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Diabetes Care. 2014 Dec;37(12):3317-24. doi: 10.2337/dc14-0596. Epub 2014 Oct 14.

Randomized trial of telephone outreach to improve medication adherence and metabolic control in adults with diabetes.

Author information

1
HealthPartners Institute for Education and Research, Minneapolis, MN patrick.j.oconnor@healthpartners.com.
2
Kaiser Permanente Division of Research, Northern California, Oakland, CA.
3
Marshfield Clinic, Marshfield, WI.
4
Geisinger Center for Health Research, Danville, PA.
5
Group Health Research Institute, Seattle, WA.
6
HealthPartners Institute for Education and Research, Minneapolis, MN.
7
University of Michigan, Center for Clinical Management Research, Ann Arbor, MI.
8
Institute for Health Research, Kaiser Permanente, Denver, CO.
9
Henry Ford Health System, Detroit, MI.

Abstract

OBJECTIVE:

Medication nonadherence is a major obstacle to better control of glucose, blood pressure (BP), and LDL cholesterol in adults with diabetes. Inexpensive effective strategies to increase medication adherence are needed.

RESEARCH DESIGN AND METHODS:

In a pragmatic randomized trial, we randomly assigned 2,378 adults with diabetes mellitus who had recently been prescribed a new class of medication for treating elevated levels of glycated hemoglobin (A1C) ≥8% (64 mmol/mol), BP ≥140/90 mmHg, or LDL cholesterol ≥100 mg/dL, to receive 1) one scripted telephone call from a diabetes educator or clinical pharmacist to identify and address nonadherence to the new medication or 2) usual care. Hierarchical linear and logistic regression models were used to assess the impact on 1) the first medication fill within 60 days of the prescription; 2) two or more medication fills within 180 days of the prescription; and 3) clinically significant improvement in levels of A1C, BP, or LDL cholesterol.

RESULTS:

Of the 2,378 subjects, 89.3% in the intervention group and 87.4% in the usual-care group had sufficient data to analyze study outcomes. In intent-to-treat analyses, intervention was not associated with significant improvement in primary adherence, medication persistence, or intermediate outcomes of care. Results were similar across subgroups of patients defined by age, sex, race/ethnicity, and study site, and when limiting the analysis to those who completed the intended intervention.

CONCLUSIONS:

This low-intensity intervention did not significantly improve medication adherence or control of glucose, BP, or LDL cholesterol. Wide use of this strategy does not appear to be warranted; alternative approaches to identify and improve medication adherence and persistence are needed.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02192255.

PMID:
25315207
PMCID:
PMC4751474
DOI:
10.2337/dc14-0596
[Indexed for MEDLINE]
Free PMC Article

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