Comment on O’Connor et al. Randomized Trial of Telephone Outreach to Improve Medication Adherence and Metabolic Control in Adults With Diabetes. Diabetes Care 2014;37:3317–3324

Response to Comment on O’Connor et al. Randomized Trial of Telephone Outreach to Improve Medication Adherence and Metabolic Control in Adults With Diabetes. Diabetes Care 2014;37:3317–3324

“…We agree with Blackberry et al ( 1 ) that timely treatment intensification in patients who have not reached evidence-based goals is desirable but difficult to achieve. A major obstacle to timely treatment intensification is lack of focus on particular clinical opportunities due to competing demands during brief clinical encounters.…”

“…We appreciate the thoughtful comments from Blackberry et al ( 1 ) on our article ( 2 ) and the insights they provide based on their efforts to improve medication adherence and timely treatment intensification in adults with diabetes ( 3 ). Although our study ( 2 ) and the study of Blackberry et al ( 3 ) failed to improve medication adherence rates, another recent report by Derose et al ( 4 ) showed that an automated telephone call from a computer to patients who had been prescribed a statin but had not filled the prescription within 2 weeks did in fact significantly and substantially improve primary adherence (first prescription fill) and statin persistence at 12 months.…”

“…A major obstacle to timely treatment intensification is lack of focus on particular clinical opportunities due to competing demands during brief clinical encounters. Prior work has shown that an electronic medical record point-of-care clinical decision support system can significantly improve glucose control and some aspects of blood pressure control in adults with diabetes ( 5 ), and we propose that broad use of clinical decision support systems that provide timely and accessible information to both the patient and the provider at the time of the encounter can complement the other care improvement strategies mentioned by Blackberry et al ( 1 ).…”

Integrative health coaching: a behavior skills approach that improves HbA1c and pharmacy claims-derived medication adherence

“…Despite the heterogeneous methods used in previous diabetes coaching studies, published results have shown the following trends: (1) simple, straightforward interventions usually do not work; 14 45 46 (2) medication adherence is not sustainable beyond the intervention period 47 and (3) adherence measured by self-report may be inaccurate. 48–50…”

“…Less than half of patients received a successful telephone call, and adherence did not improve. A published comment to that study 14 described a more intensive intervention of three telephone contacts of 30 min per call. 45 Their study was also unsuccessful.…”