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Can a multifaceted intervention including motivational interviewing improve medication adherence, quality of life, and mortality rates in older patients undergoing coronary artery bypass surgery? A multicenter, randomized controlled trial with 18-month follow-up
Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
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2017 (English)In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 34, no 2, 143-156 p.Article in journal (Refereed) Published
Abstract [en]

Background: Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for extended periods, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence in this patient group is therefore important.

Objective: The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery.

Methods: Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment-as-usual (TAU; n = 144) groups using cluster randomization at center level. Medication adherence was evaluated using the Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL was evaluated using Short Form-36. Data were collected at baseline; 3, 6, and 18 months after intervention. Survival status was followed up at 18 months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses.

Results: Compared with patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved 6 months after surgery (p < 0.01) and remained so 18 months after surgery (p < 0.01). QoL also increased among patients in the EXP group as compared with those who received TAU at 18 months post-surgery (physical component summary score p = 0.02; mental component summary score p = 0.04). HR in the EXP group compared with the TAU group was 0.38 (p = 0.04).

Conclusion: The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after 18 months. QoL and survival rates increased as a function of better medication adherence. ClinicalTrials.gov NCT02109523.

Place, publisher, year, edition, pages
Springer, 2017. Vol. 34, no 2, 143-156 p.
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Nursing
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URN: urn:nbn:se:hj:diva-34626DOI: 10.1007/s40266-016-0429-3ISI: 000394143400007PubMedID: 28004259Scopus ID: 2-s2.0-85006839800Local ID: HHJADULTIS, HHJIMPROVEISOAI: oai:DiVA.org:hj-34626DiVA: diva2:1062833
Available from: 2017-01-09 Created: 2017-01-09 Last updated: 2017-10-26Bibliographically approved

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Pakpour, Amir H.Malm, DanBroström, AndersFridlund, Bengt

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