Table 11Hyperlipidemia: detailed medication adherence outcomes

Type of InterventionTrial
N per
Group
Sample and SettingIntervention GroupsIntervention DoseMeasure (Range, direction)SourceBaselineFirst
Followup
Additional
Followups
Collaborative careLin et al., 200689

Baseline:
G1: 50
G2: 52
12 mos:
G1: 54
G2: 63
Adults with diabetes mellitus and depression

Primary care clinics
G1: Collaborative care for depression using either medications or problem-solving treatment
G2: Advised to consult PCP for depression treatment
16 phone or face-to-face visits over 12 monthsPercentage of days nonadherent to lipid-lowering agent
(0–100%)
Pharmacy refill dataBaseline
Mean (SD)
G1: 29.3% (26.7%)
G2: 24.5% (23.0%)
95% CI, NR
p: NS
12 months:
G1: 28.8% (27.1%)
G2: 27.7% (24.0%)
95% CI, NR
p: NS
NR
Adjusted difference in percentage of days non-adherent to lipid-lowering agent comparing G1 and G2Pharmacy refill dataNA12 months:
(%) = −0.2
95% CI:
−7.23 to 6.76
p: NS
NR
Decision aidsMann et al., 201092

G1: NR
G2: NR
Adult patients with diabetes mellitus

Urban primary care clinic
G1: Statin choice decision aid
G2: ADA print material
One face-to-face session + printed materialPercentage with “good adherence” on 8-item Morisky Adherence Scale
(0–100%)
Self-reportBaseline
NR
3 months:
Overall: 70%
G1: NR
G2: NR
95% CI, NR
p: No significant difference between groups
6 months:
Overall: 80%
G1: NR
G2: NR
95% CI, NR
p: No significant difference between groups
Weymiller et al., 200793
Jones et al., 200994

G1: 33
G2: 29


G1a: NR
G1b: NR
G2a: NR
G2b: NR


G1: 52
G2: 46
Adults with Type 2 diabetes mellitus

Metabolic specialty clinic
G1: Statin choice decision aid
 G1a: Research staff before visit
 G1b: Clinician during visit
G2: Standard of care educational pamphlet control
 G2a: Research staff before visit
 G2b: Delivered by clinician during visit
One face-to-face session + printed materialNumber missing no medication doses in the last weekSelf-reportNR3 months:
G1: 31
G2: 23
OR: 3.4
95% CI:
1.5 to 7.5
p: NR
NR
Number missing no medication doses in the last week, by mode of deliverySelf-reportNR3 months:
G1a: NR
G1b: NR
G2a: NR
G2b: NR
OR for delivery mode: 0.8
95% CI:
0.3, 2.6
p: NS
NR
Percentage using statins at followupSelf-reportNR3 months:
N (%)
G1: 33 (63%)
G2: 29 (63%)
95% CI, NR
p: NR
OR: 1.4
95% CI:
0.8 to 2.4
p: NR
NR
Education and behavioral supportGuthrie et al., 200195

G1: 3635
G2: 913
Adults with elevated MI risk and elevated cholesterol

Primary care clinics
G1: Education from physicians, 2 weeks of free statin, two phone reminders, and four reminder postcards
G2: Education from physicians, 2 weeks of free statin, no telephone calls, and two reminder postcards
Face-to-face + two phone calls + four mailingsPercentage reporting currently taking pravastatin as prescribedSelf-reportNR6 months:
G1: 79.7%
G2: 77.4%
95% CI, NR
p: NR
NR
Percentage indicating that no doses missed in the past 7 daysSelf-reportNR6 months:
G1: 64.3%
G2: 61.8%
95% CI, NR
p: NR
NR
Johnson et al., 200696


G1: NR
G2: NR
Adults 21 to 85 on cholesterol medication

Multiple sources
G1: Mailed individualized computer-generated intervention and manual for lipid-lowering medication adherence.
G2: Did not receive intervention materials
Three mailings over 6 monthsPre-action sample:
percentage reaching action or maintenance stage for medication adherence; stage of change algorithm (0 to 100%)
Self-reportBaseline:
G1: NR
G2: NR
95% CI, NR
p >0.05
6 months:
G1: 55.3%
G2: 40.0%
OR: 1.80
95% CI, NR
p<0.05
12 months:
G1: NR
G2: NR
95% CI, NR
p=0.057

18 months:
G1: 56.0%
G2: 37.8%
OR: NR
95% CI, NR
p<0.01
Pre-action sample:
4-item Medication Adherence Scale Score (better adherence with higher scores)
Self-reportBaseline:
G1: NR
G2: NR
95% CI, NR
p >0.05
6 months:
G1: NR
G2: NR
OR: 1.49
95% CI, NR
p<0.01
12 months:
G1: NR
G2: NR
OR: 1.62
95% CI, NR
p<0.001

18 months:
G1: NR
G2: NR
OR: 1.62
95% CI, NR
p<0.01
Pre-action sample:
Mean adherence score on 5-item survey (better adherence with lower scores)
Self-reportBaseline:
G1: NR
G2: NR
95% CI, NR
p >0.05
6 months:
G1: NR
G2: NR
OR: 2.03
95% CI, NR
p>0.05
12 months:
G1: NR
G2: NR
OR: 3.67
95% CI, NR
p<0.01

18 months:
G1: NR
G2: NR
OR: 2.86
95% CI, NR
p<0.05
Post-action sample:
percentage maintaining action or maintenance stage for medication adherence; stage of change algorithm (0 to 100%)
Self-reportBaseline:
G1: NR
G2: NR
95% CI, NR
p NR
6 months:
G1: NR
G2: NR
OR: 2.12
95% CI, NR
p>0.05
12 months:
G1: NR
G2: NR
OR: NR
95% CI, NR
p>0.05

18 months:
G1: 85.0%
G2: 55.6%
OR: NR
95% CI, NR
p<0.01
Powell et al., 199597

Overall
G1: 1,993
G2: 2,253


Simvastatin
G1: 271
G2: 297
Adults on benazepril, metoprolol, simvastatin or transdermal estrogen

HMO members
G1: Mailed educational videotapes to improve adherence
G2: Did not receive mailed videotapes
One mailed videoMPR
(0 to 1)
Pharmacy refill dataNR9 months:
Overall Mean (SD)
G1:0.70(0.23)
G2:0.70(0.28)
95% CI, NR
p: NR

Simvastatin
Mean (SD)
G1:0.73(0.26)
G2:0.70(0.28)
95% CI, NR
p: NR
NR
≥80% adherence by MPR

≥80% adherence by MPR
Pharmacy refill dataNR9 months:
Overall: N (%)
G1:917 (46%)
G2:998 (44%)
95% CI, NR
p: NR

Simvastatin
G1:135 (50%)
G2:138 (46%)
95% CI, NR
p: NR
NR
Schectman et al., 199498

Niacin:
G1: 40
G2: 40

BAS:
G1: 18
G2: 22
Adults with hyperlipidemia on treatment with either niacin or bile acid sequestrant

VA medical center
G1: Initial clinic visit + five calls for education and support
G2: No telephone contact following initial clinic visit
One face-to-face + five calls over 28 days“During the past week, how many doses of your medication have you missed?”
(Proportion measured not described)
Self-reportNR2 months:
Niacin:
G1: 76 (SD 5)
G2: 77 (SD 6)
95% CI, NR
p: 0.85

BAS:
G1: 76 (SD 7)
G2: 60 (SD 9)
95% CI, NR
p: 0.14
NR
Percentage refilling prescriptionPharmacy refill dataNR2 months:
Niacin
(Mean (SD)):
G1: 90% (2)
G2: 84% (3)
95% CI, NR
p: 0.07

BAS
(Mean (SD)):
G1: 88% (4)
G2: 82% (4)
95% CI, NR
p: 0.32
NR
Stacy et al., 200999

G1: 253
G2: 244
Adults ≥21 years old with a new statin prescription

HMO or PPO members
G1: Tailored behavioral support delivered via an IVR system + tailored printed mailed materials
G2: Nontailored behavioral advice from a single IVR call + nontailored, printed materials
One to three IVR calls over 6 monthsPercentage with MPR ≥80%Pharmacy refill dataNR6 months:
G1: 47.0%
G2: 38.9%
Unadjusted OR: 1.39
90% CI:
1.03 to 1.88
Adjusted OR: 1.43
90% CI, 1.05 to 1.96
p: <0.10
NR
Persistence: Percentage in possession of a statin at the end of 6 monthsPharmacy refill dataNR6 months:
G1: 70.4%
G2: 60.7%
Unadjusted OR, 1.54
90% CI:
1.13, 2.10
Adjusted OR: 1.64
90%CI:
1.19, 2.26
p: <0.05
NR
Continuous Persistence: statin prescription dispensed at least every 30 days after the refill date (no gaps >30 days)Pharmacy refill dataNR6 months:
G1: 52.2%
G2: 44.3%
Unadjusted OR: 1.37
90% CI:
1.02–1.85
Adjusted OR: 1.41
90%CI:
1.05–1.94
p: <0.10
NR
Both Continuous persistence (as defined above) and medication possession ratio ≥80%Pharmacy refill dataNR6 months:
G1: 45.1%
G2: 37.3%
Unadjusted OR: 1.38
90% CI:
1.03 to 1.86
Adjusted OR: 1.41
90% CI:
1.03 to 1.92
p: <0.10
NR
Multicomponent (education face-to-face, pharmacist + blister packaging)Lee et al., 200678
G1: 83
G2: 76


G1: 83
G2: 76
Adults ≥65 taking ≥four daily medications

Pharmacy at U.S. military medical center
G1: Continuation of intervention: Face-to-face educational pharmacist visits and blister packing of medications
G2: Discontinuation of intervention, medications provided in bottles
Seven face-to-face visits over 12 monthsPercentage of pills taken vs. prescribedPill countNR6 months:
Mean (SD)
G1: 95.5% (7.7)
G2: 69.1% (16.4)
95% CI, NR
p<0.001
NR
Percentage with ≥80% adherencePill countNR6 months:
G1: 97.4%
G2: 21.7%
95% CI, NR
p<0.001
NR

Abbreviations: ADA = American Diabetes Association; BAS = bile acid sequestrant; CI = confidence interval; G = group; HMO = health maintenance organization; IVR = interactive voice recognition; MI = myocardial infarction; mos = months; MPR = medication possession ratio; N = number; NA = not applicable; NR = not reported; NS = not significant; OR = odds ratio; PCP = primary care provider; PPO = preferred provider organization; SD = standard deviation; U.S. = United States; VA = Department of Veterans Affairs

From: Results

Cover of Closing the Quality Gap: Revisiting the State of the Science (Vol. 4: Medication Adherence Interventions: Comparative Effectiveness)
Closing the Quality Gap: Revisiting the State of the Science (Vol. 4: Medication Adherence Interventions: Comparative Effectiveness).
Evidence Reports/Technology Assessments, No. 208.4.
Viswanathan M, Golin CE, Jones CD, et al.

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