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Usefulness of a weekly multidose pillbox to improve therapeutic adherence in heart transplant patients, a prospective single-center study

Session HFA Discoveries - ePosters

Speaker Maria Generosa Crespo-Leiro

Event : HFA Discoveries 2020

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Cardiovascular Surgery - Transplantation
  • Session type : ePosters

Authors : MG Crespo-Leiro (La Coruña,ES), S Veiga-Seijo (La Coruña,ES), P Blanco-Canosa (La Coruña,ES), C Naya-Leira (La Coruña,ES), C Riveiro-Rodriguez (La Coruña,ES), Z Grille-Cancela (La Coruña,ES), E Barge-Caballero (La Coruña,ES), MJ Paniagua-Martin (La Coruña,ES), G Barge-Caballero (La Coruña,ES), D Couto-Mallon (La Coruña,ES), P Pardo-Martinez (La Coruña,ES), N Domenech-Garcia (La Coruña,ES), G Fernandez-Arrojo (La Coruña,ES), JM Vazquez-Rodriguez (La Coruña,ES), J Muniz (A Coruna,ES)

MG Crespo-Leiro1 , S Veiga-Seijo1 , P Blanco-Canosa1 , C Naya-Leira1 , C Riveiro-Rodriguez1 , Z Grille-Cancela1 , E Barge-Caballero1 , MJ Paniagua-Martin1 , G Barge-Caballero1 , D Couto-Mallon1 , P Pardo-Martinez1 , N Domenech-Garcia1 , G Fernandez-Arrojo1 , JM Vazquez-Rodriguez1 , J Muniz2 , 1Hospital Universitario A Coruña - La Coruña - Spain , 2University of La Coruna - A Coruna - Spain ,


Introduction: Patients with heart transplantation (HT) need complex drug therapy for life. Many drugs, including immunosuppressants and therapies that mitigate their adverse effects or for other concomitant diseases, and with several daily doses (usually 5 times a day). This complexity may make it difficult to adhere to the prescribed treatment. Adherence (correct drug intake, exact dosage and timing) is key to success. In order to facilitate medication preparation and storage, an innovative weekly multi-dose pillbox, 5 doses/day (WMDP-5) and friendly-handle was designed in our HT program.
Purpose: To assess the improvement in adherence and satisfaction with the use of the WMDP-5 within a multifactorial intervention.
Methods: Prospective single-center study started in April 2019. All heart transplant patients were invited to participate in a multilevel intervention that included the provision of the WMDP-5 as well as a training session with a specific video and information leaflets on how to use it. The study was approved by regional ethics committee.  To evaluate adherence, the Spanish versions of BAASIS (Basel Assessment of Adherence with Immunosuppressive Medication Scale) and SMAQ (Simplified Medication Adherence Questionnaire) questionnaires were used, which were done at delivery and at the follow-up visit, the next one to the center =2 months after using the WMDP-5. A Likert scale (1-5) evaluate satisfaction at the follow-up visit. All patients who had the follow-up visit until December 2019 were included in the analysis.
Results: A total of 107 HT patients (mean age 60,7 ± 13,93 years, 80.4% males, with mean time after HT of 8.92 ± 7.1 years) were included in the analysis. The highest level of education was primary school in 43%, 69,2% were married and 88,8% lived with someone. According to the SMAQ questionnaire there were 85/107 (79,4%) adherents at baseline and 97/107 (90.7%) at follow-up visit (p=0.007). Of 22 non-adherent patients at the baseline visit, 15, (68%) were adherent (improved) at the follow-up visit, while of  85 adherents at the basal visit only 3 (3,5%) became non-adherents (worsened) at the follow-up visit. The BAASIS questionnaire documented an overall improvement. Thus, the first BAASIS question (if any pill was forgotten) at the baseline visit was 8.2%, while at the follow-up visit it was 0%. Finally, according to the Likert scale, 75.7% of the patients responded that the WMDP-5 helped them to take the treatment well (49.5% responded that it helped a lot and 25.2% something). 
Conclusions: We have found that the use of a WMDP-5 in the context of a multilevel intervention, improves therapeutic adherence in HT patients. It should be noted that this improvement occurs in a cohort of HT patients with already high adherence. More studies are needed to identify in which patients the improvement is greatest. WMDP-5 may be useful in other solid-organ transplant on 5 doses/day and in whom adherence is key

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