Pharmacists using motivational interviewing in a heart disease clinic identified and resolved medication-related problems, leading to improved adherence to cholesterol and blood-clotting drugs and reduced patient concerns about medications . The intervention did not improve actual cholesterol levels despite better adherence.
The MIMeRiC trial evaluated whether a structured pharmacist intervention could improve medication adherence and outcomes in patients with coronary heart disease. The study enrolled 159 patients at a cardiology clinic, with 144 receiving the pharmacist-led intervention involving motivational interviewing and comprehensive medication reviews. The control group received standard care. This follow-up paper focused on how the intervention worked and why certain outcomes occurred.
Pharmacists conducted detailed medication reviews and identified 500 drug-related problems across the 144 patients who received the intervention, averaging 4.3 problems per patient. These ranged from adherence barriers to dosing concerns to potential drug interactions. The pharmacists managed 245 of these issues directly with patients and escalated 196 to physicians for collaborative resolution. For the 218 drug-related problems where outcome data were available, 194 were either solved or meaningfully improved. This represents an 89% resolution rate for identified medication issues. The types of problems addressed included medication efficacy concerns, side effect management, and understanding of treatment goals.
The intervention produced measurable shifts in how patients viewed their medications. Using a validated assessment tool (the Beliefs about Medicines Questionnaire), patients in the intervention group showed a greater reduction in concerns about their medications compared to controls. Notably, 52.8% of intervention patients moved from having ambivalent or conflicted views about their medications to accepting their necessity, compared to 31.0% of control patients. This change in belief structure correlated with the improved adherence rates: intervention patients took their cholesterol-lowering medications and aspirin more consistently than controls. However, despite this improved adherence, there was no significant difference in the proportion of patients reaching target low-density lipoprotein cholesterol levels between groups at six months post-discharge. Prescribing quality, assessed using a coronary heart disease-specific tool, also showed no differences between groups.
The process evaluation reveals a disconnect between improved medication adherence and clinical outcomes. The pharmacists were effective at identifying and managing medication-related problems and shifting patient attitudes toward their drugs, both of which drove improved adherence. Yet better adherence did not translate to lower cholesterol levels. This may reflect the reality that medication adherence is necessary but not always sufficient for achieving clinical targets, which can depend on factors like baseline disease severity, drug dosing, dietary factors, exercise patterns, and individual variability in drug response.
If you have coronary heart disease and struggle with medication adherence, this research suggests that a consultation with a clinical pharmacist focused on your medication concerns, rather than simple reminders to take pills, may be valuable. The shift from viewing medications with ambivalence to accepting them appears to be the active mechanism of benefit. Pharmacists can identify practical barriers and work with your physician to address them.
The finding that improved adherence did not reach the cholesterol target highlights an important reality: taking medications as prescribed is foundational, but additional interventions on diet, high-intensity interval training, smoking cessation, and daily steps may be needed to achieve clinical goals. Medication adherence is a prerequisite, not a complete solution.
For healthcare systems, the study suggests pharmacist-led interventions are resource-efficient: 144 patients generated 500 identified problems that were mostly resolved without requiring physician involvement, reducing the administrative burden on cardiologists.
| Parameter | Details |
|---|---|
| Study Type | Process evaluation of a randomized controlled trial |
| Sample Size | 159 patients (144 in intervention group) |
| Population | Coronary heart disease patients discharged from a cardiology clinic |
| Intervention | Pharmacist-led medication review using motivational interviewing techniques |
| Primary Measures | Drug-related problems identified and resolved; beliefs about medicines (BMQ-S); medication adherence; prescribing quality (MAT-CHDsp) |
| Key Finding | 194 of 218 identified drug-related problems were resolved or improved; 52.8% of intervention patients shifted to accepting medication views vs. 31.0% of controls; no difference in LDL-C target achievement between groups |
| Evidence Tier | A tier (RCT with process evaluation) |
| Journal | BMC Health Services Research |
| PubMed ID | 42760559 |
| Registration | ClinicalTrials.gov NCT02102503 |
Impact of a pharmacist adherence intervention on medication beliefs and drug-related problems in coronary patients - a process evaluation of the MIMeRiC trial. BMC Health Services Research. PubMed: 42760559
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