Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC)
|ClinicalTrials.gov Identifier: NCT02102503|
Recruitment Status : Active, not recruiting
First Posted : April 3, 2014
Last Update Posted : December 21, 2017
Low medication adherence in patients with coronary heart disease increases mortality.
This study investigates if an intervention of medication review and counselling can improve patients' medication adherence and treatment results.
|Condition or disease||Intervention/treatment|
|Coronary Heart Disease||Behavioral: Standard Treatment Behavioral: MI and Medication review|
The study will investigate the effects of medication review and Motivational Interviewing (MI) on patients with Coronary Heart Disease (CHD). Clinical pharmacists competent in MI and cardiology will conduct medication interviews and medication reviews at the outpatient clinic. The intervention will continue during 9 months, with interviews and reviews as needed.
Follow-up of results will take place 16 months after inclusion (corresponding to 4 months after the end of intervention).
The MI-Component will be quality assured by MITI 4.2-coding (Motivational Interviewing Treatment Integrity). The study will investigate effects on clinical outcomes, medication adherence, patients´ beliefs about medicines and quality of life.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||417 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Single (Outcomes Assessor)|
|Primary Purpose:||Supportive Care|
|Official Title:||Motivational Interviewing and Medication Review in the Secondary Prevention of Coronary Heart Disease|
|Study Start Date :||October 2013|
|Estimated Primary Completion Date :||March 2018|
|Estimated Study Completion Date :||March 2018|
Experimental: MI and Medication review
The intervention starts three months post-discharge after the standard treatment at the out-patients clinic. A medication review focused on cardiovascular drugs, and a counselling session with a clinical pharmacist using Motivational Interviewing (MI)-approach, and a follow-up phone call two weeks later. For patients with negative beliefs about medicines, three additional MI-sessions in clinic or by phone are planned together with the patient. Irrespective of beliefs the intervention ends with a second medication review and counselling session, which is coordinated with the 12-months post-discharge follow-up in primary care.
|Behavioral: Standard Treatment Behavioral: MI and Medication review|
Active Comparator: Standard treatment
Standard treatment at the cardiology out-patient clinic. Follow-up by nurse after two weeks and by physician after two months.
|Behavioral: Standard Treatment|
- Percentage of patients who achieve the treatment goal for Low density lipoprotein cholesterol (LDL-C) [ Time Frame: 16 months ]According to Swedish guidelines the goal is < 1,8mmol/L or at least 50% reduction from baseline.
- Percentage of patients adherent to cholesterol lowering treatment [ Time Frame: 16 months ]Self-reported adherence according to Morisky-8-Item Adherence Scale
- Percentage of patients adherent to cholesterol lowering treatment [ Time Frame: 16 months ]Prescription refill according to the Swedish Prescribed Drug Register, 1 refill month 12-16 is set as the cut-off for adherence.
- Percentage of patients adherent to cholesterol lowering treatment [ Time Frame: 16 months ]Prescription refill according to the Swedish Prescribed Drug Register, Percent Day Covered (PDC) during follow-up period, 80% is set as the cut-off for adherence.
- Percentage of patients adherent to preventive medication: Angiotensin Converter Enzyme inhibitor (ACEi) or Angiotensin Receptor Blocker (ARB) [ Time Frame: 16 months ]Prescription refill according to the Swedish Prescribed Drug Register, 1 refill month 12-16 is set as the cut-off for adherence.
- Percentage of patients adherent to preventive medication: Acetylsalicylic acid (ASA) [ Time Frame: 16 months ]Prescription refill according to the Swedish Prescribed Drug Register, 1 refill month 12-16 is set as the cut-off for adherence.
- Percentage of patients adherent to preventive medication: P2Y12-antagonist [ Time Frame: 16 months ]
- Percentage of patients adherent to preventive medication: Beta-blocker [ Time Frame: 16 months ]
- Percentage of patients with Systolic Blood Pressure <140 [ Time Frame: 16 months ]As registered in the Electronic Health Record
- Changes in Quality of Life [ Time Frame: 16 months ]The Heart QoL instrument
- Number of Cardiovascular Re-admissions and Emergency Department visits [ Time Frame: 16 months ]According to the Health Care register of Kalmar County
- Process measure: Quality of prescribing, for a random sample of 20 % of patients [ Time Frame: 6 months ]According to Medication Assessment Tool for secondary prevention of Coronary Heart disease
- Process measure: What was delivered in the Medication review [ Time Frame: 12 months, only intervention group ]Number and type of drug-related problems, as categorized by Cipolle and Strand. And documented effects of any actions taken on drug-related problems.
- Process measure: Quality of MI, for a random sample of 20 % of consultations [ Time Frame: 12 months ]According to MITI 4.2.1
- Process measure: Beliefs about medicines - percent of patients per category [ Time Frame: 16 months ]Beliefs about medicines questionnaire (BMQ-S10), categories: accepting, ambivalent, neutral, skeptical. Also temporal cahnges in both Groups and Changes in each item of the subscales.
- Process measure: Intervention experienced by patients [ Time Frame: 12 months ]Qualitative interview study of 8-15 patients with negative beliefs about medicines at baseline. Analyzed with content analysis.
- Process measure: How did the intervention affect patients´overall experience of their follow-up care after CHD. [ Time Frame: 16 months, for the last 100 patients to be included. ]Open question: What is you opinion of the follow-up care after your heart disease?" Analysed with qualitative content analysis separetly for Control and intervention group patients.
- Health economic evaluation: Costs of intervention related to costs saved and Quality-adjusted Life years [ Time Frame: 16 months ]Quality adjusted life years estimated by the re-admissions and quality of Life using Euroqol EQ-5D-5L
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02102503
|Kalmar County Hospital|
|Kalmar, Sweden, 39182|
|Principal Investigator:||Göran Petersson, MD, PhD||Linneaus University|