TY - JOUR
T1 - A randomized trial of direct-to-patient communication to enhance adherence to β-blocker therapy following myocardial infarction
AU - Smith, David H.
AU - Kramer, Judith M.
AU - Perrin, Nancy
AU - Platt, Richard
AU - Roblin, Douglas W.
AU - Lane, Kimberly
AU - Goodman, Michael
AU - Nelson, Winnie W.
AU - Yang, Xiuhai
AU - Soumerai, Stephen B.
PY - 2008/2/26
Y1 - 2008/2/26
N2 - Background: Although β-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 β-blocker therapy following MI. Methods: 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 β-blocker prescription after discharge. The intervention consisted of 2 mailings 2 months apart describing the importance of β-blocker use. The main outcomes were proportion of days covered with β-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. Results: 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). Conclusion: A low-cost, easily replicable effort to increase adherence can have a demonstrable impact on β-blocker adherence following MI. Trial Registration: clinicaltrials.gov Identifier: NCT00211172.
AB - Background: Although β-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 β-blocker therapy following MI. Methods: 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 β-blocker prescription after discharge. The intervention consisted of 2 mailings 2 months apart describing the importance of β-blocker use. The main outcomes were proportion of days covered with β-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. Results: 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). Conclusion: A low-cost, easily replicable effort to increase adherence can have a demonstrable impact on β-blocker adherence following MI. Trial Registration: clinicaltrials.gov Identifier: NCT00211172.
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U2 - 10.1001/archinternmed.2007.132
DO - 10.1001/archinternmed.2007.132
M3 - Article
C2 - 18332291
AN - SCOPUS:41949127115
SN - 0003-9926
VL - 168
SP - 477
EP - 483
JO - Archives of internal medicine
JF - Archives of internal medicine
IS - 5
ER -