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Tailored interventions improve medication adherence

A multicomponent, technologically enabled intervention led by pharmacists improved medication adherence for diabetes, hyperlipidemia and hypertension, according to findings recently published in JAMA Internal Medicine.

“A wide variety of interventions have been developed to improve medication adherence, but, when rigorously tested, many of these approaches have only been moderately successful,” Niteesh K. Choudry, MD, PhD, Brigham and Women’s Hospital, Harvard Medical School, and colleagues wrote.

“This limited efficacy may reflect the fact that many interventions do not adequately address each individual’s unique barriers to adherence and/or only do so at a single point in time. In addition, among those interventions demonstrating success, many have not been widely adopted because of the substantial human resources required to sustain them,” they added.

Choudry and colleagues randomly assigned 4,078 patients aged 18 to 85 years (mean age, 59.8 years) receiving antihypertensives, oral glucose-lowering agents or statins for their poor or worsening hypertension, diabetes or hyperlipidemia to receive either usual care or an intervention including an individually tailored telephone consultation conducted by a staff clinical pharmacist, mailed progress reports, pillboxes and text messages. Most patients in the intervention group received only two short telephone consultations totaling 29 minutes.

Researchers found that after 12 months, the intervention resulted in a 4.7% (95% CI, 3-6.4) improvement in adherence compared with usual care but made no impact in the patient achieving good disease control for at least one (OR = 1.1; 95% CI, 0.94-1.28) or all eligible 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); and significantly less likely to present at an ED (OR = 0.62; 95% CI, 0.45-0.85).

Conversely, in as-treated analyses, the intervention was linked to a 10.4% (95% CI, 8.2-12.5) increase in medication adherence, nonsignificant improved disease control for all eligible conditions (OR = 1.18; 95% CI, 0.99-1.41) and a significant increase in patients achieving disease control for at least one eligible condition (OR = 1.24; 95% CI, 1.03-1.5).

Choudry and colleagues provided potential costs of their intervention vs. other medication adherence strategies as they discussed their findings.

“Assuming a mean annual pharmacist salary of $120,000, [the phone consultation] amounts to $30 per patient per year. Our intervention also had other components although their marginal costs were small. 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.”

Because the intervention failed to improve clinical outcomes, researchers concluded that “future work should focus on identifying which groups derive the most clinical benefit from adherence improvement efforts.” – by Janel Miller

Disclosure: Choudry reports receiving unrestricted research grants to study medication adherence from AstraZeneca, Medisafe, Merck, and Sanofi. Please see the study for all other authors’ relevant financial disclosures.