title: An intervention to increase physicians' use of adherence-enhancing strategies in managing hypercholesterolemic patients.
abstract: 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.
authors.affiliation: University of Alabama School of Medicine (UASM), Birmingham, USA. casebeer@uab.edu
authors.forename: L L
authors.initials: LL
authors.lastname: Casebeer
authors.forename: J C
authors.initials: JC
authors.lastname: Klapow
authors.forename: R M
authors.initials: RM
authors.lastname: Centor
authors.forename: M A
authors.initials: MA
authors.lastname: Stafford
authors.forename: L A
authors.initials: LA
authors.lastname: Renkl
authors.forename: A P
authors.initials: AP
authors.lastname: Mallinger
authors.forename: R E
authors.initials: RE
authors.lastname: Kristofco
mesh_terms: 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