Electronic monitoring of medication adherence in cardiovascular ambulatory patients – evaluation by pharmacists to improve patient care

BACKGROUND
Cardiovascular disease (CVD) is the major cause of death worldwide. Although effective treatments are available, non-adherence to medication contributes considerably to treatment failure. In chronic treatments, non-adherence has an enormous negative impact on a patient's quality of life, clinical outcomes, and mortality. Pharmacotherapy for CVD can be complicated to maintain because of its preventive nature and lack of an immediate benefit, such as symptom relief. In addition, combining several medications results in complex regimens.
GOAL
The goal of this thesis was to identify and prevent suboptimal intake behaviours in cardiovascular ambulatory patients with the involvement of pharmaceutical care concepts.
PROJECT OVERVIEW
This goal was approached by conducting two projects. Project A analysed the implementation of direct oral anticoagulants (DOAC) in patients with ischaemic stroke attributable to atrial fibrillation. This project investigated A1) the impact of an intake reminder on timing adherence to DOAC, A2) the influence of the COVID-19 (coronavirus disease 2019) lockdown on DOAC intake behaviours, and A3) the comparability of two data sources to assess adherence to DOAC. In Project B, a tool to assess and evaluate adherence to cardiovascular medication was developed. Project B investigated B1) the benefits of medication charts, B2) the development of an adherence report to communicate adherence data, B3) the development of an Adherence Monitoring Package (AMoPac), and B4) the perceived usefulness of AMoPac among general practitioners.
FINDINGS AND CONCLUSIONS
This thesis adds valuable information on DOAC intake behaviours in stroke patients. In addition, the Adherence Monitoring Package AMoPac was developed and rated as useful by general practitioners (GPs) for identifying patients with non-adherent behaviours. The following conclusions were drawn from each project:
Project A1 demonstrated that a medication intake reminder significantly increased adherence in stroke survivors and might reduce recurrent events. Reminders should be offered to patients with recent strokes. In Project A2, it was observed that major disruptions of social life, such as the COVID-19 lockdown, might affect only patients with suboptimal adherence. Project A3 implies that although dispensing data are a convenient information source, electronic monitoring was superior for the identification of inadequate implementation of DOAC.
A systematic review of Project B1 showed several benefits of using medication charts. The findings of this review should encourage healthcare providers to incorporate medication charts into their daily routine. A compact adherence report was developed in Project B2 to communicate electronic monitoring data to GPs. In Project B3, the Adherence Monitoring Package AMoPac was developed. AMoPac delivers a multifaceted picture of the patient's behaviour by combining clinical values with a clinical-pharmaceutical evaluation of adherence data. In Project B4, GPs rated AMoPac as useful for identifying or excluding non-adherence in hypertensive patients. Overall, the AMoPac tool demonstrated itself to be feasible, acceptable, and useful in the opinion of GPs and patients.