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.
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