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Direct-to-patient mailings increase adherence to beta-blocker therapy after heart attack

Beta-blocker therapy improves survival dramatically among heart attack patients. In fact, heart attack survivors who stop taking beta-blockers are almost twice as likely to die within the next year as those who continue therapy. Yet, use of beta-blockers remains low. Direct-to-patient mailings can be a low cost way to boost adherence to beta-blocker therapy, finds a new study.

To determine the effect of direct-to-patient communication following hospitalization for heart attack on adherence to beta-blocker therapy, researchers examined its impact on heart attack survivors in four health maintenance organizations. Patients received two mailings that explained why the use of beta-blockers was important to patients who had been treated for heart attack, the risk of not taking these drugs, and information on the drugs' adverse effects; the content of the mailings was based on input from focus groups. The first mailing was a personalized letter, followed 2 months later by a similar letter and an accompanying brochure. Both mailings included a wallet card with questions for the patient to ask their clinician.

Patients randomly assigned to usual care were not contacted by the researchers. Researchers calculated the proportion of days covered (PDC) by prescriptions filled for 426 patients who received the intervention and 410 patients who received usual care.

Patients who received the intervention were 17 percent more likely to have a PDC of at least 80 percent (i.e., availability of beta blocker medication at least 4 out of every 5 days) over the entire postintervention period. Patients in the intervention group had an increase of 4.3 percent in days covered by beta-blockers per month compared with patients who received usual care, an absolute increase of 1.3 days of coverage per month. The treatment effect was consistent across the four study sites.

The study was funded by the Agency for Healthcare Research and Quality through the Center for Education and Research on Therapeutics (CERT) at the HMO Research Network (HS10391). For more information on the CERTs program, go to http://www.ahrq.gov

See "A randomized trial of direct-to-patient communication to enhance adherence to beta-blocker therapy following myocardial infarction," by David H. Smith, R.Ph., Ph.D., Judith M. Kramer, M.D., M.S., Nancy Perrin, Ph.D., and others in the March 10, 2008, Archives of Internal Medicine 168(5), pp. 477-483.

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