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A Systems-Level Approach to Improving Medication Adherence in Hypertensive Latinos: a Randomized Control Trial

  • Antoinette SchoenthalerEmail author
  • Franzenith de la Calle
  • Maria Pitaro
  • Audrey Lum
  • William Chaplin
  • Jazmin Mogavero
  • Milagros C. Rosal
Original Research

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

KEY WORDS

medication adherence hypertension Latino team care 

Notes

Acknowledgments

The authors would like to thank the Health Coaches (Palmira Brown, Cindy Ruiz, Ana Ventura, Jacqueline Camacho, and Luis Carrasco) at Union Health Center for their dedication to this project in the delivery of the intervention. Morisky Widget™, MMAS™, MMAS4™, MMAS-8™, Morisky Medication Adherence Protocol™, and Morisky Medication Adherence Scale™ content, name, and trademarks are protected by U.S. and International Trademark and Copyright laws. Permission for use of the scale and its coding is required. A license agreement is available from Donald E. Morisky, ScD, ScM, MSPH, 14735 NE 20th St Bellevue, WA 98007, USA; dmorisky@gmail.com or Trubow1@gmail.com.

Funding Information

This work was financially supported by grant 12GRNT11670001 from the American Heart Association (PI: Schoenthaler).

Compliance with Ethical Standards

The study was approved by the NYU Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Antoinette Schoenthaler
    • 1
    Email author
  • Franzenith de la Calle
    • 1
  • Maria Pitaro
    • 2
  • Audrey Lum
    • 2
  • William Chaplin
    • 3
  • Jazmin Mogavero
    • 3
  • Milagros C. Rosal
    • 4
  1. 1.Department of Population Health, Center for Healthful Behavior ChangeNew York University School of MedicineNew YorkUSA
  2. 2.Union Health CenterNew YorkUSA
  3. 3.Department of PsychologySt. Johns UniversityJamaicaUSA
  4. 4.Preventive and Behavioral Medicine, Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterUSA

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