Evaluating the Efficacy of Motivational Interviewing on Enhancing Medication Adherence for Heart Failure Patients at An Academic Health System

Date

2019-05

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Abstract

PURPOSE: Heart disease is one of the leading causes of death in the United States. Heart disease encompasses several heart related disorders, one of which is heart failure. The Harris Health System hospital average for heart failure readmission rate is 22.9%, which is comparable to the national average of 22%. Medication non-adherence is a contributing factor for readmission rates. Motivational interviewing is a technique which can be used to help combat some of the challenges our patients face with medication adherence and empower the patient to change their behavior and improve their health. This study will evaluate the efficacy of motivational interviewing on the improvement of medication adherence for heart failure patients. METHODS: This is a single center pilot study evaluating the use of motivational interviewing on medication adherence for patients admitted due to heart failure. This study utilized trained pharmacy students to provide heart failure education using motivational interviewing techniques on patients admitted with heart failure from November 2018 to February 2019. An IT report was used to identify our control group which consisted of patients that have been educated by a pharmacist using the teach back method between October 2017 to February 2018. Post discharge, we retrospectively reviewed patient’s charts to determine if the patient picked up their medication within 48 hours, attended their follow up hospital visit and if they were readmitted back to the hospital within 30 days. To retain power, we determined that we needed to evaluate a total of 188 patients, 94 per arm, to provide a power of 80% at a type I error rate of 0.05 to detect a difference of 20% between the motivational interviewing group and the teach back method group. Our primary outcome was the percentage of patients that picked up their medications within 48 hours after discharge in the motivational interviewing group compared to the teach back method. Our secondary endpoints are 30-day hospital readmission as well as the percentage of attendance to hospital follow up visit. RESULTS: There were a total of 197 charts that we reviewed of which 99 patients were educated using the teach back method and 98 patients were educated using motivational interviewing. Overall, 111 patients met the inclusion criteria, with 52 patients in the teach back method group and 59 patients in the motivational interviewing group. The number of patients that picked up their medication within 48 hours post discharge was 25 (48%) and 38 (64.5%) in the teach back method and motivational interviewing group respectively, with a p-value of 0.08. CONCLUSIONS: This study found that use of motivational interviewing showed a 16.3% increase the percentage of patients that pick up their medications within 48 hours post discharge. This trend did not reach statistical significance possibly due to the small sample size and future studies in larger samples are warranted. Additionally, research to identify the best structure for training in motivational interviewing may result in better application and use of techniques which could result in better identification of barriers to medication non-adherence and enhance intervention effectiveness.

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Keywords

Motivational interviewing, Transitions of care, Heart failure, Medication adherence

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