Improving Medication Adherence through Graphically Enhanced Interventions in Coronary Heart Disease (IMAGE-CHD): A Randomized Controlled Trial

Background Up to 50 % of patients do not take medications as prescribed. Interventions to improve adherence are needed, with an understanding of which patients benefit most. Objective To test the effect of two low-literacy interventions on medication adherence. Design Randomized controlled trial, 2 × 2 factorial design. Participants Adults with coronary heart disease in an inner-city primary care clinic. Interventions For 1 year, patients received usual care, refill reminder postcards, illustrated daily medication schedules, or both interventions. Main Measures The primary outcome was cardiovascular medication refill adherence, assessed by the cumulative medication gap (CMG). Patients with CMG