Improving Medication Adherence in Underrepresented Patients with Heart Disease: Piloting a Motivational Intervention

Abstract

Essential to reducing the risk of recurrence in individuals with cardiovascular disease (CVD), adherence to cardioprotective medications has been shown to decrease risk of cardiac-related hospitalization and mortality. Rates of nonadherence to these medications are high. Furthermore, racial and socioeconomic disparities in adherence are evident. Financial, informational, behavioral, and combined approach interventions to improve cardioprotective medication adherence utilize a variety of delivery methods (e.g., in-person, electronically, by mail). Intervention success rates have ranged from no improvement to moderate improvement in adherence. However, intervention generalizability is limited by: (1) underrepresentation of patients with low-income and racial minorities, (2) outcomes that do not adequately capture typical medication regimens, and (3) feasibility at a wide-scale level given their time and resource-intensive nature. This study aimed to address these limitations by developing and piloting a brief motivational interviewing (MI) session to increase medication adherence rates in patients with CVD, recently discharged from the hospital. It was hypothesized that the intervention group receiving a telephone-based brief MI counseling session for medication adherence (i.e., MI-medication Group) would show higher adherence to cardioprotective medications, assessed by both objective pharmacy fill data (Hypothesis 1) and by self-report data (Hypothesis 2) compared to the other two study groups (i.e., standard of care [SC Group] and MI for cardiac rehabilitation [CR] intervention group [MI-CR Group]). Further, this study examined the Information, Motivation, Behavioral Skills model (IMB) within the MI-medication Group as secondary outcomes. The MI-medication Group was hypothesized to experience a significant increase in medication information (Hypothesis 3), autonomous and controlled motivation to adhere to medications (Hypothesis 4), and behavioral skills (Hypothesis 5) from Time 2 to Time 3. Missing data precluded statistical testing of Hypothesis 1. Descriptive statistics for the received pharmacy data are presented and suggests mixed findings. Hypothesis 2 was not supported. Within the MI-medication Group, medication knowledge (information) and controlled motivation did appear to increase from Time 2 (approximately 1-week post-discharge) to Time 3 (approximately 5-weeks post-discharge). Changes in autonomous motivation and behavioral skills were not observed. Clinical and theoretical implications are discussed.