Improvement of Adherence to Drug Therapy Using a Weekly Multidose Pillbox in Heart Transplant Patients. A Prospective Single-Center Study

Purpose Heart Transplant (HT) patients need complex drug treatment for life: many drugs and several daily doses (usually 5 times a day). This complexity may make it difficult to adhere to the treatment, which is key to therapeutic success. In order to facilitate medication preparation, a Weekly Multi-Dose Pillbox (WMDP-5), 5 doses/day, was designed in our HT program. The aim is to assess the improvement in adherence and satisfaction with the use of the WMDP-5 within a multifactorial intervention. Methods Prospective single-center study started in April 2019. All HT patients were invited to participate. The multilevel intervention included the provision of the WMDP-5 as well as a training session with a specific video and information leaflets. The study was approved by regional ethics committee. To evaluate adherence, the Spanish version of BAASIS (Basel Assessment of Adherence with Immunosuppressive Medication Scale) Patient Questionnaire Interview and the Simplified Medication Adherence Questionnaire (SMAQ) were used at delivery and at the follow-up visit. A Likert Scale (1-5) evaluate satisfaction at the follow-up visit (the next one to the center ≥ 1 months after using the WMDP). Patients with the follow-up visit until October 2019 were analyzed. Results A total of 214 HT patients (mean age 61,8±12,89 years, 79,4% males, with mean time after HT of 9,86±6,9 years) were included in the analysis. The highest level of education was primary school in 45,3%, 67,3% were married and 85% lived with someone. According to the SMAQ, there were 156/214 (72.89%) adherents at baseline and 193/214 (90,2%) at follow-up visit (p=0.006). Of 58 non-adherent patients at the baseline visit, 47 (81%) were adherent (improved) at the follow-up visit; while of 156 adherents at the basal visit, only 10 (6,4%) became non-adherents (worsened). The BAASIS questionnaire documented an overall improvement. Thus, the fist BAASIS question (if any pill was forgotten) at the baseline visit was 8%, while at the follow-up visit was 1,7%. Finally, according to the Likert Scale, 71,5% of the patients responded that the WMDP-5 helped them to take the treatment well. Conclusion The use of a WMDP-5 in the context of a multilevel intervention improves therapeutic adherence in HT patients. It should be noted that this improvement occurs in a cohort of HT patients with already high adherence.