Improving adherence and reducing medication discrepancies in patients with diabetes.
OBJECTIVE
To improve medication adherence by reducing self-reported adherence barriers, and to identify medication discrepancies by comparing physician-prescribed and patient-reported medical regimens.


METHODS
Prospective, randomized, controlled trial.


METHODS
A single academically affiliated community health center. Eligible patients had type 2 diabetes, had undergone laboratory testing in the year preceding the study, and had visited the clinic in the 6 months preceding the study.


METHODS
A pharmacist administered detailed questionnaires, provided tailored education regarding medication use and help with appointment referrals, and created a summary of adherence barriers and medication discrepancies that was entered into the medical record and electronically forwarded to the primary care provider.


METHODS
Changes in self-reported adherence rates and barriers were compared 3 months after the initial interview. Intervention patients with medication discrepancies at baseline were assessed for resolution of discrepancies at 3 months.


RESULTS
Rates of self-reported medication adherence were very high and did not improve further at 3 months (6.9 of 7 d, with all medicines taken as prescribed; p = 0.3). Medical regimen discrepancies were identified in 44% of intervention patients, involving 45 doses of medicines. At 3-month follow-up, 60% of discrepancies were resolved by corrections in the medical record, while only 7% reflected corrections by patients.


CONCLUSIONS
In this community cohort, patients reported few adherence barriers and very high medication adherence rates. Our patient-tailored intervention did not further reduce these barriers or improve self-reported adherence. The high prevalence of medication discrepancies appeared to mostly reflect inaccuracies in the medical record rather than patient errors.
Grant
Richard W
RW
General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114-2517, USA. rgrant@partners.org
Devita
Nicole G
NG
Singer
Daniel E
DE
Meigs
James B
JB
D000368:Aged; D003142:Communication; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004282:Documentation; D004363:Drug Utilization; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010349:Patient Compliance; D010595:Pharmacists; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires
D007004:Hypoglycemic Agents