Improving Post-Discharge Medication Adherence in Patients with CVD: A Pilot Randomized Trial / Otimização da Adesão Terapêutica Pós-alta Hospitalar de Pacientes com DCV: Ensaio Clínico Randomizado - Estudo Piloto

Background: Effective interventions to improve medication adherence are usually complex and expensive. Objective: To assess the impact of a low-cost intervention designed to improve medication adherence and clinical outcomes in post-discharge patients with CVD. Method: A pilot RCT was conducted at a teaching hospital. Intervention was based on the four-item Morisky Medication Adherence Scale (MMAS-4). The primary outcome measure was medication adherence assessed using the eight-item MMAS at baseline, at 1 month post hospital discharge and re-assessed 1 year after hospital discharge. Other outcomes included readmission and mortality rates. Results: 61 patients were randomized to intervention (n = 30) and control (n = 31) groups. The mean age of the patients was 61 years (SD 12.73), 52.5% were males, and 57.4% were married or living with a partner. Mean number of prescribed medications per patient was 4.5 (SD 3.3). Medication adherence was correlated to intervention (p = 0.04) and after 1 month, 48.4% of patients in the control group and 83.3% in the intervention group were considered adherent. However, this difference decreased after 1 year, when adherence was 34.8% and 60.9%, respectively. Readmission and mortality rates were related to low adherence in both groups. Conclusion: The intervention based on a validated patient self-report instrument for assessing adherence is a potentially effective method to improve adherent behavior and can be successfully used as a tool to guide adherence counseling in the clinical visit. However, a larger study is required to assess the real impact of intervention on these outcomes. .

Fundamento: Intervenções eficazes para melhorar a adesão à terapia medicamentosa são geralmente complexas e caras. Objetivo: Avaliar o impacto de uma intervenção de baixo custo delineada para melhorar a adesão à medicação e desfechos clínicos em pacientes no pós-alta com DCV. Método: Um ECR - estudo piloto foi realizado em um hospital-escola. A intervenção foi baseada na escala de adesão terapêutica de Morisky de quatro itens - MMAS-4. O desfecho primário medido foi a avaliação da adesão à medicação utilizando a MMAS de oito itens no momento da alta, 1 mês após a alta hospitalar, e a reavaliação 1 ano depois da alta. Outros resultados incluíram reinternação e as taxas de mortalidade. Resultados: Foram randomizados 61 pacientes para grupos de intervenção (n = 30) e controle (n = 31). A idade média dos pacientes foi de 61 anos (DP 12,73), 52,5% eram do sexo masculino e 57,4% eram casados ou moravam com parceiro (a). O número médio de medicamentos prescritos por paciente foi de 4,5 (DP 3,3). A adesão à medicação foi correlacionada à intervenção (p = 0,04) e após 1 mês, 48,4% dos pacientes do grupo controle e 83,3% no grupo de intervenção foram considerados aderentes. No entanto, essa diferença diminuiu depois de 1 ano, quando a adesão foi de 34,8% e 60,9%, respectivamente. As taxas de readmissão e de mortalidade foram relacionadas à baixa adesão nos dois grupos. Conclusão: A intervenção com base em um instrumento validado de auto-relato do paciente para avaliar a adesão é um método potencialmente eficaz para melhorar o comportamento aderente e pode ser usado com sucesso como uma ferramenta para orientar o aconselhamento da adesão na visita ...

What do Brazilian community pharmacists know about self-medication for minor illnesses: A pilot study in the northeast of Brazil.

The benefits of self-medication are undeniable and include a decrease in the number of medical visits. In this work, among other objectives, it sought to describe the knowledge of a group of community pharmacists about minor illness and self-medication. This study was quantitative and qualitative, and took place between June and August 2012 in two groups of chain community pharmacies. All community pharmacists were interviewed faceto- face. Thirty-five community pharmacist completed the interview. Eighty-eight percent of the respondents were women and were aged above 25 years. A total of 88.8% said that they knew the definition of minor illness. Pharmacists that having studied management of minor illness as an undergraduate from private universities had more exposure to minor illness manager subject (p = 0.0043). Regarding the definition of minor illness, pharmacists cited specific parameters, such as duration of disease, and treatment or possible pharmacist intervention for symptoms, which showed a way to distinguish a minor symptom from a chronic disease. Pharmacists included detailed comments on particular aspects of the self-medication practice or highlighted medicine-specific characteristics. Findings indicated that community pharmacists have poor knowledge about minor illness that could explain the passive attitudes towards self-medication.