Full prescription coverage , reduced copayments , FDC and counselling were facilitators associated with higher adherence .
BACKGROUND Secondary prevention is cost-effective for cardiovascular disease ( CVD ) , but uptake is suboptimal .
Underst and ing barriers and facilitators to adherence to secondary prevention for CVD at multiple health system levels may inform policy .
OBJECTIVES To conduct a systematic review of barriers and facilitators to adherence/persistence to secondary CVD prevention medications at health system level .
Full Prescription Coverage Versus Usual Prescription Coverage After Coronary Artery Bypass Graft Surgery: Analysis From the Post-Myocardial Infarction Free Rx Event and Economic Evaluation (FREEE) Randomized Trial
Background — Eliminating out-of-pocket costs for patients after myocardial infa rct ion ( MI ) improves adherence to preventive therapies and reduces clinical events . Because adherence to medical therapy is low among patients treated with coronary artery bypass graft surgery ( CABG ) , we evaluated the impact of providing full prescription coverage to this patient subgroup . Methods and Results — The MI Free Rx Event and Economic Evaluation ( FREEE ) trial r and omly assigned 5855 patients with MI to full prescription coverage or usual formulary coverage for all statins , & bgr;-blockers , angiotensin-converting enzyme inhibitors , or angiotensin receptor blockers . We assessed the impact of full prescription coverage on adherence , clinical outcomes , and healthcare costs using adjusted models among the 1052 patients who underwent CABG at the index hospitalization and 4803 who did not . CABG patients were older and had more comorbid illness ( P<0.01 ) . After MI , CABG patients were significantly more likely to receive & bgr;-blockers and statins but were less likely to receive angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy ( P<0.01 ) . Receiving full drug coverage increased rates of adherence to all preventative medications after CABG ( all P<0.05 ) . Full coverage was also associated with nonsignificant reductions in the rate of major vascular events or revascularization for patients treated with CABG ( hazard ratio , 0.91 ; 95 % confidence interval , 0.66–1.25 ) or without CABG ( hazard ratio , 0.93 ; 95 % confidence interval , 0.82–1.06 ) , with no interaction noted ( Pint = NS ) . After CABG , full prescription coverage significantly reduced patient out-of-pocket spending for drugs ( P=0.001 ) without increasing overall health expenditures ( P = NS ) . Conclusions — Eliminating drug copayments after MI provides consistent benefits to patients treated with or without CABG , leading to increased medication adherence , trends toward improved clinical outcomes , and reduced patient out-of-pocket expenses
Full prescription coverage , reduced copayments , FDC and counselling were facilitators associated with higher adherence .
BACKGROUND Secondary prevention is cost-effective for cardiovascular disease ( CVD ) , but uptake is suboptimal .
Underst and ing barriers and facilitators to adherence to secondary prevention for CVD at multiple health system levels may inform policy .
OBJECTIVES To conduct a systematic review of barriers and facilitators to adherence/persistence to secondary CVD prevention medications at health system level .