A randomized trial of direct-to-patient communication to enhance adherence to beta-blocker therapy following myocardial infarction.

Published

Journal Article

BACKGROUND: 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. 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 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. 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 beta-blocker adherence following MI. Trial Registration clinicaltrials.gov Identifier: NCT00211172.

Full Text

Duke Authors

Cited Authors

  • Smith, DH; Kramer, JM; Perrin, N; Platt, R; Roblin, DW; Lane, K; Goodman, M; Nelson, WW; Yang, X; Soumerai, SB

Published Date

  • March 2008

Published In

Volume / Issue

  • 168 / 5

Start / End Page

  • 477 - 447

PubMed ID

  • 18332291

Pubmed Central ID

  • 18332291

Electronic International Standard Serial Number (EISSN)

  • 1538-3679

International Standard Serial Number (ISSN)

  • 0003-9926

Digital Object Identifier (DOI)

  • 10.1001/archinternmed.2007.132

Language

  • eng