Effect of pharmacist discharge counselling on medication adherence in elderly heart failure patients: a pilot study

Abstract

Objectives The objectives of this study were to evaluate the effect of pharmacist discharge counselling on patient adherence to heart failure (HF) therapy among an elderly US population and assess hospital readmission rates. Methods A randomized prospective pilot study included patients 65 years or older, admitted with a new HF diagnosis or readmission for HF exacerbation. The intervention arm received HF counselling by the pharmacist, and the control group received regular discharge care provided by a nurse. Medication adherence was assessed using prescription refill history and the Morisky Medication Adherence Scale (MMAS-8) given during the phone call follow-up at days 3, 30, 60 and 90. Key findings A total of nine patients were included in the control group and seven patients in the intervention group. MMAS-8 scores increased in the intervention group and suggested higher adherence versus the control group; 7.5 versus 7.1 at day 3, 8 versus 5.5 at day 30 and 8 versus 7.6 at day 60. At day 90, MMAS-8 scores decreased in both the intervention group and control group respectively (6.5 versus 6.9). Prescription filling rates showed greater adherence in the intervention group compared with the control group at day 30 (100% versus 86%) and day 60 (100% versus 83%). There were less HF re-hospitalizations in the intervention group compared with the control group (0% versus 11%) at day 30 compared with day 60 (29% versus 11%). At day 90, no difference was found for the readmission rates between the groups. Conclusions Pharmacists providing counselling may improve medication adherence and decrease readmission rates in patients with HF in the first month after discharge. Improvement was not maintained in successive months. More frequent communication involving more than one follow-up phone call in a month may be needed to re-emphasize important counseling points.