Improving Adherence to Cardiovascular Medications
Medication adherence is a growing concern to healthcare providers and stakeholders (i.e., payers) because of the mounting evidence that non-adherence is prevalent and associated with adverse outcomes and higher costs of care. The measurement of medication adherence and use of interventions to improve adherence are rare in routine clinical practice, thus medication adherence has been called "the next frontier in quality improvement," and is an important part of cardiovascular outcomes research. This article focuses on cardiovascular medication adherence and discusses studies that address: 1) different methods of measuring adherence, 2) prevalence of non-adherence, 3) association between non-adherence and outcomes, 4) reasons for non-adherence, and 5) interventions to improve medication adherence.
Findings show that while there are many different methods for assessing medication adherence, non-adherence to cardiovascular medications is common and associated with adverse outcomes. For example, one study found that following hospitalization for acute myocardial infarction (AMI), nearly 25% of patients had not filled their cardiac medications seven days after hospital discharge. Another study found that medication non-adherence was strongly associated with adverse cardiac events, including death from cardiac heart disease, MI, and stroke. The authors also found that non-adherence is not solely a patient problem but is impacted by both providers and the healthcare system. One study showed that less than 50% of patients were able to list all of their medications and fewer understood their purpose, suggesting that system factors like the educational process at hospital discharge can impact medication adherence.
To date, interventions targeting medication adherence have produced only modest success. Multi-modal interventions have shown the most promise in improving adherence, but require the clinical personnel to manage and coordinate multiple intervention components. Integrated health systems like VA may be able to implement these interventions more easily than other healthcare systems.
Ho P, Bryson C, and Rumsfeld J. Medication adherence: Its importance in cardiovascular outcomes. Circulation June 16, 2009;119(23):3028-35.
Drs. Ho and Bryson are supported by HSR&D Career Development Awards. All authors are part of VA/HSR&D's Ischemic Heart Disease Quality Enhancement Research Initiative (IHD-QUERI).