title: Efficacy of a transtheoretical model-based expert system for antihypertensive adherence.
abstract: Blood pressure is not controlled in as many as 50%-75% of hypertensive patients, primarily because of inadequate adherence to treatment. This paper examines the efficacy of a Transtheoretical Model (TTM)-based expert system intervention designed to improve adherence with antihypertensives in a sample of 1,227 adults. Participants were proactively recruited and randomly assigned to receive usual care or three individualized expert system reports and a stage-matched manual over 6 months. Participants were surveyed at baseline, and 6, 12, and 18 months. Significantly more of the intervention group participants reported being in Action and Maintenance at follow-up time points (ie, 73.1% of the treatment group versus 57.6% of the control group at 12 months and 69.1% of the treatment group versus 59.2% of the control group at 18 months). Scores on a behavioral measure of nonadherence differed significantly at follow-up time points. TTM-based expert system interventions have the potential for a significant impact on entire populations of individuals who fail to adhere, regardless of their readiness to change.
authors.affiliation: Pro-Change Behavior Systems, Inc., 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: Janice M
authors.initials: JM
authors.lastname: Prochaska
authors.forename: William
authors.initials: W
authors.lastname: Zwick
authors.forename: James O
authors.initials: JO
authors.lastname: Prochaska
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006266:Health Education; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009511:New England; D010349:Patient Compliance; D017216:Telemedicine
chemical_list: D000959:Antihypertensive Agents