A multi-component, family-focused and literacy-sensitive intervention to improve medication adherence in patients with heart failure-A randomized controlled trial.
Jia-Rong Wu, Barbara Mark, George J Knafl and 3 others
PMID 31182217WHAT IT FOUND
Heart failure patients and care partners who received FamLit had better measured medication adherence at 3 and 6 months than attention control, though the 80% adherence cut-off difference was not significant.
Key findings
01Patients in the FamLit group had better medication adherence than attention control at 3 months (87.6% vs 80.9%) and at 6 months (87.8% vs 74%), and the group-by-time interaction was significant (F = 5.003, p = .03).
02When adherence was dichotomized at the 80% cut-off, the FamLit group had a higher percentage adherent at 3 months (78% vs 60%, p = .21) and at 6 months (83% vs 60%, p = .11), but neither difference reached statistical significance.
03Process measures showed non-significant trends toward improvement in FamLit group patient attitudes/knowledge, care partner attitudes/knowledge, care partner perceived behavioral control, and care partner perceived support, while control showed little change, no change, or lower scores.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was small and came from one southeastern academic medical center, so the results may not apply to other settings. Only patients with an involved care partner were included, so it does not show what to do for patients without support. The electronic monitoring measured bottle-cap openings and assumed each opening meant one dose was taken; without serum drug levels, opening may not equal ingestion. The differences in the proportion of patients reaching 80% adherence were not statistically significant. The process measures were described as non-significant trends, so the proposed mechanisms were not confirmed. The authors analysed a small sample of 43 patient-care partners, though 47 were enrolled at baseline. The intervention was multi-component, including HF instruction, teach-back, coaching, role-play, barrier problem-solving, goal setting, care-partner support, and phone follow-up, so the study cannot separate the contribution of any single component.
Declared interests
No conflict-of-interest or funding-design statement is provided in the supplied text. The publication types indicate NIH extramural research support.
The easy way to misread this
Do not conclude that FamLit is proven to raise the proportion of patients reaching 80% adherence. The differences at the 80% cut-off were not statistically significant at 3 or 6 months.