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- Title
A Systems-Level Approach to Improving Medication Adherence in Hypertensive Latinos: a Randomized Control Trial.
- Authors
Schoenthaler, Antoinette; de la Calle, Franzenith; Pitaro, Maria; Lum, Audrey; Chaplin, William; Mogavero, Jazmin; Rosal, Milagros C.
- Abstract
<bold>Background: </bold>Despite numerous interventions targeting medication adherence in patients with uncontrolled hypertension, practice-based trials in Latino patients are scant.<bold>Objective: </bold>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.<bold>Study Design: </bold>Randomized control trial.<bold>Participants: </bold>Patients (50% women; mean age, 61 years) were recruited from April 2013 to August 2015 in a community-based practice in New York.<bold>Intervention: </bold>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.<bold>Main Outcome Measures: </bold>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.<bold>Key Results: </bold>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.<bold>Conclusions: </bold>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.<bold>Clinical Trial Registration: </bold>NCT03560596.
- Subjects
NEW York (State); PATIENT compliance; DIRECTLY observed therapy; CLINICAL trial registries; BLOOD pressure testing machines; ELECTRONIC health records; MEDICAL assistants; ELECTRONIC surveillance; HYPERTENSION; ANTIHYPERTENSIVE agents; BLOOD pressure; RESEARCH; RESEARCH methodology; MEDICAL cooperation; EVALUATION research; COMPARATIVE studies; RANDOMIZED controlled trials; DRUGS; PHARMACODYNAMICS
- Publication
JGIM: Journal of General Internal Medicine, 2020, Vol 35, Issue 1, p182
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-019-05419-3