Medication Adherence
Conditions
Keywords
Myocardial Infarction, Adherence, Medication
Brief summary
Quasi-experimental, controlled interrupted time series design, evaluating the impact of the intervention at Hamilton Health Sciences (HHS) where standardized prescriptions and education will be provided and St Joseph's Hospital (SJH) and Niagara Health Services (NHS) where education alone will be provided, with remaining Ontario cardiac sites as a concurrent control group.
Detailed description
The overarching goal of this study is to reduce the morbidity and mortality of post-MI patients through improved long-term cardiac medication adherence. The specific objectives include: 1. Assess the impact on long-term cardiac medication adherence following the implementation of a standardized increase in discharge prescription length to 90-days with 3 repeats in post-MI patients as compared to education alone and usual care; 2. Assess the cost implications of the intervention as compared to usual care; 3. Compare clinical outcomes between longer (\>60 days) versus shorter prescription durations; 4. Collect baseline information to inform a multi-centre interventional study (i.e., simple monthly proportions of 1-year adherence by hospitals in Ontario). Intervention:1. Policy Change implementing a standardized discharge prescription form available on all wards where MI patients are managed at HHS that includes a 90-day supply with 3 repeats for all cardiac medications, and education alone provided at SJH and NHS 2. Educational materials will be disseminated to all involved health care providers (e.g., physicians, residents, nurses) at the start of the intervention period to ensure the new discharge prescriptions are understood and used. Furthermore, extensive outreach to community pharmacies in LHIN IV will be undertaken with help from Ontario Pharmacists' Association (OPA) and Ontario Pharmacy Evidence Network (OPEN). 3\. Education (e.g., emails, mail-outs, site visits) will recur every 3-4 months during the intervention period. Furthermore, monthly monitoring will ensure standardized prescription forms and point of care reminders are implemented at all intervention sites. The intervention group will be exposed to this intervention post-MI and include all eligible patients at HHS/SJH/NHS in the 6-months post-intervention implementation.
Interventions
OTHER90 Day Supply
Policy Change implementing a 90 day standardized discharge prescription form with 3 repeats for all cardiac medications available on all wards where MI patients are managed at Hamilton Health Sciences sites
BEHAVIORALEducation
Education Alone provided at St. Joseph's Hospital and Niagara Health System
Sponsors
Population Health Research Institute
Institute for Clinical Evaluative Sciences
Hamilton Health Sciences Corporation
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Use of Ontario Drug Benefits (ODB-Age \>65 years, social assistance, and disability); * Cardiac catheterization during an index admission with an MI; * Evidence of obstructive coronary artery disease; * Discharged alive * Ontario Residents (Ontario, Canada)
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Patients with High Adherence | One year | Increased proportion of patients with high adherence (proportion of days covered (PDC) \>80%) for the combined four cardiac medications classes at one year |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Difference in adherence of medication classes | One year | Difference in proportion with high adherence (mean PDC \>80%) to the individual cardiac medication classes |
| Difference in combined and individual medications as measured by Proportion of Days Covered (PDC) | One year | Difference in mean of Proportion of Days Covered (PDC \>80%) of the combined cardiac medications as compared to PDC of individual cardiac medications classes as collected by Ontario Drug Benefits usage and reported to the Institute of Clinical Evaluative Sciences (ICES). |
| Discharge Prescription Length | One year | Difference in discharge prescription length (\<90 days and ≥90 days) |
| Clinical outcomes as measured by number of participants who experience death, myocardial infarction, coronary revascularization, and hospital readmission | One year | Difference in proportion of participants experiencing death, myocardial infarction, coronary revascularization and hospital readmission at one year at each interventional site compared to control sites, as reported by Cardiac Care Network and analyzed by ICES. |
| Cost implications | One year | Cost implications of interventions of each arm |
Countries
Canada
Outcome results
None listed