Smith, David H.Kramer, Judith M.Perrin, NancyPlatt, RichardRoblin, Douglas W.Lane, KimberlyGoodman, Michael LeeNelson, Winnie W.Yang, XuihaiSoumerai, Stephen2017-05-162008Smith, David H. 2008. “A Randomized Trial of Direct-to-Patient Communication to Enhance Adherence to β-Blocker Therapy Following Myocardial Infarction.” Archives of Internal Medicine 168 (5) (March 10): 477. doi:10.1001/archinternmed.2007.132.0003-9926http://nrs.harvard.edu/urn-3:HUL.InstRepos:32692593Background Although β-blockers are routinely prescribed at hospital discharge after myocardial infarction (MI), patients' adherence has been shown to decline substantially over time. We sought to test the hypothesis that a simple, direct-to-patient intervention can improve adherence to β-blocker therapy following MI. Methods We conducted a cluster randomized controlled trial in 4 geographically dispersed health maintenance organizations testing the hypothesis that a simple direct-to-patient intervention could improve adherence. The study was carried out from June 2004 to March 2005. The primary analyses were based on 836 post-MI patients who were dispensed a β-blocker prescription after discharge. The intervention consisted of 2 mailings 2 months apart describing the importance of β-blocker use. The main outcomes were proportion of days covered with β-blocker therapy and percentage of patients with at least 80% of days covered in the 9 months after the first mailing. Analyses were adjusted for age, sex, total medications dispensed, days between MI and intervention, and intervention site. Results Over the entire follow-up period, patients in the treatment arm had a mean absolute increase of 4.3% of days covered per month compared with patients in the control arm (a 5.7% relative change from baseline), representing 1.3 extra days (P = .04). Treatment patients were 17% more likely (relative risk, 1.17; 95% confidence interval, 1.02-1.29) to have 80% of days covered. For every 16 patients receiving the intervention, 1 additional patient would become adherent (80% or more days covered per month). Conclusion A low-cost, easily replicable effort to increase adherence can have a demonstrable impact on β-blocker adherence following MI.en-USJournal Article2017-05-1610.1001/archinternmed.2007.132