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A Randomized Trial of Direct-to-Patient Communication to Enhance Adherence to β-Blocker Therapy Following Myocardial Infarction
David H. Smith, RPh, PhD;
Judith M. Kramer, MD, MS;
Nancy Perrin, PhD;
Richard Platt, MD, MS;
Douglas W. Roblin, PhD;
Kimberly Lane, MPH;
Michael Goodman, PhD;
Winnie W. Nelson, PharmD, MS;
Xiuhai Yang, MS;
Stephen B. Soumerai, ScD
Arch Intern Med. 2008;168(5):477-483.
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
Author Affiliations: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Drs Smith, Perrin, and Goodman and Mr Yang); HMO Research Network's Center for Education and Research on Therapeutics (CERTs), Boston, Massachusetts (Drs Smith, Perrin, Platt, Roblin, Goodman, Nelson, and Soumerai, Ms Lane, and Mr Yang); Duke Center for Education and Research on Therapeutics, Durham, North Carolina (Dr Kramer); Department of Ambulatory Care and Prevention, School of Nursing, Oregon Health and Sciences University, Portland (Dr Perrin); Department of Ambulatory Care and Prevention, Harvard Medical School, and Harvard Pilgrim Health Care, Boston, Massachusetts (Drs Platt and Soumerai and Ms Lane); Health Partners Research Foundation, Minneapolis, Minnesota (Drs Goodman and Nelson); and Kaiser Permanente, Atlanta, Georgia (Dr Roblin).
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A Randomized Trial of Direct-to-Patient Communication to Enhance Adherence to β-Blocker Therapy Following Myocardial Infarction—Invited Commentary
Edward P. Havranek
Arch Intern Med. 2008;168(5):483.
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An Intervention to Improve Post-MI Patient Adherence to Beta-Blockers
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