Article Text

Download PDFPDF

Original research article
Re-engineering the post-myocardial infarction medicines optimisation pathway: a retrospective analysis of a joint consultant pharmacist and cardiologist clinic model
  1. Rani Khatib1,2,3,
  2. Nasrin Patel1,2,
  3. Una Laverty1,
  4. Gina Mcgawley2,
  5. Jim McLenachan2,
  6. Sarah Shield4 and
  7. Alistair S Hall2,3
  1. 1 Medicines Management & Pharmacy Services, Leeds Teaching Hospital NHS Trust, Leeds, UK
  2. 2 Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3 Leeds Institute of Cardiovascular and Metabolic Medicine, Universityof Leeds, Leeds, UK
  4. 4 NHS Relations, AstraZeneca, Horizon Place, Capability Green, Luton, UK
  1. Correspondence to Dr Rani Khatib; r.khatib{at}leeds.ac.uk

Abstract

Background Inadequate medicines optimisation and adherence are significant problems among patients taking secondary prevention medications following myocardial infarction (MI). A novel joint consultant cardiology pharmacist and cardiologist medicines optimisation clinic was initiated for patients recently discharged following MI.

Methods Patients completed a locally developed tool, the ‘My Experience of Taking Medicines’ questionnaire, designed to allow sharing of barriers to adherence with medications. They then attended a clinic with the consultant pharmacist or cardiologist (or both). Secondary prevention medicines needs and barriers to adherence were identified and discussed, and an action plan developed. The data provided are from a retrospective review of 270 post-MI patients attending the service between October 2015 and December 2016.

Results Mean age was 67.3 years and 67.8% were male. The mean time from discharge to first outpatient clinic attendance was reduced by 56.1% (49.4 days vs 88 days before the service began). More than 95% of patient without planned non-pharmacological intervention postdischarge did not need a cardiologist’s input. Levels of medicines optimisation were improved substantially after attendance: patients receiving a recommended angiotensin-converting enzyme inhibitor/angiotensin receptor blocker dose increased from 16.3% to 73.9% (p<0.001); patients receiving a recommended beta-blocker dose increased from 6.2% to 46.1% (p<0.001). Patient concerns about their medications were significantly decreased (all p<0.001). Rates of non-adherence fell by 42.6%–70.8% at 3–6 months post-clinic. Readmission rates also declined after the service opened.

Conclusions A medicines optimisation and patient adherence strategy based on a joint consultant cardiology pharmacist and cardiologist clinic can improve both adherence and outcomes post-MI.

  • cardiovascular diseases
  • patient adherence
  • shared decision making
  • myocardial infarction
  • secondary prevention
  • medicines adherence

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors The project was led by RK with the support of the steering committee, which included all of the co-authors. The clinics were conducted in parallel with AH and JML. Data were collected with the help of NP. All planning and findings were presented to and discussed by the authors. The manuscript was drafted by the lead author and reviewed and adjusted based on suggestions from all of the co-authors. All authors gave final approval and agreed to be accountable for all aspects of the work. All revision were made by the lead author and co-authors reviewed and commented were appropriate.

  • Funding Funding for the proof-of-concept phase of the service was partly funded by Astra Zeneca, within a joint working agreement. The success of this phase led to the service to be fully commissioned by the Leeds Clinical Commissioning Groups and became the new standard service offered for our patients with myocardial infarction.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The full data can be obtained by contacting the corresponding author.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.