providing longer duration prescriptions at discharge may improve long-term adherence to secondary preventative cardiac medications among post-myocardial infarction (MI) patients. We implemented and assessed the effects of two hospital-based interventions-(1) standardized prolonged discharge prescription forms (90-day supply with 3 repeats for recommended cardiac medications) plus education and (2) education only-on long-term cardiac medication adherence among elderly patients post-MI.
We conducted an interrupted time series study of all post-MI patients aged 65-104 years in Ontario, Canada, discharged from hospital between September 2015 and August 2018 with ≥ 1 dispensation(s) for a statin, beta blocker, angiotensin system inhibitor, and/or secondary antiplatelet within 7 days post-discharge. The standardized prolonged discharge prescription forms plus education and education-only interventions were implemented at 2 (1,414 patients) and 4 (926 patients) non-randomly selected hospitals in September 2017 for 12 months, with all other Ontario hospitals (n = 143; 18,556 patients) comprising an external control group. The primary outcome, long-term cardiac medication adherence, was defined at the patient-level as an average proportion of days covered (over 1-year post-discharge) ≥ 80% across cardiac medication classes dispensed at their index fill. Primary outcome data were aggregated within hospital groups (intervention 1, 2, or control) to monthly proportions and independently analyzed using segmented regression to evaluate intervention effects. A process evaluation was conducted to assess intervention fidelity.
At 12 months post-implementation, there was no statistically significant effect on long-term cardiac medication adherence for either intervention-standardized prolonged discharge prescription forms plus education (5.4%; 95% CI - 6.4%, 17.2%) or education only (1.0%; 95% CI - 28.6%, 30.6%)-over and above the counterfactual trend; similarly, no change was observed in the control group (- 0.3%; 95% CI - 3.6%, 3.1%). During the intervention period, only 10.8% of patients in the intervention groups received ≥ 90 days, on average, for cardiac medications at their index fill.
Recognizing intervention fidelity was low at the pharmacy level, and no statistically significant post-implementation differences in adherence were found, the trends in this study-coupled with other published retrospective analyses of administrative data-support further evaluation of this simple intervention to improve long-term adherence to cardiac medications.
ClinicalTrials.gov : NCT03257579 , registered June 16, 2017 Protocol available at: https://pubmed.ncbi.nlm.nih.gov/33146624/ .
初步证据表明，在出院时提供更长时间的处方可能会提高心肌梗死后（MI）患者长期服用二级预防心脏药物的依从性。我们实施并评估了两种基于医院的干预措施的效果-（1）标准化的延长出院处方表（90 天供应量，推荐的心脏药物可重复 3 次）加教育，（2）仅教育-对老年 MI 后患者的长期心脏药物依从性的影响。
我们对加拿大安大略省所有 65-104 岁的 MI 后患者进行了一项中断时间序列研究，这些患者在出院后 7 天内至少有 1 次处方（出院后），用于他汀类药物、β受体阻滞剂、血管紧张素系统抑制剂和/或二级抗血小板药物。标准化的延长出院处方表加教育和教育仅干预措施于 2017 年 9 月在 2（1414 名患者）和 4（926 名患者）个非随机选择的医院实施了 12 个月，所有其他安大略省医院（n=143；18556 名患者）组成外部对照组。主要结局，长期心脏药物依从性，定义为在索引填充时服用的心脏药物类别中平均覆盖天数（出院后 1 年）≥80%的患者水平。将主要结局数据汇总到医院组（干预 1、2 或对照）的每月比例中，并使用分段回归独立分析，以评估干预效果。进行了一项过程评估，以评估干预的一致性。
在实施后 12 个月，标准化延长出院处方表加教育（5.4%；95%CI-6.4%，17.2%）或仅教育（1.0%；95%CI-28.6%，30.6%）的干预均未对长期心脏药物依从性产生统计学显著影响-除了假设趋势之外；同样，对照组也没有观察到变化（-0.3%；95%CI-3.6%，3.1%）。在干预期间，干预组中只有 10.8%的患者在索引填充时平均接受了≥90 天的心脏药物治疗。
鉴于药房级别的干预一致性较低，并且在实施后未发现依从性的统计学显著差异，本研究中的趋势-结合其他已发表的行政数据回顾性分析-支持进一步评估这种简单的干预措施，以提高心脏药物的长期依从性。
ClinicalTrials.gov：NCT03257579，注册于 2017 年 6 月 16 日；方案可在以下网址获取：https://pubmed.ncbi.nlm.nih.gov/33146624/。
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