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Achieving optimal adherence to medical therapy by telehealth: findings from the ORBITA medication adherence sub-study
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  • David Thompson,
  • Rasha Al-lamee,
  • Michael Foley,
  • Hakim Dehbi,
  • Simon Thom,
  • Justin Davies,
  • Darrel Francis,
  • Prashanth Patel,
  • Pankaj Gupta
David Thompson
Imperial College London
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Rasha Al-lamee
Imperial College London
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Michael Foley
Imperial College London
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Hakim Dehbi
University College London
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Simon Thom
Imperial College London
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Justin Davies
Imperial College London
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Darrel Francis
Imperial College London
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Prashanth Patel
University Hospitals of Leicester NHS Trust
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Pankaj Gupta
University Hospitals of Leicester NHS Trust
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Abstract

Introduction The ORBITA trial of PCI versus a placebo procedure for patients with stable angina was conducted across 6 sites in the United Kingdom via home monitoring and telephone consultations. Patients underwent detailed assessment of medication adherence which allowed us to measure the efficacy of the implementation of the optimisation protocol and interpretation of the main trial endpoints. Methods Prescribing data were collected throughout the trial. Self-reported adherence was assessed, and urine samples collected at pre-randomisation and at follow-up for direct assessment of adherence using HPLC MS/MS. Results Self-reported adherence was >96% for all drugs in both treatment groups at both stages. The percentage of samples in which drug was detected at pre-randomisation and at follow-up in the PCI vs. OMT groups respectively was: clopidogrel, 96% vs. 90% and 98% vs. 94%; atorvastatin, 95% vs. 92% and 92% vs. 91%; perindopril, 95% vs. 97% and 85% vs. 100%; bisoprolol, 98% vs. 99% and 96% vs. 97%; amlodipine, 99% vs. 99% and 94% vs. 96%; nicorandil, 98% vs. 96% and 94% vs. 92%; ivabradine, 100% vs. 100% and 100% vs. 100%; and ranolazine, 100% vs. 100% and 100% vs. 100%. Conclusions Adherence levels were high throughout the study when quantified by self-reporting methods and similarly high proportions of drug were detected by urinary assay. The results indicate successful implementation of the optimisation protocol delivered by telephone, an approach that could serve as a model for treatment of chronic conditions, particularly as consultations are increasingly conducted online.

Peer review status:POSTED

09 Sep 2020Submitted to British Journal of Clinical Pharmacology
10 Sep 2020Assigned to Editor
10 Sep 2020Submission Checks Completed