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Medicines optimisation

Patient-centred clinic improves outcomes after myocardial infarction

Researchers say their results show the need to re-examine how outpatient follow-up is arranged post myocardial infarction.

A post-myocardial infarction (MI) medicines optimisation clinic, led primarily by a pharmacist with support from a cardiologist, has resulted in improved medicines adherence and guideline concordance, study results published in Open Heart show (10 December 2018)[1].

Patients in the study (n=270) completed a newly designed questionnaire that was used to tailor a 20–25-minute patient-centred consultation with a consultant cardiology pharmacist, a cardiologist or both. The questionnaire covered the patients’ medicines-taking experiences, their understanding of and concerns about their medicines, and their self-reported adherence.

The results revealed that the mean time from discharge to clinic attendance was substantially lower than the mean waiting time to first outpatient cardiology review before the service began (49 days vs. 88 days). Furthermore, the majority of patients were seen only by the pharmacist, with fewer than 5% requiring input from a cardiologist.

The percentage of patients receiving appropriate doses of an angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers increased from 16% to 74%, and for beta blockers from 6% to 46%. Adherence and readmission rates also improved.

“The new model shows the need to re-examine how outpatient follow up is arranged post-MI … adopting a new approach based on the principles of medicines optimisation and adherence to deliver a more patient-centred medicines review,” the researchers said.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2019.20206136

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