{"title":"Pharmacist-Led Management Model and Medication Adherence Among Patients With Chronic Heart Failure: A Randomized Clinical Trial.","authors":"Lingjiao Wang, Yuanyuan Zhao, Liping Han, Huan Zhang, Hejun Chen, Aixia Liu, Jing Yu, Ran Fu, Liguang Duan, Feiyue An, Zhimin Guo, Yang Lun, Chaoli Chen, Fangfang Cheng, Chaohui Song, Haixia Gao, Chunhua Zhou","doi":"10.1001/jamanetworkopen.2024.53976","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>Poor medication adherence is associated with high morbidity and mortality among patients with chronic heart failure (CHF), which is particularly concerning in China.</p><p><strong>Objective: </strong>To assess the effect of a pharmacist-led management model incorporating a social media platform vs usual care on medication adherence in patients with CHF.</p><p><strong>Design, setting, and participants: </strong>This prospective, multicenter randomized clinical trial was conducted from March 2021 to May 2023, with a follow-up duration of 52 weeks. The trial was conducted in the cardiology wards of 5 hospitals in China. Participants were 18 years or older, had a CHF diagnosis, and were receiving stable medication. They were randomly assigned to either the intervention group (pharmacist-led management) or the control group (usual care) in a 1:1 ratio using a computer-generated random number table with concealed allocation via opaque envelopes. Intention-to-treat data analysis was performed from June 2023 to July 2024.</p><p><strong>Intervention: </strong>The intervention group received a multimodal pharmaceutical intervention, including WeChat application-based communication and education, and a standardized follow-up visit from a pharmacist every month. The control group received the standardized follow-up visit from nurses every month.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the proportion of days covered (PDC) by heart failure medication at 52 weeks.</p><p><strong>Results: </strong>Among the 445 participants analyzed, 223 were assigned to the intervention group and 222 to the control group. These patients had a mean (SD) age of 63.2 (13.3) years and included 263 males (59.1%). A total of 333 patients (74.8%) had a New York Heart Association class III or IV heart failure, indicating severe limitations in physical activity. At 52 weeks, the intervention group had a significantly higher PDC for heart failure medication (8.1%; 95% CI, 5.5%-10.7%; P < .001) and a greater proportion of patients with PDC of 80% or greater (odds ratio, 0.34; 95% CI, 0.21-0.54; P < .001) compared with the control group.</p><p><strong>Conclusions and relevance: </strong>This randomized clinical trial found a modest improvement in medication adherence among patients with CHF who received the pharmacist-led management intervention vs usual care.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry Identifier: ChiCTR2000040232.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2453976"},"PeriodicalIF":10.5000,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA Network Open","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamanetworkopen.2024.53976","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Importance: Poor medication adherence is associated with high morbidity and mortality among patients with chronic heart failure (CHF), which is particularly concerning in China.
Objective: To assess the effect of a pharmacist-led management model incorporating a social media platform vs usual care on medication adherence in patients with CHF.
Design, setting, and participants: This prospective, multicenter randomized clinical trial was conducted from March 2021 to May 2023, with a follow-up duration of 52 weeks. The trial was conducted in the cardiology wards of 5 hospitals in China. Participants were 18 years or older, had a CHF diagnosis, and were receiving stable medication. They were randomly assigned to either the intervention group (pharmacist-led management) or the control group (usual care) in a 1:1 ratio using a computer-generated random number table with concealed allocation via opaque envelopes. Intention-to-treat data analysis was performed from June 2023 to July 2024.
Intervention: The intervention group received a multimodal pharmaceutical intervention, including WeChat application-based communication and education, and a standardized follow-up visit from a pharmacist every month. The control group received the standardized follow-up visit from nurses every month.
Main outcomes and measures: The primary outcome was the proportion of days covered (PDC) by heart failure medication at 52 weeks.
Results: Among the 445 participants analyzed, 223 were assigned to the intervention group and 222 to the control group. These patients had a mean (SD) age of 63.2 (13.3) years and included 263 males (59.1%). A total of 333 patients (74.8%) had a New York Heart Association class III or IV heart failure, indicating severe limitations in physical activity. At 52 weeks, the intervention group had a significantly higher PDC for heart failure medication (8.1%; 95% CI, 5.5%-10.7%; P < .001) and a greater proportion of patients with PDC of 80% or greater (odds ratio, 0.34; 95% CI, 0.21-0.54; P < .001) compared with the control group.
Conclusions and relevance: This randomized clinical trial found a modest improvement in medication adherence among patients with CHF who received the pharmacist-led management intervention vs usual care.
Trial registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000040232.
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