Impact of a pharmacist adherence intervention on medication beliefs and drug-related problems in coronary patients – a process evaluation of the MIMeRiC trial

Abstract Background The Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC) randomized controlled trial investigated the effects of a pharmacist-led intervention at a cardiology clinic on patient adherence and clinical outcomes. The results demonstrated that the intervention group had increased adherence to cholesterol-lowering medications and aspirin, as well as improved overall beliefs about medicines. However, the intervention did not lead to a higher proportion of patients reaching the target for low-density lipoprotein cholesterol (LDL-C) levels. This paper reports on the implementation of the intervention and explores potential mechanisms underlying these outcomes, focusing on the content of medication reviews, quality of prescribing, and changes in beliefs about medicines. Methods Medication reviews were evaluated by classification of identified drug-related problems (DRPs), actions taken to address these problems, and the outcomes of those actions, utilizing data from electronic health records (EHR). The Medication Assessment Tool for secondary prevention of Coronary Heart Disease (MAT-CHDsp) was applied to EHR data to evaluate prescribing quality. Beliefs about medicines were evaluated using the Beliefs about Medicines Questionnaire specific (BMQ-S), completed by participants at baseline and follow-up. Descriptive and comparative statistics were used to analyze the data. Results Medication reviews were conducted for 144 of the 159 patients in the intervention group, with a mean of 4.3 DRPs per patient. Pharmacists identified 500 DRPs and managed 245 of these with patients alone, while 196 required discussions with physicians. The resulting status of 218 DRPs was known, and for 194 of these, the issue was solved or improved. No differences in prescribing quality were observed between groups at six months post-discharge. The mean concern score on the BMQ-S decreased more in the intervention group, and 52.8% of intervention patients vs. 31.0% of control patients ( p = 0.051) shifted from an ambivalent to an accepting attitudinal category. Conclusions This process evaluation demonstrates that clinical pharmacists were effective in identifying and managing DRPs through collaboration with patients and physicians, leading to the resolution or improvement of a substantial number of DRPs. The intervention did not impact prescription quality. Patients in the intervention group reported reduced concerns about their medications, which explains the improved medication adherence. Trial registration This study is based on data from a randomized controlled trial (RCT) registered at ClinicalTrials.gov (NCT02102503; registered 03/04/2014).