Improving Medication Adherence Through Graphically Enhanced Interventions in Acute Coronary Syndromes

Coronary heart disease (CHD) is the leading cause of death in the United States. Most people
who die from CHD die of a heart attack. Acute coronary syndrome (ACS) is a term that includes
mild heart attacks, as well as other episodes of chest pain that may serve as a warning sign
for an upcoming heart attack.

There are many medicines that can help prevent and treat ACS. However, at least 25% of
patients don't take their medications as prescribed. When patients don't take their
medications, we say they are noncompliant or nonadherent with the treatment.

The period following hospital discharge is a vulnerable time for many patients. Patients are
often confused about what to do when they return home from the hospital. Many patients don't
take their medications correctly, or they don't take them at all. Patients with poor literacy
skills have more trouble than others, because it is harder for them to follow written
instructions. Overall, about half of the adults in the U.S. have poor literacy skills. It is
important to develop ways to help these adults manage their health better.

The purposes of this research project are 1) to learn more about the relationship between low
literacy and medication adherence after hospital discharge, and 2) to test a strategy
designed to help patients take their medicines more regularly. We will recruit consenting
patients hospitalized with ACS. We will measure their literacy skills, ask questions about
how they take their medicines, and measure other related factors like social support and
self-efficacy. Patients will then be assigned to 1 of 2 groups. One group will receive only
usual care at hospital discharge, which usually includes the nurse and physician briefly
reviewing the medication prescriptions. The other group will receive an illustrated daily
medication schedule and special, tailored counseling from a pharmacist at their time of
discharge. About 1 week after patients leave the hospital we will contact them by phone to
ask them questions about how they have been taking their medicines. We will get data from
patients records for 6 months to see if the intervention had an impact on their medication
compliance, blood pressure, cholesterol, and diabetes measurements.

If this study is successful, this simple strategy could be implemented by hospitals to
improve medication compliance after discharge. This study will also provide more information
about how patients' literacy skills affect their medication compliance.