Abstract
Hypothesis: Early intervention in VaMCI leads to improved management of vascular risk factors and decreased utilization of hospital resources. Methods: An individualized patient and family education session encouraging increased supervision of medication use, specifically for antiplatelets, statins, antihypertensives, diabetes medications and anticoagulants, was implemented at the time of diagnosis and continued at 6-month intervals. Medication adherence, treatment parameters and number of individuals with emergency room (ER) visits or hospital admissions were recorded in 72 consecutive patients for 12 months before and after the VaMCI diagnosis. Treatment parameters included average systolic (SBP) and diastolic (DBP) blood pressure, LDL, HgA1c and percentage of INR within therapeutic range. Non-adherence was defined as a lag of ≥3 months in refills over 12 months. Results: Improved adherence for antiplatelets (55% to 94%), statins (68% to 94%) and antihypertensives (59% to 93%; p’s <0.0001), decreases in average SBP (-8.6 mmHg, p<0.0001), DBP (-3.2 mmHg, p=0.01), LDL (-9.4, p<0.0001), and HgA1c (-0.4%, p=0.001) and increased percentage of INR within therapeutic range (+21%, p=0.001) were noted after the intervention. The number of ER visits and/or hospital admissions declined after the intervention (36 vs 20, p=0.001) with a decline in one ER visit or hospital admission for every three patients receiving the intervention. Logistic regression showed that improved adherence to antiplatelets was the only significant predictor of a decline in ER visits or hospital admissions (OR=3.0, p=0.04). Conclusions: Medication adherence counselling for VaMCl patients leads to improved treatment of risk factors and decreased utilization of hospital resources. The strongest predictor of reduced ER visits and admissions in our cohort was improved adherence to antiplatelet therapy.
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