Effect of an emergency department-based educational intervention on medication adherence and disease understanding after acute myocardial infarction in Tanzania.

INTRODUCTION: Patient adherence to evidence-based secondary preventative therapies is limited among Tanzanians with acute myocardial infarction (AMI). We evaluated the effect of an emergency department (ED)-based quality improvement intervention on disease understanding and medication use among Tanzanians with AMI. METHODS: In this pre-post study, patients with AMI symptoms were enrolled in a Tanzanian ED from September 2022 to August 2024. In September 2023, a quality improvement intervention consisting of provider training, provider reminders, and educational pamphlets for patients was implemented in the ED. Thirty days following enrollment, participants were contacted via telephone to assess medication use and understanding of diagnosis, and pre- and post-intervention outcomes were compared. The Acceptability of Intervention Measure (AIM) was administered to participants who reported reading the pamphlet at follow-up. RESULTS: Of 981 participants, 74 pre-intervention participants and 141 post-intervention participants had AMI. Post-intervention participants were more likely to report taking evidence-based therapies including antiplatelet agents (16% vs. 57%, OR 6.53, 95% CI: 2.85-16.63, p < 0.001), beta-blockers (4% vs. 40%, OR 14.56, 95% CI: 4.09-99.88, p < 0.001), and statins (8% vs. 42%, OR 7.87, 95% CI: 2.86-28.50, p < 0.001). Post-intervention participants who read the educational pamphlet (n = 22, 24%) were more likely to report understanding their treatment than post-intervention patients who did not read the pamphlet (100% vs. 74%, OR 0.00, 95% CI 0.00-0.58, p = 0.005). All participants who read the pamphlet agreed or strongly agreed with all 4 AIM items. CONCLUSION: An ED-based educational intervention in Tanzania increased adherence to evidence-based therapies and improved disease understanding among AMI patients.

Duke Scholars

Author Nathan Maclyn Thielman Medicine, Infectious Diseases

Author Gerald Bloomfield Medicine, Cardiology

Author Julian T Hertz Emergency Medicine