PT  - JOURNAL ARTICLE
AU  - Lin, Elizabeth H. B.
AU  - Von Korff, Michael
AU  - Ciechanowski, Paul
AU  - Peterson, Do
AU  - Ludman, Evette J.
AU  - Rutter, Carolyn M.
AU  - Oliver, Malia
AU  - Young, Bessie A.
AU  - Gensichen, Jochen
AU  - McGregor, Mary
AU  - McCulloch, David K.
AU  - Wagner, Edward H.
AU  - Katon, Wayne J.
TI  - Treatment Adjustment and Medication Adherence for Complex Patients With Diabetes, Heart Disease, and Depression: A Randomized Controlled Trial
AID  - 10.1370/afm.1343
DP  - 2012 Jan 01
TA  - The Annals of Family Medicine
PG  - 6--14
VI  - 10
IP  - 1
4099  - http://www.annfammed.org/content/10/1/6.short
4100  - http://www.annfammed.org/content/10/1/6.full
SO  - Ann Fam Med2012 Jan 01; 10
AB  - PURPOSE Medication nonadherence, inconsistent patient self-monitoring, and inadequate treatment adjustment exacerbate poor disease control. In a collaborative, team-based, care management program for complex patients (TEAMcare), we assessed patient and physician behaviors (medication adherence, self-monitoring, and treatment adjustment) in achieving better outcomes for diabetes, coronary heart disease, and depression. METHODS A randomized controlled trial was conducted (2007–2009) in 14 primary care clinics among 214 patients with poorly controlled diabetes (glycated hemoglobin [HbA1c] ≥8.5%) or coronary heart disease (blood pressure >140/90 mm Hg or low-density lipoprotein cholesterol >130 mg/dL) with coexisting depression (Patient Health Questionnaire-9 score ≥10). In the TEAMcare program, a nurse care manager collaborated closely with primary care physicians, patients, and consultants to deliver a treat-to-target approach across multiple conditions. Measures included medication initiation, adjustment, adherence, and disease self-monitoring. RESULTS Pharmacotherapy initiation and adjustment rates were sixfold higher for antidepressants (relative rate [RR] = 6.20; P <.001), threefold higher for insulin (RR = 2.97; P <.001), and nearly twofold higher for antihypertensive medications (RR = 1.86, P <.001) among TEAMcare relative to usual care patients. Medication adherence did not differ between the 2 groups in any of the 5 therapeutic classes examined at 12 months. TEAMcare patients monitored blood pressure (RR = 3.20; P <.001) and glucose more frequently (RR = 1.28; P = .006). CONCLUSIONS Frequent and timely treatment adjustment by primary care physicians, along with increased patient self-monitoring, improved control of diabetes, depression, and heart disease, with no change in medication adherence rates. High baseline adherence rates may have exerted a ceiling effect on potential improvements in medication adherence.