Effect of a remotely delivered tailored multicomponent approach to enhance medication taking for patients with hyperlipidemia, hypertension, and diabetes: The STIC2IT cluster randomized clinical trial

JAMA Internal Medicine Aug 10, 2018

Choudhry NK, et al. - Researchers investigated if a remotely delivered multicomponent behaviorally tailored intervention improves adherence to medications for hyperlipidemia, hypertension, and diabetes vs usual care. Outcomes of this study suggest a statistically significant increase in medication adherence in association with this remotely delivered multicomponent behaviorally tailored intervention, however, there appeared no change in clinical outcomes.

Methods

  • Researchers performed a two-arm pragmatic cluster randomized controlled trial at a multispecialty group practice.
  • Participants were patients (18 to 85 years old) with suboptimal hyperlipidemia, hypertension, or diabetes control, and were not adherent to prescribed medications for these conditions.
  • Participants were provided usual care or a multicomponent intervention using telephone-delivered behavioral interviewing by trained clinical pharmacists, text messaging, pillboxes, and mailed progress reports.
  • Medication adherence from pharmacy claims data was assessed as the primary outcome measure.
  • They assessed disease control based on achieved levels of low-density lipoprotein cholesterol, systolic blood pressure, and hemoglobin A1c via electronic health records, and health care resource use from claims data as secondary outcome measures.
  • Using intention-to-treat principles and multiple imputation for missing values, they evaluated the outcomes.

Results

  • From 14 practice sites, researchers included 4,078 participants (mean (SD) age: 59.8 (11.6) years; 45.1% females).
  • They noted a 4.7% (95% CI, 3.0%-6.4%) improvement in adherence with intervention vs usual care, however, there was no difference in the odds of achieving good disease control for at least 1 (odds ratio [OR], 1.10; 95% CI, 0.94-1.28) or all eligible conditions (OR, 1.05; 95% CI, 0.91-1.22), hospitalization (OR, 1.02; 95% CI, 0.78-1.34), or having a physician office visit (OR, 1.11; 95% CI, 0.91-1.36).
  • Intervention participants displayed significantly less risk for an emergency department visit (OR, 0.62; 95% CI, 0.45-0.85).
  • In as-treated analyses, a 10.4% (95% CI, 8.2%-12.5%) increase in adherence, a significant increase in patients achieving disease control for at least 1 eligible condition (OR, 1.24; 95% CI, 1.03-1.50), and nonsignificantly improved disease control for all eligible conditions was evident in association with the intervention (OR, 1.18; 95% CI, 0.99-1.41).
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