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Title: Impact of motivational interviews within pharmacy care upon adherence to cardiovascular medicines : a feasibility pilot controlled trial
Author: Al Jalal, Zahraa Sabeeh Mohammed Ali
ISNI:       0000 0004 7230 2008
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2016
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Background Non adherence to medication in myocardial infarction patients ranges from 13-60% (Garavalia et al, 2009). Consistent use of secondary prevention medication after a coronary event is associated with lower adjusted mortality and higher survival rates compared with patients who are not compliant (Newby et al, 2006). Strategies to tackle the burden of non adherence could involve pharmacy care and services including Medication Use Review and the New Medicine Service with a motivational interview as part of the counselling session of a community pharmacist. Objective To investigate the feasibility and potential impact of a pharmacy care intervention involving motivational interviews and referral to the community pharmacy services, amongst patients with acute coronary syndrome, on adherence to medication and on health outcomes. Methods This thesis reports a prospective, intervention, controlled feasibility/pilot study. Seventy one patients discharged from a London Heart Attack Centre following acute treatment for a coronary event were enrolled and followed up for six months. Thirty two pharmacies in London were allocated into intervention or control sites. The intervention was delivered by community pharmacists face-to-face in the pharmacy, or by telephone as part of the New Medicine Service or a Medication Use Review. The consultation included a 15-20 minute motivational interviewing session aimed at improving protective cardiovascular medicine adherence. As this was a feasibility study, measures of uptake, workability and acceptability were gathered from all stakeholders. A measure of fidelity to the intervention was also performed. The primary outcome measure was adherence to secondary prevention medication using a self report adherence measure. Secondary clinical outcomes included blood pressure and LDL-C. Data collection of outcome measures took place at baseline, 3 months and 6 months. An intention-to-treat analysis was conducted for the outcome measures. Results Given a small sample size, the feasibility study was not powered to measure clinical outcomes. However, at 3 and 6 months there was a statistically significant difference in adherence between the intervention group and the control group (P= 0.026), (P=0.004) respectively. In addition, there was a statistically significant relationship between the level of adherence at 3 months and beliefs regarding medicines (P=0.028). Patients who reported better adherence expressed positive beliefs regarding the necessity of taking their medicines. However, given the small sample size, no statistically significant outcome difference in terms of recorded blood pressure and LDL-C was observed over the six months of the study. Conclusion The feasibility, acceptability and potentially positive clinical outcome of the intervention was demonstrated, along with a high level of patient acceptability. It had a significant impact on cardiovascular medicine taking adherence. But these findings must be interpreted with caution. The intervention should be tested in a larger trial to ascertain its full clinical utility.
Supervisor: Smith, F. ; Taylor, D. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available