A Systems-Level Approach to Improving Medication Adherence in Hypertensive Latinos: a Randomized Control Trial
dc.contributor.author | Schoenthaler, Antoinette | |
dc.contributor.author | de la Calle, Franzenith | |
dc.contributor.author | Pitaro, Maria | |
dc.contributor.author | Lum, Audrey | |
dc.contributor.author | Chaplin, William | |
dc.contributor.author | Mogavero, Jazmin | |
dc.contributor.author | Rosal, Milagros C. | |
dc.date | 2022-08-11T08:10:19.000 | |
dc.date.accessioned | 2022-08-23T17:04:02Z | |
dc.date.available | 2022-08-23T17:04:02Z | |
dc.date.issued | 2019-10-17 | |
dc.date.submitted | 2019-11-14 | |
dc.identifier.citation | <p>J Gen Intern Med. 2019 Oct 17. doi:10.1007/s11606-019-05419-3. <a href="https://doi.org/10.1007/s11606-019-05419-3">Link to article on publisher's site</a></p> | |
dc.identifier.issn | 0884-8734 (Linking) | |
dc.identifier.doi | 10.1007/s11606-019-05419-3 | |
dc.identifier.pmid | 31625041 | |
dc.identifier.uri | http://hdl.handle.net/20.500.14038/44553 | |
dc.description.abstract | BACKGROUND: Despite numerous interventions targeting medication adherence in patients with uncontrolled hypertension, practice-based trials in Latino patients are scant. OBJECTIVE: 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. STUDY DESIGN: Randomized control trial. PARTICIPANTS: Patients (50% women; mean age, 61 years) were recruited from April 2013 to August 2015 in a community-based practice in New York. INTERVENTION: 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. MAIN OUTCOME MEASURES: 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. KEY RESULTS: 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. CONCLUSIONS: 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. CLINICAL TRIAL REGISTRATION: NCT03560596. | |
dc.language.iso | en_US | |
dc.relation | <p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=31625041&dopt=Abstract">Link to Article in PubMed</a></p> | |
dc.relation.url | https://doi.org/10.1007/s11606-019-05419-3 | |
dc.subject | medication adherence | |
dc.subject | hypertension | |
dc.subject | Latino | |
dc.subject | team care | |
dc.subject | Behavioral Medicine | |
dc.subject | Cardiovascular Diseases | |
dc.subject | Community Health and Preventive Medicine | |
dc.subject | Health Services Administration | |
dc.subject | Preventive Medicine | |
dc.subject | Telemedicine | |
dc.title | A Systems-Level Approach to Improving Medication Adherence in Hypertensive Latinos: a Randomized Control Trial | |
dc.type | Journal Article | |
dc.source.journaltitle | Journal of general internal medicine | |
dc.identifier.legacycoverpage | https://escholarship.umassmed.edu/prc_pubs/147 | |
dc.identifier.contextkey | 15775041 | |
html.description.abstract | <p>BACKGROUND: Despite numerous interventions targeting medication adherence in patients with uncontrolled hypertension, practice-based trials in Latino patients are scant.</p> <p>OBJECTIVE: 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.</p> <p>STUDY DESIGN: Randomized control trial.</p> <p>PARTICIPANTS: Patients (50% women; mean age, 61 years) were recruited from April 2013 to August 2015 in a community-based practice in New York.</p> <p>INTERVENTION: 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.</p> <p>MAIN OUTCOME MEASURES: 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. KEY</p> <p>RESULTS: 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.</p> <p>CONCLUSIONS: 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.</p> <p>CLINICAL TRIAL REGISTRATION: NCT03560596.</p> | |
dc.identifier.submissionpath | prc_pubs/147 | |
dc.contributor.department | Prevention Research Center | |
dc.contributor.department | Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine |