Older adults with chronic heart failure need assistance with their medications to facilitate medication adherence and improve their health outcomes. Adherence decreases in patients who have complicated medication regimens. Recent expert guidelines for the treatment of heart failure recommend that patients receive as many as four to five medications. Furthermore, many older adults with heart failure must regularly administer and manage additional drugs for their other chronic diseases. Although medications have been shown to reduce morbidity and mortality of patients with heart failure, patients must reliably take them to derive any benefits. A particular concern in the United States is that during the past decade rates of hospitalization and death have disproportionately increased in elderly patients with heart failure. Recent studies suggest that the outcomes of patients with heart failure improve when pharmacists provide patients with education and monitoring. Drawing upon our recent studies of pharmaceutical care for patients with chronic diseases, we aim to develop and test a multileveled pharmacy-based program to improve the care of patients with heart failure. The program is built upon two models: (1) a social-cognitive model for medication adherence, and (2) a behavioral model of healthcare utilization. We have designed patient education materials and medication packaging that have been specifically formatted to promote comprehension by older adults. Using these materials, a schema for instruction for use by a pharmacist, and a computer that is integrated into an electronic medical record system, we will conduct a randomized controlled trial. Elderly patients (N=244) with heart failure will be assigned to usual care or to intervention by a pharmacist equipped with the designed educational support and integrated computer. The study duration will be 12 months: 9 months of active intervention and 3 months of post-intervention follow-up. Adherence will be assessed using electronic monitoring of all medications for heart failure. Endpoints of the trial will include health-related quality of life, heart failure exacerbation, patient satisfaction, and healthcare costs. We hypothesize that the pharmacy-based program will result in improved adherence to heart failure medications, which will be accompanied by improved health-related quality of life, fewer exacerbations of heart failure, greater satisfaction with care, and reduced health care costs.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG019105-03
Application #
6533909
Study Section
Special Emphasis Panel (ZRG1-RPHB-4 (02))
Program Officer
Stahl, Sidney M
Project Start
2000-09-30
Project End
2004-08-31
Budget Start
2002-09-01
Budget End
2003-08-31
Support Year
3
Fiscal Year
2002
Total Cost
$358,955
Indirect Cost
Name
Purdue University
Department
Other Health Professions
Type
Schools of Pharmacy
DUNS #
072051394
City
West Lafayette
State
IN
Country
United States
Zip Code
47907
Noureldin, Marwa; Plake, Kimberly S; Morrow, Daniel G et al. (2012) Effect of health literacy on drug adherence in patients with heart failure. Pharmacotherapy 32:819-26
Kim, Kye-Min; Murray, Michael D; Tu, Wanzhu et al. (2012) Pharmacogenetics and healthcare outcomes in patients with chronic heart failure. Eur J Clin Pharmacol 68:1483-91
Hansen, Richard A; Kim, Mimi M; Song, Liping et al. (2009) Comparison of methods to assess medication adherence and classify nonadherence. Ann Pharmacother 43:413-22
Hansen, Richard A; Dusetzina, Stacie B; Song, Liping et al. (2009) Depression affects adherence measurement but not the effectiveness of an adherence intervention in heart failure patients. J Am Pharm Assoc (2003) 49:760-8
Murray, M D; Tu, W; Wu, J et al. (2009) Factors associated with exacerbation of heart failure include treatment adherence and health literacy skills. Clin Pharmacol Ther 85:651-8
Murray, Michael D; Ritchey, Mary E; Wu, Jingwei et al. (2009) Effect of a pharmacist on adverse drug events and medication errors in outpatients with cardiovascular disease. Arch Intern Med 169:757-63
Murray, Michael D; Young, James; Hoke, Shawn et al. (2007) Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med 146:714-25
Morrow, Daniel G; Weiner, Michael; Steinley, Douglas et al. (2007) Patients'health literacy and experience with instructions: influence preferences for heart failure medication instructions. J Aging Health 19:575-93
Stroupe, Kevin T; Teal, Evgenia Y; Tu, Wanzhu et al. (2006) Association of refill adherence and health care use among adults with hypertension in an urban health care system. Pharmacotherapy 26:779-89
Morris, Andrew B; Li, Jingjin; Kroenke, Kurt et al. (2006) Factors associated with drug adherence and blood pressure control in patients with hypertension. Pharmacotherapy 26:483-92

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