title: Transtheoretical model intervention for adherence to lipid-lowering drugs.
abstract: An estimated 60% of individuals prescribed lipid-lowering medications are nonadherent. Failure to adhere increases morbidity, mortality, healthcare utilization, and healthcare costs. This study examined the effectiveness of a population-based, individualized Transtheoretical Model (TTM) expert system intervention to improve adherence and increase exercise and diet in a randomized 18-month trial involving 404 adults. Compared to usual care, treatment participants who started in a pre-action stage were significantly more likely to be in the Action and Maintenance (A/M) stages for adherence at end of treatment (55.3% versus 40%, z = 2.11, p < 0.05, h = 0.31) and at 18-months (56% versus 37.8%, z = 2.38, p < 0.01, h = 0.36). The treatment group scored significantly better on two measures of adherence at six and 12 months post-treatment (all p < 0.05, odds ratios [OR] 1.49-3.67). Among those who began in A/M, treatment participants were significantly more likely to remain in A/M at 18 months (85.2% versus 55.6%, z = 2.63, p < 0.01, h = 0.67). Those receiving treatment were significantly more likely to progress to A/M for exercise and dietary fat reduction (43.3% versus 24.7% for exercise, and 24.7% versus 12.5% for diet). TTM expert system interventions can have a significant impact on entire populations for adherence. Results for dietary fat and exercise suggest covariation of treatment effects.
authors.affiliation: Pro-Change Behavior Systems, Inc., West Kingston, Rhode Island, USA. sjohnson@prochange.com
authors.forename: Sara S
authors.initials: SS
authors.lastname: Johnson
authors.forename: Mary-Margaret
authors.initials: MM
authors.lastname: Driskell
authors.forename: Janet L
authors.initials: JL
authors.lastname: Johnson
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Dyment
authors.forename: James O
authors.initials: JO
authors.lastname: Prochaska
authors.forename: Janice M
authors.initials: JM
authors.lastname: Prochaska
authors.forename: Leslie
authors.initials: L
authors.lastname: Bourne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018752:Diet, Fat-Restricted; D015444:Exercise; D005103:Expert Systems; D005246:Feedback; D005260:Female; D015438:Health Behavior; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D018579:Patient Selection; D014481:United States
chemical_list: D000960:Hypolipidemic Agents