Phone Outreach Study Finds No Significant Improvement in Diabetes Medication Compliance

A recent AHRQ-funded study found that patients with diabetes did not improve their medication compliance after a phone call from a diabetes educator or pharmacist. The study, “Randomized Trial of Telephone Outreach To Improve Medication Adherence and Metabolic Control in Adults With Diabetes,” was published with an abstract online October 14 in Diabetes Care. The study included 2,378 adults with diabetes mellitus who had recently been prescribed a new class of medication. In a randomized trial, some patients received one scripted telephone call from a diabetes educator or clinical pharmacist to discuss adapting to the new medication. This intervention did not significantly improve medication adherence among patients, regardless of age, sex or race/ethnicity. Because nonadherence to medication is a major obstacle to better control of glucose, blood pressure and low-density lipoprotein cholesterol in adults with diabetes, the study noted, more research is needed to identify effective strategies to increase medication adherence.

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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 withdiabetes.

O'Connor PJ1, Schmittdiel JA2, Pathak RD3, Harris RI4, Newton KM5, Ohnsorg KA6, Heisler M7, Sterrett AT8, Xu S8, Dyer WT2, Raebel MA8, Thomas A9,Schroeder EB8, Desai JR6, Steiner JF8.

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Abstract

OBJECTIVE:

Medication nonadherence is a major obstacle to better control of glucose, blood pressure (BP), and LDL cholesterol in adults withdiabetes. 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.