23 This discordance between

pill cap and MMAS data may have been due to poor acceptability of pill caps among study participants or due to biased reporting with MMAS, as patients may have learnt to provide favourable answers. Furthermore, 7 (30%) participants who completed the study follow-up did not return their electronic pill caps at the study intervention, handicapping our www.selleckchem.com/products/17-AAG(Geldanamycin).html ability to draw inferences concerning patient medication adherence and representing a large drawback to this methodology. Use of pill caps in low-income populations poses challenges. Future studies should initiate measures to ensure adequate patient education on their use and return. Physician adherence to ACE-I/ARB and β-blockers was high at baseline with not much room for improvement. For aldosterone antagonists, the prescription rate was low at baseline. Aldosterone antagonists require careful and regular monitoring of renal function and serum potassium levels. Such rigorous monitoring may be difficult in the challenging patient population that we studied, and could account for the low adherence to a certain extent. In a larger trial, if we can ensure timely physician follow-up, the prescription of

this class of medications to appropriate patients may see a better trend. Recruiting physicians was met with resistance, as some physicians were unwilling to participate. Our dual intervention strategy is relatively novel, and with this being a pilot study, resistance from physicians is

not surprising. It is plausible that the physicians who refused to participate may represent a subset of providers who are not receptive to feedback. The impact of physicians’ unwillingness to participate on patients’ outcome remains unknown. Providing feedback to physicians regarding their adherence to evidence-based therapy is likely to be part of healthcare delivery going forward. These have been implemented in a variety of ways such as providing reimbursement incentives, penalties and electronic medical record alerts. In this trial, we chose to provide more personalised and patient-centred feedback. The ideal mechanism and format of most effective feedback needs to be investigated. Approximately 27% of the enrolled patients withdrew or were lost to follow-up. Of these, two patients completed their interventions but did not return for the postintervention visit; four patients Anacetrapib refused additional follow-up after the baseline visit. Our interactions with these participants revealed that they were experiencing a variety of social, psychological and emotional challenges that limited their ability to effectively manage their HF. Expanding the scope of the patient-level intervention to provide stronger and more personal support may enhance their ability to self-manage their condition.