Approximately 30% of patients hospitalized for myocardial infarction (MI) do not take medications as prescribed 6 weeks after being discharged, thus leading to worse outcomes and higher costs, reports a new study in Circulation: Cardiovascular Quality and Outcomes. Lead author Robin Mathews, MD, a cardiologist at Duke Clinical Research Institute, says the number is “unacceptably high.”
Mathews says the findings are somewhat surprising. “Although rates were consistent with historical findings, significant changes in health care have occurred in recent years such as the availability of generic medications, the drug-benefit plan, and recent health care reforms that increase the number of patients who have access to health care coverage. While perfect adherence is not a realistic expectation, this study highlights that room for improvement exists.”
Researchers used a validated, 8-question medication adherence scale to assess modifiable factors of adherence in 7,425 patients with MI admitted to 216 hospitals across the country. “To have such detailed data through patient interviews and chart review on a large sample is unique and was a strength of our analysis,” Mathews explains.
Patients were more likely to blame financial hardship, depression, an unclear understanding of the need for medication, and intolerable adverse events as reasons for nonadherence. In comparison, patients who arranged follow-up visits prior to hospital discharge and those who received explanations from providers on specific medications were more likely to adhere to treatment than their counterparts. There was a nonstatistically significant increase in the risk of death or hospital readmission among patients who were nonadherent 2 months after being discharged.
In an effort to convince patients to take medications following MI, Mathews recommends that the hospital discharge process include an assessment of each patient’s possible obstacles to taking medications. “Once these have been identified, a patient-tailored strategy can be used to address these barriers,” he says.
In addition, it is crucial to help patients understand the importance of medications through effective education and ensure their close contact with the health care system through follow-up visits with outpatient providers.
“Ultimately, determining specific hospital and provider-level practices that positively impact short and long-term medication adherence is critical,” Mathews maintains. “Once identified, these should be disseminated as best practices in order to provide some standardization to the hospital discharge process.”