A Systems-Level Approach to Improving Medication Adherence in Hypertensive Latinos: a Randomized Control Trial.
Latino
hypertension
medication adherence
team care
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
19
11
2018
accepted:
21
08
2019
revised:
08
07
2019
pubmed:
19
10
2019
medline:
15
5
2021
entrez:
19
10
2019
Statut:
ppublish
Résumé
Despite numerous interventions targeting medication adherence in patients with uncontrolled hypertension, practice-based trials in Latino patients are scant. To evaluate the effect of a systems-level adherence intervention, delivered by medical assistants (MAs), versus a comparison condition on medication adherence and blood pressure (BP) in 119 hypertensive Latino patients who were initially non-adherent to their antihypertensive medications. Randomized control trial. Patients (50% women; mean age, 61 years) were recruited from April 2013 to August 2015 in a community-based practice in New York. Systems-level approach that included an office system component built into the electronic health record and a provider support component consisting of nine MA-delivered health coaching sessions for improving medication adherence. The comparison group received the standard health coaching procedures followed at the clinic. The primary outcome was rate of medication adherence measured by an electronic monitoring device (EMD) across 6 months. The secondary outcomes were self-reported medication adherence measured by the eight-item Morisky Medication Adherence Scale (MMAS-8) and BP reduction from baseline to 6 months. Adherence as measure by EMD worsened for both groups (p = 0.04) with no between-group difference (- 9.6% intervention and - 6.6% control, p = 0.66). While systolic BP improved in both groups, the difference between groups was not significant (- 6 mmHg in intervention vs. - 2.7 mmHg in control, p = 0.34). In contrast, the intervention group had a greater improvement in self-reported adherence (mean change 1.98 vs. 1.26, p = 0.03) when measured using the MMAS-8. Among Latinos with poorly controlled BP who were non-adherent to their antihypertensive medications, a systems-level intervention did not improve adherence as measured by EMD nor blood pressure. However, many patients reported challenges to using the EMD. Improvements in self-reported adherence suggest that this measure captures different aspects of adherence behavior than EMD. NCT03560596.
Sections du résumé
BACKGROUND
Despite numerous interventions targeting medication adherence in patients with uncontrolled hypertension, practice-based trials in Latino patients are scant.
OBJECTIVE
To evaluate the effect of a systems-level adherence intervention, delivered by medical assistants (MAs), versus a comparison condition on medication adherence and blood pressure (BP) in 119 hypertensive Latino patients who were initially non-adherent to their antihypertensive medications.
STUDY DESIGN
Randomized control trial.
PARTICIPANTS
Patients (50% women; mean age, 61 years) were recruited from April 2013 to August 2015 in a community-based practice in New York.
INTERVENTION
Systems-level approach that included an office system component built into the electronic health record and a provider support component consisting of nine MA-delivered health coaching sessions for improving medication adherence. The comparison group received the standard health coaching procedures followed at the clinic.
MAIN OUTCOME MEASURES
The primary outcome was rate of medication adherence measured by an electronic monitoring device (EMD) across 6 months. The secondary outcomes were self-reported medication adherence measured by the eight-item Morisky Medication Adherence Scale (MMAS-8) and BP reduction from baseline to 6 months.
KEY RESULTS
Adherence as measure by EMD worsened for both groups (p = 0.04) with no between-group difference (- 9.6% intervention and - 6.6% control, p = 0.66). While systolic BP improved in both groups, the difference between groups was not significant (- 6 mmHg in intervention vs. - 2.7 mmHg in control, p = 0.34). In contrast, the intervention group had a greater improvement in self-reported adherence (mean change 1.98 vs. 1.26, p = 0.03) when measured using the MMAS-8.
CONCLUSIONS
Among Latinos with poorly controlled BP who were non-adherent to their antihypertensive medications, a systems-level intervention did not improve adherence as measured by EMD nor blood pressure. However, many patients reported challenges to using the EMD. Improvements in self-reported adherence suggest that this measure captures different aspects of adherence behavior than EMD.
CLINICAL TRIAL REGISTRATION
NCT03560596.
Identifiants
pubmed: 31625041
doi: 10.1007/s11606-019-05419-3
pii: 10.1007/s11606-019-05419-3
pmc: PMC6957668
doi:
Substances chimiques
Antihypertensive Agents
0
Banques de données
ClinicalTrials.gov
['NCT03560596']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
182-189Références
MMWR Morb Mortal Wkly Rep. 2013 May 10;62(18):351-5
pubmed: 23657109
J Gen Intern Med. 2010 Nov;25(11):1172-7
pubmed: 20571929
BMJ. 2008 May 17;336(7653):1114-7
pubmed: 18480115
Am J Cardiovasc Drugs. 2012 Jun 1;12(3):165-78
pubmed: 22583147
Circulation. 2009 Jun 16;119(23):3028-35
pubmed: 19528344
Ann Epidemiol. 2009 Mar;19(3):172-9
pubmed: 19216999
Trials. 2015 Jul 02;16:290
pubmed: 26134837
J Hypertens. 1999 Jul;17(7):1041-5
pubmed: 10419079
Ann Fam Med. 2007 Sep-Oct;5(5):457-61
pubmed: 17893389
J Clin Hypertens (Greenwich). 2008 May;10(5):348-54
pubmed: 18453793
Med Care. 2001 Jun;39(6):575-87
pubmed: 11414262
BMC Health Serv Res. 2006 Feb 10;6:8
pubmed: 16472388
Patient Prefer Adherence. 2012;6:207-19
pubmed: 22536057
Health Psychol. 2004 Sep;23(5):443-51
pubmed: 15367063
Med Care. 2004 Mar;42(3):200-9
pubmed: 15076819
Arch Intern Med. 1990 Sep;150(9):1881-4
pubmed: 2102668
Health Psychol. 1985;4(2):115-35
pubmed: 4018002
Health Aff (Millwood). 2010 May;29(5):963-5
pubmed: 20439889
J Gen Intern Med. 2012 Jan;27(1):57-64
pubmed: 21879374
J Behav Med. 2009 Jun;32(3):278-84
pubmed: 19184390
Clin Ther. 1999 Jun;21(6):1074-90; discussion 1073
pubmed: 10440628
J Am Board Fam Med. 2015 Jan-Feb;28(1):38-45
pubmed: 25567821
Am J Hypertens. 2008 Oct;21(10):1137-43
pubmed: 18654123
Med Care. 2004 Jul;42(7):649-52
pubmed: 15213489
AIDS Patient Care STDS. 2005 Nov;19(11):745-59
pubmed: 16283835
Med Care. 1985 May;23(5):556-63
pubmed: 4010351
Health Psychol. 1985;4(3):203-18
pubmed: 4029105
Public Health Nurs. 2010 Mar-Apr;27(2):115-20
pubmed: 20433665
J Hypertens. 2004 Oct;22(10):1849-55
pubmed: 15361751
Res Nurs Health. 2002 Apr;25(2):145-58
pubmed: 11933008
J Am Soc Hypertens. 2012 May-Jun;6(3):201-9
pubmed: 22520931
Ann Fam Med. 2012 May-Jun;10(3):199-205
pubmed: 22585883
Clin Med Res. 2013 Jun;11(2):54-65
pubmed: 23580788
Consult Pharm. 2007 May;22(5):411-6
pubmed: 17658958
Am J Hypertens. 2014 Jun;27(6):793-800
pubmed: 24627442
J Clin Epidemiol. 2011 Mar;64(3):255-7; discussion 258-63
pubmed: 21144706
J Clin Hypertens (Greenwich). 2012 Jan;14(1):38-44
pubmed: 22235822
Hypertension. 2011 Jun;57(6):1101-7
pubmed: 21502561
Circ Cardiovasc Qual Outcomes. 2017 Jan;10(1):
pubmed: 28096206
Biomed Res Int. 2015;2015:217047
pubmed: 26539470
N Engl J Med. 2017 Nov 23;377(21):2097
pubmed: 29166234
Ann Behav Med. 2005 Apr;29 Suppl:46-54
pubmed: 15921489
J Acquir Immune Defic Syndr. 2006 Oct 1;43(2):247-8
pubmed: 17003672