This article is more than 5 years old. Information may no longer be current.
Compound intervention fails to improve readmission, medication adherence after acute MI
Click Here to Manage Email Alerts
An intervention combining wireless pill bottles, lottery-based incentives and social support did not affect medication adherence or rehospitalization outcomes in patients with acute MI, researchers reported.
The researchers conducted a two-arm randomized trial with a 12-month intervention between 2013 and 2016. The trial included 1,509 patients with acute MI (mean age, 61 years; 36% women) taking at least two of the following medications: a statin, aspirin, a beta-blocker or an antiplatelet agent.
Kevin G. Volpp, MD, PhD, from the department of medical ethics and health policy, Perelman School of Medicine, University of Pennsylvania, and colleagues randomly assigned 1,003 patients to the intervention consisting of electronic pill bottles (Vitality GlowCaps), lottery incentives based on medication adherence the previous day and social support for medication adherence, and 506 patients to the usual care.
The social support component consisted of a family member or friend being notified if the electronic pill bottles were not used 2 of the 3 previous days, access to a social worker and access to a staff engagement adviser charged with monitoring, providing feedback and reinforcing adherence.
The primary outcome was time to death or first vascular rehospitalization. Secondary outcomes included time to first all-cause rehospitalization, total repeat hospitalizations, medication adherence and total medical costs.
Volpp and colleagues found no difference between the groups in the primary outcome (HR = 1.04; 95% CI, 0.71-1.52), time to first all-cause rehospitalization (HR = 0.89; 95% CI, 0.73-1.09) or total number of repeat hospitalizations (HR = 0.94; 95% CI, 0.6-1.48).
Medication adherence as assessed by proportion of days covered was similar between the control group (0.42) and the intervention group (0.46; difference, 0.04; 95% CI, –0.01 to 0.09), according to the researchers.
Mean medical costs were also not significantly different between the groups (control group, $29,811; intervention group, $24,038; difference, –$5,773; 95% CI, –13,682 to 2,137).
“The fact that this intervention had negative results is important in highlighting some of the approaches we might expect to significantly improve adherence in the context of a health plan-based intervention for patients after [acute MI],” Volpp and colleagues wrote. “Despite this intervention’s lack of success, further investigation in this area remains critical because the population value of therapeutic advances depends fundamentally on identifying ways to improve adherence to them.” – by Erik Swain
Disclosures: Volpp reports being a principal and owner of VAL Health, consulting for CVS Caremark and receiving grants from CVS Caremark, Discovery (South Africa), Hawaii Medical Services Association, Humana, Merck and Weight Watchers. Please see the full study of a list of the other researchers’ relevant financial disclosures.
Click Here to Manage Email Alerts