An intervention to increase physicians' use of adherence-enhancing strategies in managing hypercholesterolemic patients.
OBJECTIVE
Patients' lack of adherence to medical regimens frustrates many practicing physicians. This study was conducted to determine the effectiveness of a combined continuing medical education intervention in increasing physicians' adherence-enhancing skills and improving hypercholesterolemic patients' health.


METHODS
A prospective, randomized, controlled trial was designed using a nested cohort of 28 community physicians throughout Alabama and 222 of their hypercholesterolemic outpatients. The intervention, carried out in 1998, consisted of three interactive case audio-conferences plus chart reminders. Physicians' learning was measured by unannounced standardized patients, and patients' health by serum cholesterol levels, weight, knowledge of hypercholesterolemia, self-reported dietary habits, and health status.


RESULTS
No significant difference was found in the numbers of physician adherence-enhancing strategies, although the number did increase within the treatment group. There were significant differences in the intervention group's patients' knowledge of cholesterol management (p = .008) and significant reductions in their self-reported consumption of dietary fats (p = .002). A significant difference was found in the serum cholesterol level of men in the intervention group nine months after the intervention (p = .02).


CONCLUSIONS
Combining a series of interactive case audio-conferences with chart reminders shows promise in increasing physicians' adherence-enhancing strategies. In chronic disease management, the problem of enhancing adherence remains complex.
Casebeer
L L
LL
University of Alabama School of Medicine (UASM), Birmingham, USA. casebeer@uab.edu
Klapow
J C
JC
Centor
R M
RM
Stafford
M A
MA
Renkl
L A
LA
Mallinger
A P
AP
Kristofco
R E
RE
D000328:Adult; D000407:Alabama; D000704:Analysis of Variance; D002983:Clinical Competence; D015331:Cohort Studies; D015897:Comorbidity; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D018709:Statistics, Nonparametric