Begeleiding verbetert therapietrouw: Apotheker stimuleert correct gebruik lisdiuretica bij patiënten met hartfalen

Abstract

Objective. To determine the effect of a pharmacist-led intervention on medication compliance in patients with heart failure. Design. Randomised controlled trial. Setting. 7 hospitals and 79 pharmacies in The Netherlands. Participants. Patients with heart failure (predominantly NYHA II and III) treated with loop diuretics, presenting to a cardiology outpatient clinic or admitted to hospital. Intervention. Patients in the intervention group received monthly consultations from their community pharmacist during a 6-month period. Patients in the control group received usual care. Main outcome measures. Primary endpoint was medication compliance, assessed with a Medication Event Monitoring System (MEMS®), an electronic pill bottle that registers time of opening. Secondary endpoints were the number of re-hospitalisations and mortality. Results. 152 patients were randomised: 74 patients to the intervention group and 78 patients to the usual care group. Over the 6-month study period, patients in the intervention group had 140/7656 days without use of loop diuretics compared to 337/6196 days in the usual care group (relative risk 0,33 [CI 95% 0.24-0.38]). Two consecutive days of non-dosing occurred on 18/7656 days in the intervention group compared to 46/6196 days in the usual care group (relative risk 0,32 [CI 95% 0.19-0.55]). There were no significant differences in re-hospitalisations and mortality. Conclusion. A pharmacy-led intervention can improve medication compliance in patients with moderate to severe heart failure, even in those with relatively high compliance. Future interventions should also focus at less compliant patients.