Improving adherence with lipid-lowering agents

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.075

Gissette Soffer MD, Susan Renz PhD, Lau Yan Yung DNP

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引用次数: 0

Abstract

Background/Synopsis

Atherosclerotic cardiovascular disease (ASCVD) remains a major cause of death and disability, particularly in patients with hypercholesterolemia who require lipid-lowering agents to reduce ASCVD risk. However, non-adherence to lipid-lowering drugs can diminish the benefits of medications and increase cardiovascular risk.

Objective/Purpose

To determine whether sending medication adherence reminders through the patient portal and incorporating education for patients with hypercholesterolemia can improve medication adherence.

Methods

The project enrolled new patients referred to the clinic with hypercholesterolemia who required lipid-lowering agents for ASCVD risk reduction. Participants were required to have the patient portal installed and manage the patient's portal apps independently. The eligible participants for the project were English-speaking, aged > 18 years, and never on lipid-lowering medications or added new lipid-lowering agents to achieve the therapeutic goal. The interventions included sending weekly medication adherence reminders through the patient portal and incorporating education on medication adherence during the initial visit. All participants were asked to complete the Medication Adherence Report Scale-5 (MARS-5) questionnaire during their initial and post-treatment visits. Lipid profiles are the standard of care for monitoring medication responses. Additional data: Patient self-report of medication adherence, patient review message report from Epic, and participants' show-up rate in the post-treatment follow-up at 6 weeks as additional data to measure medication adherence.

Results

Eight participants were enrolled in the project. Data were analyzed using the Wilcoxon signed-rank test to compare pre-and post-LDL-C, Triglycerides, and MARS-5. A statistically significant comparison of pre-and post-intervention for LDL-C was found p =0.012, z = -2.52. The comparison of pre- and post-intervention triglyceride levels was p =0 .484, z = -0.70. The comparison of the pre-and post-intervention MARS-5 scores for medication adherence was p =0.11, z = 1.60. The patient self-reported adherence rate was 97%, the patient message review rate was 70%, and post-treatment follow-up at 6 weeks was 100%.

Conclusions

This project demonstrated improved medication adherence based on self-reported adherence, LDL-C reduction, and high MARS-5 scores. The participants’ feedback also indicated that education on medication adherence improved their awareness of disease prevention. The project was unable to show that sending messages of medication adherence reminders via Epic to the patient portal was associated with improved medication adherence; however, patient portals have demonstrated improved patient engagement and outcomes. The post-treatment follow-up rate in this study was 100%. Future studies should target patients with medication adherence problems using a short MARS-5 questionnaire as a screening tool to identify patients with medication nonadherence before enrolling in the project. This project was used as a cost-effective intervention for sending medication adherence reminders to the patient portal, which can be implemented in any outpatient clinic for patients with chronic diseases to improve their medication adherence. Future interventions should focus on long-term clinical outcomes of medication adherence, such as heart attacks/strokes, which are highly associated with adherence to lipid-lowering agents may be warranted.

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提高对降脂药物的依从性

背景/简介动脉粥样硬化性心血管疾病（ASCVD）仍然是导致死亡和残疾的主要原因，特别是对于需要降脂药物来降低ASCVD风险的高胆固醇血症患者。然而，不坚持使用降脂药物会减少药物的益处，增加心血管风险。目的/目的探讨通过患者门户发送药物依从性提醒并结合教育是否能提高高胆固醇血症患者的药物依从性。方法该项目招募了新就诊的高胆固醇血症患者，这些患者需要降脂药物来降低ASCVD风险。参与者需要安装患者门户并独立管理患者门户应用程序。这个项目的合格参与者是会说英语的、年龄较大的；18年来，从未服用降脂药物或添加新的降脂剂来达到治疗目的。干预措施包括每周通过患者门户发送药物依从性提醒，并在初次就诊期间纳入药物依从性教育。所有参与者被要求在他们最初和治疗后的访问期间完成药物依从性报告量表-5 （MARS-5）问卷调查。脂质谱是监测药物反应的标准。附加数据：患者服药依从性自我报告、Epic患者评价信息报告和参与者在治疗后随访6周的出勤率作为测量服药依从性的附加数据。结果共纳入8名受试者。数据分析使用Wilcoxon符号秩检验比较前后ldl - c、甘油三酯和MARS-5。干预前后LDL-C比较p =0.012, z = -2.52，差异有统计学意义。干预前后甘油三酯水平比较p = 0.484, z = -0.70。干预前后患者服药依从性MARS-5评分比较p =0.11, z = 1.60。患者自我报告依从率为97%，患者信息回顾率为70%，治疗后6周随访率为100%。结论：基于自我报告的依从性、LDL-C降低和较高的MARS-5评分，该项目证明了改善的药物依从性。参与者的反馈还表明，关于药物依从性的教育提高了他们的疾病预防意识。该项目无法证明通过Epic向患者门户网站发送药物依从性提醒信息与改善药物依从性有关；然而，患者门户网站已经证明改善了患者的参与和结果。本研究治疗后随访率为100%。未来的研究应该针对有药物依从性问题的患者，使用简短的MARS-5问卷作为筛选工具，在入选项目之前识别药物不依从性患者。本项目作为一种具有成本效益的干预措施，向患者门户发送药物依从性提醒，可在任何慢性病患者门诊实施，以提高患者的药物依从性。未来的干预措施应侧重于药物依从性的长期临床结果，如心脏病发作/中风，这与坚持使用降脂药物高度相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.