Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States

Viswanathan, Meera; Golin, Carol E.; Jones, Christine; Ashok, Mahima; Blalock, Susan J.; Wines, Roberta; Coker-Schwimmer, Emmanuel; Rosen, David L.; Sista, Priyanka; Lohr, Kathleen N

doi:10.7326/0003-4819-157-11-201212040-00538

Cited by 665 publications

(548 citation statements)

References 154 publications

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“…Miller et al, followed by other reports and reviews, previously highlighted the importance of such action at the various levels of the healthcare system 7, 21, 24, 43, 63…”

Section: Discussionmentioning

confidence: 99%

“…The evidence base for multilevel medication adherence interventions is more limited than at the patient level 14, 24, 63, 64, 65. High‐quality studies included in the latest Cochrane review of medication adherence interventions65 highlight the value of complex multicomponent interventions featuring support by both family members and healthcare workers (including pharmacists).…”

Section: Discussionmentioning

confidence: 99%

“…However, despite addressing adherence barriers via tailored education, counseling, or daily treatment support, they have shown no significant improvements in adherence or clinical outcomes 65. The systematic review by Viswanathan et al indicates that reducing out‐of‐pocket expenses and case management together with patient education and behavioral support are effective interventions 24. At the macro level, policy interventions to decrease transplant patients’ financial burden,52 including full medication coverage, have been proven effective at enhancing adherence 66…”

Section: Discussionmentioning

confidence: 99%

“…6, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32 Reflecting this perspective, a multilevel approach to medication nonadherence is novel,15, 33 as multilevel medication nonadherence factors have received little attention in transplantation 6, 11, 13, 14, 34. Should this new perspective reveal independent multilevel immunosuppressant nonadherence correlates, addressing such correlates would demand interventional approaches targeting not only patients but healthcare workers/family, organizations, and policymakers 6, 21, 24…”

Section: Introductionmentioning

confidence: 99%

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Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

Denhaerynck

Berben

Dobbels

et al. 2018

American Journal of Transplantation

100

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Factors at the level of family/healthcare worker, organization, and system are neglected in medication nonadherence research in heart transplantation (HTx). The 4‐continent, 11‐country cross‐sectional Building Research Initiative Group: Chronic Illness Management and Adherence in Transplantation (BRIGHT) study used multistaged sampling to examine 36 HTx centers, including 36 HTx directors, 100 clinicians, and 1397 patients. Nonadherence to immunosuppressants—defined as any deviation in taking or timing adherence and/or dose reduction—was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale© (BAASIS ©) interview. Guided by the Integrative Model of Behavioral Prediction and Bronfenbrenner's ecological model, we analyzed factors at these multiple levels using sequential logistic regression analysis (6 blocks). The nonadherence prevalence was 34.1%. Six multilevel factors were associated independently (either positively or negatively) with nonadherence: patient level: barriers to taking immunosuppressants (odds ratio [OR]: 11.48); smoking (OR: 2.19); family/healthcare provider level: frequency of having someone to help patients read health‐related materials (OR: 0.85); organization level: clinicians reporting nonadherent patients were targeted with adherence interventions (OR: 0.66); pickup of medications at physician's office (OR: 2.31); and policy level: monthly out‐of‐pocket costs for medication (OR: 1.16). Factors associated with nonadherence are evident at multiple levels. Improving medication nonadherence requires addressing not only the patient, but also family/healthcare provider, organization, and policy levels.

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“…Miller et al, followed by other reports and reviews, previously highlighted the importance of such action at the various levels of the healthcare system 7, 21, 24, 43, 63…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

Denhaerynck

Berben

Dobbels

et al. 2018

American Journal of Transplantation

100

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“…16 These include interventions that reduce out-of-pocket costs, simplify regimens, facilitate delivery of medications, or offer behavioral support. [16][17][18][19] Unfortunately, many of these approaches have been difficult to sustain outside of research settings. 16 To test potentially sustainable interventions in real world settings, we conducted a randomized controlled clinical trial (RCT) testing the comparative effectiveness of a telephone-based behavioral intervention versus an educational DVD at improving 12-month adherence to thienopiridines among minority coronary stent recipients.…”

mentioning

confidence: 99%

Can Phone-Based Motivational Interviewing Improve Medication Adherence to Antiplatelet Medications After a Coronary Stent Among Racial Minorities? A Randomized Trial

et al. 2014

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BACKGROUND:Minorities have lower adherence to cardiovascular medications and have worst cardiovascular outcomes post coronary stent placement OBJECTIVE: The aim of this study is to compare the efficacy of phone-delivered Motivational Interviewing (MINT) to an educational video at improving adherence to antiplatelet medications among insured minorities. DESIGN: This was a randomized study. PARTICIPANTS: We identified minorities with a recently placed coronary stent from an administrative data set by using a previously validated algorithm. INTERVENTIONS: MINT subjects received quarterly phone calls and the DVD group received a one-time mailed video. MAIN MEASURES: Outcome variables were collected at baseline and at 12-month post-stent, using surveys and administrative data. The primary outcome was antiplatelet (clopidogrel and prasugrel) adherence measured by Medication Possession Ratio (MPR) and self-reported adherence (Morisky score). We also measured appropriate adherence defined as an MPR ≥ 0.80. KEY RESULTS: We recruited 452 minority subjects with a new coronary stent (44 % Hispanics and 56 % Black). The patients had a mean age of 69.5±8.8, 58 % were males, 78 % had an income lower than $30,000 per year and only 22 % had achieved high school education or higher. The MPR for antiplatelet medications was 0.77 for the MINT group compared to 0.70 for the DVD group (p<0.05). The percentage of subjects with adequate adherence to their antiplatelet medication was 64 % in the MINT group and 50 % in the DVD group (p<0.01). Self-reported adherence at 12 months was higher in the MINT group compared to the DVD group (p<0.01). Results were similar among drug-eluting stent (DES) recipients. CONCLUSIONS: Among racial minorities, a phone-based motivational interview is effective at improving adherence to antiplatelet medications post coronary stent placement. Phone-based MINT seems to be a promising and cost-effective strategy to modify risk behaviors among minority populations at high cardiovascular risk. BACKGROUNDThe safe use of coronary stents requires the daily use of thienopyridines for 3 to 12 months after percutaneous coronary intervention (PCI). 1 The premature discontinuation of these medications 1 is associated with an increased risk of instent thrombosis, cardiovascular events and death. 2-6 Unfortunately, lack of medication adherence is common and is associated with significant health care costs and mortality. 7,8 Vulnerable groups such as racial minorities and the elderly have a higher risk of poor adherence. 5,6,9,10 In the case of antiplateletet medications, blacks are more likely to not receive a clopidogrel prescription 11 or to not fill it after PCI. Further, our prior analyses of insurer claims data showed that minority populations were less adherent to antiplatelet medications post drug-eluting stent (DES) placement. 12 The lack of appropriate use of evidence-based therapies after PCI may partially contribute to the excess morbidity and mortality reported among minorities. 13,14,6 The improvement of med...

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Medication Nonadherence

Marcum

Sevick

Handler

2013

JAMA

158

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Medication nonadherence is widely recognized as a common and costly problem. 1 Approximately 30% to 50% of US adults are not adherent to long-term medications leading to an estimated $100 billion in preventable costs annually. 1 The barriers to medication adherence are similar to other complex health behaviors, such as weight loss, which have multiple contributing factors. Despite the widespread prevalence and cost of medication nonadherence, it is undetected and undertreated in a significant proportion of adults across care settings. According to the World Health Organization, "increasing the effectiveness of adherence interventions may have far greater impact on the health of the population than any improvement in specific medical treatments." How can adherence be improved? We propose that the first step is to view medication nonadherence as a diagnosable and treatable medical condition.To treat a medical condition, an accurate diagnosis must first be established. However, for undetected and under-treated conditions such as medication nonadherence, one way to identify the population of interest is to conduct screening. The 1968 World Health Organization principles on screening tests have clear application to medication nonadherence. For example, the condition is an important problem, there are suitable tests available, and there are acceptable treatments for those with this problem. However, most clinicians are not formally trained on screening for, and diagnosing, medication nonadherence, nor are they fully aware of how best to treat nonadherence if detected. As a result, research has shown that clinicians develop varying heuristics surrounding the diagnosis and documentation of medication nonadherence. For example, one of the most common diagnostic assessments for medication nonadherence is simply asking patients if they have any problems taking the medication regimen as prescribed (and assuming the patient's response is accurate). When no further questions are asked, potentially addressable medication issues are left unattended.

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Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States

Abstract: Agency for Healthcare Research and Quality.

Cited by 665 publications

References 154 publications

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

Can Phone-Based Motivational Interviewing Improve Medication Adherence to Antiplatelet Medications After a Coronary Stent Among Racial Minorities? A Randomized Trial

Medication Nonadherence

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