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 coverage for preventive medications after myocardial infarction.
BACKGROUND Adherence to medications that are prescribed after myocardial infa rct ion is poor . Eliminating out-of-pocket costs may increase adherence and improve outcomes . METHODS We enrolled patients discharged after myocardial infa rct ion and r and omly assigned their insurance-plan sponsors to full prescription coverage ( 1494 plan sponsors with 2845 patients ) or usual prescription coverage ( 1486 plan sponsors with 3010 patients ) for  all statins , beta-blockers , angiotensin-converting-enzyme inhibitors , or angiotensin-receptor blockers . The primary outcome was the first major vascular event or revascularization . Secondary outcomes were rates of medication adherence , total major vascular events or revascularization , the first major vascular event , and health expenditures . RESULTS Rates of adherence ranged from 35.9 to 49.0 % in the usual-coverage group and were 4 to 6 percentage points higher in the full-coverage group ( P<0.001 for all comparisons ) . There was no significant between-group difference in the primary outcome ( 17.6 per 100 person-years in the full-coverage group vs. 18.8 in the usual-coverage group ; hazard ratio , 0.93 ; 95 % confidence interval [ CI ] , 0.82 to 1.04 ; P=0.21 ) . The rates of total major vascular events or revascularization were significantly reduced in the full-coverage group ( 21.5 vs. 23.3 ; hazard ratio , 0.89 ; 95 % CI , 0.90 to 0.99 ; P=0.03 ) , as was the rate of the first major vascular event ( 11.0 vs. 12.8 ; hazard ratio , 0.86 ; 95 % CI , 0.74 to 0.99 ; P=0.03 ) . The elimination of copayments did not increase total spending ( $ 66,008 for the full-coverage group and $ 71,778 for the usual-coverage group ; relative spending , 0.89 ; 95 % CI , 0.50 to 1.56 ; P=0.68 ) . Patient costs were reduced for drugs and other services ( relative spending , 0.74 ; 95 % CI , 0.68 to 0.80 ; P<0.001 ) . CONCLUSIONS The elimination of copayments for drugs prescribed after myocardial infa rct ion did not significantly reduce rates of the trial 's primary outcome . Enhanced prescription coverage improved medication adherence and rates of first major vascular events and decreased patient spending without increasing overall health costs . ( Funded by Aetna and the Commonwealth Fund ; MI FREEE Clinical Trials.gov number , NCT00566774 . )
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 .