Pharmacist education and telephone follow-up after hospitalization for an acute coronary event: The assessment of cardiology peri-discharge counseling (ACDC) pilot study

Background: Poor adherence to Acute Coronary Syndrome (ACS) medications is associated with increased 1-year mortality. Patients' beliefs about medications were identified as a key modifiable barrier to adherence. Objectives: To evaluate the feasibility of a pharmacist intervention to improve adherence that targets patients' beliefs about medications, the feasibility of conducting a randomized trial to assess this intervention, and this intervention's effect on patient beliefs and adherence. Methods: This was a post-test only, with non-equivalent groups pilot study. Participants were adult inpatients with ACS to be discharged home. Intervention group participants received pharmacist discharge counseling and telephone follow-up 1 week post-discharge. Both intervention and control participants received usual care discharge education by nurses. Primary outcomes include recruitment rate, attrition rate and duration of pharmacist intervention. Secondary outcomes include Beliefs about Medicines Questionnaire (BMQ) Necessity and Concerns subscales (scores out of 25), 8-Item Morisky Medication Adherence Scale (MMAS-8, score out of 8) and self-reported prescription fill rate. Results:Of 53 patients screened, 20 (37.7%) were recruited and 7 (35%) were lost to follow-up at 1 month. The intervention took 25 minutes per patient on average. Intervention group patients scored significantly higher on the BMQ-Necessity subscale compared to controls (24 vs 17.5; p < 0.001). No significant difference was found in BMQ-Concerns scores (11 vs 15; p = 0.102); MMAS-8 scores (8 vs 8; p = 0.430); and prescription fill rates (100% vs 100%). Conclusions: The study recruitment rate is comparable to larger, randomized adherence trials with similar eligibility criteria. Lack of dedicated, funded research staff limited the stringency of follow-up, contributing to the high attrition rate. A larger study is feasible but will require additional resources. The intervention feasibility is highly dependent on pharmacist patient load. Pharmacist discharge counseling and telephone follow-up may improve patients' beliefs about the necessity of their medications.