Joseph E Dunsmoor, Gregory L Murphy
Categories, concepts, and conditioning: how humans generalize fear
Trends in cognitive sciences
patients heart failure take several prescription medications sometimes poor adherence treatment regimens interventions designed improve adherence therapy rigorously testedto determine whether pharmacist intervention improves medication adherence health outcomes compared usual care lowincome patients heart failurerandomized controlled trial conducted february 2001 june 2004universityaffiliated innercity ambulatory care practice314 lowincome patients 50 years age older heart failure confirmed primary care physicianpatients randomly assigned intervention 39 n 122 usual care 61 n 192 groups followed 12 months pharmacist provided 9month multilevel intervention 3month poststudy phase interdisciplinary team investigators designed intervention support medication management patients low health literacy limited resourcesprimary outcomes adherence measured using electronic prescription monitors exacerbations requiring emergency department care hospital admission secondary outcomes included healthrelated quality life patient satisfaction pharmacy services total direct costsduring 9month intervention period medication adherence 679 788 usual care intervention groups respectively difference 109 percentage points 95 ci 50 167 percentage points however salutary effects dissipated 3month postintervention followup period adherence 667 706 respectively difference 39 percentage points ci 59 65 percentage points medications taken schedule 472 time usual care group 531 time intervention group difference 59 percentage points ci 04 115 percentage points effect also dissipated end intervention 489 vs 486 respectively difference 03 percentage point ci 59 65 percentage points emergency department visits hospital admissions 194 less incidence rate ratio 082 ci 073 093 annual direct health care costs lower 2960 ci 7603 1338 intervention groupbecause electronic monitors used ascertain adherence patients permitted use medication container adherence aids intervention involved 1 pharmacist single study site served large indigent innercity population patients intervention several components intervention effects could attributed single componenta pharmacist intervention outpatients heart failure improve adherence cardiovascular medications decrease health care use costs benefit probably requires constant intervention effect dissipates intervention ceases clinicaltrialsgov registration number nct00388622