Effect of Community Pharmacist Intervention on Adherence to Long-Term Medications

NCT ID: NCT02604901

Last Updated: 2015-11-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1091 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-06-30

Study Completion Date

2014-07-31

Brief Summary

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The 4-arm factorial design RCT tested the impact of a behavioral intervention (SBI or BI), a reminder device (Pillbox), and the combination of the two on adherence in adult patients who filled a prescription for oral medications to treat diabetes or hyperlipidemia.

Detailed Description

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Patients diagnosed with chronic diseases often fail to follow their prescribed medication regimens, (16355071,19954264,16732693,23111664) which accounts for up to 290 billion dollars per year in unnecessary medical costs, largely because medication nonadherence increases their risk of disease progression, hospitalization, and premature death.(16355071, 23373139, 23032359) A number of studies have investigated ways to improve medication adherence; (18425859, 18537843) however, few studies on interventions have demonstrated large improvements in adherence and few have used scientifically rigorous study methods such as randomized controlled trials (RCTs).(24422970) A recent systematic review identified a need for adherence interventions and suggested the use of factorial designs in RCTs to study multiple interventions and combinations within large patient populations.(24422970)

This study used a factorial-designed, four-armed, RCT to examine the impact of three pharmacy-based interventions versus standard care on improving medication adherence and health outcomes in patients with diabetes and hyperlipidemia. The three interventions used in this study were a behavioral intervention, a pillbox weekly reminder, and the combination of the two.

Pillboxes (PB) used in this study had compartments for each day (7X1) and for participants taking multiple medications, sub-compartments for each medication per day (7X4).

The behavioral intervention, called Screening and Brief Intervention (SBI or BI), consisted of a short 2-5 minute conversation between the patient and the provider aimed to encourage modification in the patient's health behavior. While BI has primarily been used to address unhealthy alcohol use in patients (11), the researchers hypothesized that this patient-centered approach can be particularly useful for improving medication adherence in chronically ill patients. In this study, motivational interviewing counseling principles were used for motivating patients to take more active roles in self-managing their health. Motivational interviewing can take many forms, however, in this study, the BIs used a schema of motivational interviewing originally developed by the principal investigator titled POLAR\*S™ .

The specific aims of this research study included testing the impact of three community pharmacy intervention for adult patients with diabetes or hyperlipidemia on: (1) medication adherence; (2) biologic outcomes associated with medication adherence; (3) self-reported health and psychosocial status; and (4) pharmacists' impressions on how BI could be scalable to community pharmacy settings.

Conditions

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Medication Adherence

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Blinding Strategy

NONE

Study Groups

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Screening and Brief Intervention (BI)

Screening and Brief Intervention (BI) at initial prescription fill and at each additional refill.

Group Type EXPERIMENTAL

Screening and Brief Intervention (BI)

Intervention Type BEHAVIORAL

Rite Aid® pharmacists screened patients at the time of the initial fill with the Adherence Estimator™ and using the screening results, provided the behavioral intervention, Brief Intervention using motivational interviewing principles based on POLAR\*S (BI). BI was considered an active intervention method.

Pill Box (PB)

Pill Box (PB) and information about their medications at the initial fill and at each additional refill.

Group Type EXPERIMENTAL

Pill Box (PB)

Intervention Type BEHAVIORAL

Rite Aid® pharmacists provided patients with a Pill Box (PB) and information about their medications. However, pharmacists did not use motivational interviewing principles for engaging patients in direct interventions to modify behavior. PB was considered a passive intervention method.

Brief Intervention + Pill Box (BI+PB)

Screening and Brief Intervention (BI) and Pill Box (PB) at initial prescription fill and at each additional refill.

Group Type EXPERIMENTAL

Screening and Brief Intervention (BI)

Intervention Type BEHAVIORAL

Rite Aid® pharmacists screened patients at the time of the initial fill with the Adherence Estimator™ and using the screening results, provided the behavioral intervention, Brief Intervention using motivational interviewing principles based on POLAR\*S (BI). BI was considered an active intervention method.

Pill Box (PB)

Intervention Type BEHAVIORAL

Rite Aid® pharmacists provided patients with a Pill Box (PB) and information about their medications. However, pharmacists did not use motivational interviewing principles for engaging patients in direct interventions to modify behavior. PB was considered a passive intervention method.

Standard Care (SC)

The Standard Care (SC) arm administered traditional dispensing and counseling by Rite Aid® pharmacists.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Screening and Brief Intervention (BI)

Rite Aid® pharmacists screened patients at the time of the initial fill with the Adherence Estimator™ and using the screening results, provided the behavioral intervention, Brief Intervention using motivational interviewing principles based on POLAR\*S (BI). BI was considered an active intervention method.

Intervention Type BEHAVIORAL

Pill Box (PB)

Rite Aid® pharmacists provided patients with a Pill Box (PB) and information about their medications. However, pharmacists did not use motivational interviewing principles for engaging patients in direct interventions to modify behavior. PB was considered a passive intervention method.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Patients taking oral medications for diabetes or hyperlipidemia
* 30-85 years of age
* Comfortable speaking in English
* Not institutionalized
* Not diagnosed with psychosis or dementia.
* Needed at least one prescription refill with the index medication picked up within 14 days of the index prescription fill

Exclusion Criteria

\-
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Rite Aid Corp.

INDUSTRY

Sponsor Role collaborator

RTI International

OTHER

Sponsor Role collaborator

Pharmacy Quality Alliance

OTHER

Sponsor Role collaborator

Merck Sharp & Dohme LLC

INDUSTRY

Sponsor Role collaborator

University of Pittsburgh

OTHER

Sponsor Role lead

Responsible Party

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Jan Pringle

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Janice L Pringle, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Pittsburgh

Newell McElwee, PharmD, MSPH

Role: STUDY_CHAIR

Merck Sharp & Dohme LLC

Locations

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Rite Aid® Corporation

Marietta, Georgia, United States

Site Status

University of Pittsburgh

Pittsburgh, Pennsylvania, United States

Site Status

Countries

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United States

References

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Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005 Aug 4;353(5):487-97. doi: 10.1056/NEJMra050100. No abstract available.

Reference Type BACKGROUND
PMID: 16079372 (View on PubMed)

Yeaw J, Benner JS, Walt JG, Sian S, Smith DB. Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm. 2009 Nov-Dec;15(9):728-40. doi: 10.18553/jmcp.2009.15.9.728.

Reference Type BACKGROUND
PMID: 19954264 (View on PubMed)

Vik SA, Hogan DB, Patten SB, Johnson JA, Romonko-Slack L, Maxwell CJ. Medication nonadherence and subsequent risk of hospitalisation and mortality among older adults. Drugs Aging. 2006;23(4):345-56. doi: 10.2165/00002512-200623040-00007.

Reference Type BACKGROUND
PMID: 16732693 (View on PubMed)

Traynor K. Poor medication adherence remains a problem. Am J Health Syst Pharm. 2012 Nov 1;69(21):1850. doi: 10.2146/news120074. No abstract available.

Reference Type BACKGROUND
PMID: 23111664 (View on PubMed)

Stefanacci RG, Guerin S. Why medication adherence matters to patients, payers, providers. Manag Care. 2013 Jan;22(1):37-9. No abstract available.

Reference Type BACKGROUND
PMID: 23373139 (View on PubMed)

Williams J, Steers WN, Ettner SL, Mangione CM, Duru OK. Cost-related nonadherence by medication type among Medicare Part D beneficiaries with diabetes. Med Care. 2013 Feb;51(2):193-8. doi: 10.1097/MLR.0b013e318270dc52.

Reference Type BACKGROUND
PMID: 23032359 (View on PubMed)

Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000011. doi: 10.1002/14651858.CD000011.pub3.

Reference Type BACKGROUND
PMID: 18425859 (View on PubMed)

Williams A, Manias E, Walker R. Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. J Adv Nurs. 2008 Jul;63(2):132-43. doi: 10.1111/j.1365-2648.2008.04656.x.

Reference Type BACKGROUND
PMID: 18537843 (View on PubMed)

Viswanathan M, Golin CE, Jones CD, Ashok M, Blalock S, Wines RC, Coker-Schwimmer EJ, Grodensky CA, Rosen DL, Yuen A, Sista P, Lohr KN. Closing the quality gap: revisiting the state of the science (vol. 4: medication adherence interventions: comparative effectiveness). Evid Rep Technol Assess (Full Rep). 2012 Sep;(208.4):1-685.

Reference Type BACKGROUND
PMID: 24422970 (View on PubMed)

Babor TF, Kadden RM. Screening and interventions for alcohol and drug problems in medical settings: what works? J Trauma. 2005 Sep;59(3 Suppl):S80-7; discussion S94-100. doi: 10.1097/01.ta.0000174664.88603.21.

Reference Type BACKGROUND
PMID: 16355071 (View on PubMed)

Other Identifiers

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ECOPHIL

Identifier Type: -

Identifier Source: org_study_id

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