Impact of a clinical pharmacy intervention on medication adherence and the quality use of medicines in patients with acute coronary syndrome: a single centre nonrandomised controlled clinical trial.

Abstract

Background: Acute coronary syndrome is a major global disease burden with high morbidity and mortality. This study aims to assess the impact of clinical pharmacy interventions on improving the quality use of medicines and drug-related problems in acute coronary syndrome patients.

Methods: An open, prospective, controlled, nonrandomised clinical trial was conducted at the Teaching Hospital, Peradeniya, Sri Lanka. Consenting patients were recruited and divided into control and intervention groups. Medication history, medication adherence and drug-related problems were assessed. The intervention group received clinical pharmacy interventions for six months. Improvements in medication adherence, discharge medication appropriateness, reduction of hospital readmissions for six months, and responses from the healthcare team's awareness and perception on clinical pharmacy services were recorded.

Results: Both groups (control - 180 patients, intervention - 185 patients) showed poor medication adherence at baseline. Medication adherence improved significantly after 6-months post-discharge in the intervention group compared to the control group (49.3% vs 18.8%). The clinical pharmacists successfully identified drug-related problems and provided suggestions for resolving them. The treating team accepted the majority (60%) of these suggestions. Discharge medication appropriateness in the intervention group was significantly higher compared to the control group. There was no significant difference in hospital readmissions related to cardiovascular disorders between the groups. Most doctors and nurses were aware of clinical pharmacists but none of them had previously worked with one.

Conclusion: Clinical pharmacist-led interventions significantly improved medication adherence and appropriateness, underscoring the added value of clinical pharmacists in a multidisciplinary healthcare team. While most doctors and nurses were aware of clinical pharmacists, none of them had prior experience working with them, emphasising an opportunity to foster greater multidisciplinary integration for improved health outcomes. Overall findings highlight the potential role of clinical pharmacists in enhancing good patient outcomes and improving real-world patient care.