Abstract
BackgroundDespite continual improvements in the management of acute coronary syndromes, adherence to guideline-based medications remains suboptimal. We aim to improve adherence with guideline-based therapy following acute coronary syndrome using an existing service that is provided by specifically trained pharmacists, called a Home Medicines Review. We have made two minor adjustments to target the focus of the existing service including an acute coronary syndrome specific referral letter and a training package for the pharmacists providing the service.Methods/DesignWe will be conducting a randomized controlled trial to compare the directed home medicines review service to usual care following acute coronary syndromes. All patients aged 18 to 80 years and with a working diagnosis of acute coronary syndrome, who are admitted to two public, acute care hospitals, will be screened for enrolment into the trial. Exclusion criteria will include: not being discharged home, documented cognitive decline, non-Medicare eligibility, and presence of a terminal malignancy. Randomization concealment and sequence generation will occur through a centrally-monitored computer program. Patients randomized to the control group will receive usual post-discharge care. Patients randomized to receive the intervention will be offered usual post-discharge care and a directed home medicines review at two months post-discharge. The study endpoints will be six and twelve months post-discharge. The primary outcome will be the proportion of patients who are adherent to a complete, guideline-based medication regimen. Secondary outcomes will include hospital readmission rates, length of hospital stays, changes in quality of life, smoking cessation rates, cardiac rehabilitation completion rates, and mortality.DiscussionAs the trial is closely based on an existing service, any improvements observed should be highly translatable into regular practice. Possible limitations to the success of the trial intervention include general practitioner approval of the intervention, general practitioner acceptance of pharmacists' recommendations, and pharmacists' ability to make appropriate recommendations. A detailed monitoring process will detect any barriers to the success of the trial. Given that poor medication persistence following acute coronary syndrome is a worldwide problem, the findings of our study may have international implications for the care of this patient group.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12611000452998
Highlights
Despite continual improvements in the management of acute coronary syndromes, adherence to guideline-based medications remains suboptimal
As the trial is closely based on an existing service, any improvements observed should be highly translatable into regular practice
This trial aims to achieve this outcome using an intervention that is based on only minor adjustments to a currently existing and funded service, such that any success derived from this trial may be translated into regular practice
Summary
Despite continual improvements in the management of acute coronary syndromes, adherence to guideline-based medications remains suboptimal. We aim to improve adherence with guideline-based therapy following acute coronary syndrome using an existing service that is provided by trained pharmacists, called a Home Medicines Review. We have made two minor adjustments to target the focus of the existing service including an acute coronary syndrome specific referral letter and a training package for the pharmacists providing the service. Optimal medication management is critical to improving outcomes following acute coronary syndrome (ACS), yet prescribing practices and patient behaviors often fall below recognized targets [1,2,3]. Research demonstrates that the prescribing of guideline-based medications following ACS, including antithrombotics, beta-blockers, angiotensin-converting enzyme inhibitors, and statins, has improved over recent years [4] but is not yet ideal [3]. Much of the focus on improving patient outcomes following ACS has centered on the acute phase of care, it is crucial that more attention is paid to the development of new, post-discharge strategies to improve outcomes following hospital discharge
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