Can phone-based motivational interviewing improve medication adherence to antiplatelet medications after a coronary stent among racial minorities? A randomized trial

J Gen Intern Med. 2015 Apr;30(4):469-75. doi: 10.1007/s11606-014-3139-8. Epub 2014 Dec 13.

Abstract

Background: Minorities have lower adherence to cardiovascular medications and have worst cardiovascular outcomes post coronary stent placement

Objective: The aim of this study is to compare the efficacy of phone-delivered Motivational Interviewing (MINT) to an educational video at improving adherence to antiplatelet medications among insured minorities.

Design: This was a randomized study.

Participants: We identified minorities with a recently placed coronary stent from an administrative data set by using a previously validated algorithm.

Interventions: MINT subjects received quarterly phone calls and the DVD group received a one-time mailed video.

Main measures: Outcome variables were collected at baseline and at 12-month post-stent, using surveys and administrative data. The primary outcome was antiplatelet (clopidogrel and prasugrel) adherence measured by Medication Possession Ratio (MPR) and self- reported adherence (Morisky score). We also measured appropriate adherence defined as an MPR ≥ 0.80.

Key results: We recruited 452 minority subjects with a new coronary stent (44 % Hispanics and 56 % Black). The patients had a mean age of 69.5 ± 8.8, 58 % were males, 78 % had an income lower than $30,000 per year and only 22 % had achieved high school education or higher. The MPR for antiplatelet medications was 0.77 for the MINT group compared to 0.70 for the DVD group (p < 0.05). The percentage of subjects with adequate adherence to their antiplatelet medication was 64 % in the MINT group and 50 % in the DVD group (p < 0.01). Self-reported adherence at 12 months was higher in the MINT group compared to the DVD group (p < 0.01). Results were similar among drug-eluting stent (DES) recipients.

Conclusions: Among racial minorities, a phone-based motivational interview is effective at improving adherence to antiplatelet medications post coronary stent placement. Phone-based MINT seems to be a promising and cost-effective strategy to modify risk behaviors among minority populations at high cardiovascular risk.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Blacks / ethnology
  • Blacks / psychology
  • Coronary Vessels / pathology
  • Coronary Vessels / surgery
  • Female
  • Hispanic or Latino / ethnology
  • Hispanic or Latino / psychology
  • Humans
  • Interviews as Topic / methods*
  • Male
  • Medication Adherence / ethnology*
  • Medication Adherence / psychology
  • Middle Aged
  • Minority Groups* / psychology
  • Motivational Interviewing / methods*
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Stents*

Substances

  • Platelet Aggregation Inhibitors