Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure**

https://doi.org/10.1016/S0002-9343(96)00172-6Get rights and content

purpose

The objectives of this investigation were to prospectively assess medication compliance rates in elderly patients with congestive heart failure, to identify factors associated with reduced compliance, and to evaluate the effect of a multidisciplinary treatment approach on medication adherence. patients and methods: A total of 156 patients ≥70 years of age (mean, 79.4 ± 6.0; 67% female, 65% nonwhite) hospitalized with congestive heart failure were evaluated prospectively. Prior to discharge, patients were randomized to the study intervention (n = 80) or conventional care (n = 76). The intervention consisted of comprehensive patient education, dietary and social service consultations, medication review, and intensive postdischarge follow-up. Detailed data were collected on all prescribed medications at the time of discharge, and compliance was assessed by pill counts 30 ± 2 days later.

results

The overall compliance rate during the first 30 days after discharge was 84.6 ± 15.1% (range, 23.1–100%). Compliance was 87.9 ± 12.0% in patients randomized to the study intervention, compared with 81.1 ± 17.2% in the control group (P = 0.003). A compliance rate of ≥80% was achieved by 85.0% of the treatment group versus 69.7% of the control group (P = 0.036). By multivariate analysis, assignment to the treatment group was the strongest independent predictor of compliance (P = 0.008). Other variables included in the model were Caucasian race (P = 0.044) and not living alone (P = 0.09). conclusions: A multidisciplinary treatment strategy is associated with improved medication compliance during the first 30 days following hospital discharge in elderly patients with congestive heart failure. Improved compliance may contribute to improved outcomes in these patients.

References (25)

  • GravesEJ
  • GoodingJ et al.

    Hospital readmissions among the elderly

    J Am Geriatr Soc.

    (1985)
  • RichMW et al.

    Effect of DRGs on three-month readmission rate of geriatric patients with congestive heart failure

    Am J Pub Health.

    (1988)
  • VinsonJM et al.

    Early readmission of elderly patients with congestive heart failure

    J Am Geriatr Soc.

    (1990)
  • ColleyC et al.

    Polypharmacy: the cure becomes the disease

    J Gen Intern Med.

    (1993)
  • GhaliJK et al.

    Precipitating factors leading to decompensation of heart failure. Traits among urban blacks

    Arch Intern Med.

    (1988)
  • RichMW et al.

    A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure

    NEJM

    (1995)
  • RichMW et al.

    Prevention of readmission in elderly patients with congestive heart failure: results of a prospective, randomized pilot study

    J Gen Intern Med.

    (1993)
  • MonaneM et al.

    Noncompliance with congestive heart failure therapy in the elderly

    Arch Intern Med.

    (1994)
  • GermanP et al.

    Medication and the elderly: issues of prescription and use

    J Ageing Health

    (1989)
  • CargillJ

    Medication compliance in elderly people: influencing variables and interventions

    J Adv Nurs.

    (1992)
  • CoonsS et al.

    Predictors of medication noncompliance in a sample of older adults

    Clin Ther.

    (1994)
  • Cited by (0)

    **

    Supported by grant no. R29 HL44739 from the National Heart, Lung, and Blood Institute.

    View full text