Trial included patients with poorly controlled hypertension, hyperlipidemia, diabetes
- A multicomponent, technologically enabled pharmacist-led intervention tailored to patients' adherence barriers and level of health activation was associated with a small but statisically significant 4.7% improvment in medication adherence, but did not change clinical outcomes in certain chronic conditions.
- Note that in a separate "as-treated" analysis, limited to patients who adhered to the intervention, those receiving the intervention had a 10.4% increase in medication adherence, as well as significantly greater odds of achieving disease control for at least one of the conditions: hypelipidemia, hypertension, and diabetes.
A behavioral-based remote intervention may help increase medication adherence in patients with certain conditions, researchers reported.
Patients with hyperlipidemia, hypertension, and diabetes increased their medication adherence by 4.7% (95% CI 3.0%-6.4%) when placed into a pharmacist-led multicomponent, behaviorally-tailored intervention compared with those receiving usual care, reported Niteesh Choudhry, MD, PhD, of Brigham and Women's Hospital in Boston, and colleagues.
Findings from the Study of a Telepharmacy Intervention for Chronic Diseases to Improve Treatment Adherence (STIC2IT) cluster randomized trial were published in JAMA Internal Medicine.
Still, the researchers noted that despite the significant improvement in medication adherence, patients receiving the intervention did not have any notable changes in clinical outcomes. There weren't any significant differences between the tailored intervention compared with usual care for several secondary outcomes:
- Odds of achieving good disease control for one condition: OR 1.10 (95% CI 0.94-1.28)
- Good disease control for all conditions: OR 1.05 (95% CI 0.91-1.22)
- Hospitalization: OR 1.02 (95% CI 0.78-1.34)
- Having a physician office visit: OR 1.11 (95% CI 0.91-1.36)
Patients receiving the specialized intervention did have a significant decline in the odds of having an emergency department visit compared with those receiving usual care (OR 0.62, 95% CI 0.45-0.85). However, the researchers said that because there weren't any significant differences in the other outcomes, this finding was likely due to reasons other than improvement in medication adherence.
The open-label, intention-to-treat trial included over 4,000 adults from 14 practice sites -- half were randomized to receive the tailored multicomponent medication-enhancing intervention, and half received usual care. All participants had been nonadherent to their current therapy for poorly controlled hypertension, hyperlipidemia, and diabetes.
The intervention program was led by pharmacists and began with a consultation via telephone in order to individually tailor each patient's care. The program included several strategies related to patients' willingness to modify behaviors and barriers to adherence, which included structured consultation reports sent to the patients' primary care physicians along with recommendations for treatment modifications and coordination of care. The intervention also included strategies aimed at promoting medication adherence, such as sending text messages and using pillboxes, as well as establishing follow-up consultation with the pharmacist.
In a separate "as-treated" analysis -- limited only to the patients who adhered to the intervention -- those receiving the tailored intervention had a 10.4% (95% CI 8.2%-12.5%) increase in medication adherence, as well as a significantly greater odds of achieving disease control for at least one of the conditions (OR 1.24, 95% CI 1.03-1.50). Other secondary outcomes measured remained similar between the two treatment groups, Choudhry and colleagues reported, adding that the program was specifically designed to be "scalable in a domestic context."
Most of the patients in this group had two short consultations in the form of telephone calls by the clinical pharmacists; the researchers calculated that these pharmacists spent a total of 985 hours -- or 29 minutes per patient.
"Assuming a mean annual pharmacist salary of $120,000, this amounts to $30 per patient per year," the team said, noting that the other costs associated with this intervention were marginal. "By comparison, removing financial barriers for evidence-based medication typically improves adherence by 3% to 6% and is one of the most consistently effective adherence interventions reported in the literature. Eliminating patient out-of-pocket costs for just one medication, conservatively assuming monthly copayments of $10, would cost $120 per patient per year."
One limitation to the study. the team said, was the measurement of prescription claims to assess medication adherence, which might not truly show whether the patients were actually consuming more pills or whether this simply reflected an uptake in the frequency of prescriptions filled.
The study was supported by a grant from the National Heart, Lung, and Blood Institute to Brigham and Women's Hospital.
Choudhry reported receiving unrestricted research grants to study medication adherence from Sanofi, AstraZeneca, Merck, and Medisafe; another co-author reported salary support from Sanofi and AstraZeneca.
JAMA Internal Medicine
Source Reference: Choudhry N, et al "Effect of a Remotely Delivered Tailored Multicomponent Approach to Enhance Medication Taking for Patients With Hyperlipidemia, Hypertension, and Diabetes The STIC2IT Cluster Randomize" JAMA Intern Med 2018; DOI: 10.1001/jamainternmed.2018.3189.
Read the original article on Medpage Today: Trial included patients with poorly controlled hypertension, hyperlipidemia, diabetes