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Motivational interviewing failed to improve osteoporosis medication adherence
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The use of telephone intervention that included motivational interviewing did not show a statistically significant improvement in adherence to osteoporosis medication among Medicare beneficiaries, according to data from a randomized controlled trial.
“More than 2 million fractures associated with osteoporosis or osteopenia occur annually in the United States, at an estimated medical cost of $19 billion,” Daniel H. Solomon, MD, MPH, division of rheumatology, immunology and allergy at Brigham and Women’s Hospital, and colleagues wrote in their study. “Medications have been shown to reduce fracture risk in many populations; thus, improving adherence to osteoporosis drug regimens is a public health priority.”
To improve adherence, Solomon and colleagues tested the efficacy of a telephone-based counseling program with motivational interviewing. The mean age of the more than 2,000 participants was 78 years, and they were recruited from a large pharmacy benefits program for Medicare beneficiaries. Participants were randomly assigned to telephone-based counseling (n=1,046) or a control group that received mailed educational materials (n=1,041) in the 1-year study.
The primary outcome was medication adherence, measured as the median medication possession rate, which was calculated as the ratio of days with filled prescriptions to total days of follow-up, according to the abstract. Secondary outcomes included self-reported fractures, falls and poor or fair general health.
There was no statistically significant increase in adherence in the intervention group vs. control: median adherence was 49% vs. 41% (P=.07).
Additionally, secondary outcomes were not statistically significant between the two groups. The rate of self-reported fractures was 10.9% for intervention vs. 11.2% for control; falls were 38.1% for intervention vs. 35.7% for control, and poor or fair general health was 40.2% for intervention vs. 40.9% for control. Persistence with osteoporosis medication regimens was also similar across the two groups (P=.34).
The researchers said they remain optimistic about the intervention, despite the lack of significant results. They wrote, “Although our results were not statistically significant, we demonstrated that a relatively simple intervention has the potential to achieve modest improvements in medication adherence, particularly in select pre-specified subgroups.”
Seth A. Berkowitz, MD, and Kirsten L. Johansen, MD, of the University of California at San Francisco, wrote in an accompanying editorial that there is no single antidote to improve treatment adherence.
“As we think about future directions for motivational interviewing, and interventions that seek to produce behavior change as a whole, it is worth noting that the effect sizes of almost all interventions have been rather modest, and there is likely no ‘magic bullet’ in the behavior change arsenal in general or for increasing treatment adherence specifically. This does not mean, however, that the effects may not be clinically significant,” they wrote.
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