RT Journal Article
SR Electronic
T1 Treatment Adjustment and Medication Adherence for Complex Patients With Diabetes, Heart Disease, and Depression: A Randomized Controlled Trial
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 6
OP 14
DO 10.1370/afm.1343
VO 10
IS 1
A1 Lin, Elizabeth H. B.
A1 Von Korff, Michael
A1 Ciechanowski, Paul
A1 Peterson, Do
A1 Ludman, Evette J.
A1 Rutter, Carolyn M.
A1 Oliver, Malia
A1 Young, Bessie A.
A1 Gensichen, Jochen
A1 McGregor, Mary
A1 McCulloch, David K.
A1 Wagner, Edward H.
A1 Katon, Wayne J.
YR 2012
UL http://www.annfammed.org/content/10/1/6.abstract
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.