Hospital Variation in Adherence Rates to Secondary Prevention Medications and the Implications on Quality

This US study found that hospitals with higher hospital-level adherence to post-MI medications at 90 days had lower incidence of downstream major cardiovascular events (adjusted HR 0.88, 95% CI 0.80–0.96), as well as death or readmission (HR 0.90, 95% CI 0.85–0.96).

The authors note that the hospital adherence groups differed in several patient characteristics, as well as sociodemographic factors. Hospital-level variation however persists after adjusting for patient case-mix. Inter-hospital differences in discharge practices may contribute to variation in hospital-level medication adherence. For example, the routine use of a cardiovascular team-based model has been associated with a reduction in readmissions; this model includes pharmacists, advanced care practitioners, social workers, and the discharging physician.

 

They conclude that the transition from hospital to home represents a key opportunity to implement policies that address barriers to medication adherence, and that further work is needed to identify the best discharge practices.