Achieving optimal adherence to medical therapy by telehealth: findings
from the ORBITA medication adherence sub-study
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