title: Increasing the detection and response to adherence problems with cardiovascular medication in primary care through computerized drug management systems: a randomized controlled trial.
abstract: BACKGROUND
  Adherence with antihypertensive and lipid-lowering therapy is poor, resulting in an almost 2-fold increase in hospitalization. Treatment side effects, cost, and complexity are common reasons for nonadherence, and physicians are often unaware of these potentially modifiable problems.
  
  
  OBJECTIVE
  To determine if a cardiovascular medication tracking and nonadherence alert system, incorporated into a computerized health record system, would increase drug profile review by primary care physicians, increase the likelihood of therapy change, and improve adherence with antihypertensive and lipid-lowering drugs.
  
  
  METHODS
  There were 2293 primary care patients prescribed lipid-lowering or antihypertensive drugs who were randomized to the adherence tracking and alert system or active medication list alone to determine if the intervention increased drug profile review, changes in cardiovascular drug treatment, and refill adherence in the first 6 months. An intention to treat analysis was conducted using generalized estimating equations to account for clustering within physician.
  
  
  RESULTS
  Overall, medication adherence was below 80% for 36.3% of patients using lipid-lowering drugs and 40.8% of patients using antihypertensives at the start of the trial. There was a significant increase in drug profile review in the intervention compared to the control group (44.5% v. 35.5%; P < 0.001), a nonsignificant increase in drug discontinuations due to side effects (2.3% v. 2.0%; P = 0.61), and a reduction in therapy increases (28.5% v. 29.1%; P = 0.86). There was no significant change in refill adherence after 6 months of follow-up.
  
  
  CONCLUSIONS
  An adherence tracking and alert system increases drug review but not therapy changes or adherence in prevalent users of cardiovascular drug treatment. Targeting incident users where adverse treatment effects are more common and combining adherence tracking and alert tools with motivational interventions provided by multidisciplinary primary care teams may improve the effectiveness of the intervention.
authors.affiliation: Department of Epidemiology & Bio-statistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Robyn
authors.initials: R
authors.lastname: Tamblyn
authors.forename: Kristen
authors.initials: K
authors.lastname: Reidel
authors.forename: Allen
authors.initials: A
authors.lastname: Huang
authors.forename: Laurel
authors.initials: L
authors.lastname: Taylor
authors.forename: Nancy
authors.initials: N
authors.lastname: Winslade
authors.forename: Gillian
authors.initials: G
authors.lastname: Bartlett
authors.forename: Roland
authors.initials: R
authors.lastname: Grad
authors.forename: André
authors.initials: A
authors.lastname: Jacques
authors.forename: Martin
authors.initials: M
authors.lastname: Dawes
authors.forename: Pierre
authors.initials: P
authors.lastname: Larochelle
authors.forename: Alain
authors.initials: A
authors.lastname: Pinsonneault
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage*; D008297:Male; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D008875:Middle Aged; D010821:Physicians, Family / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D017010:Reminder Systems / Q000295:instrumentation*; D012737:Sex Factors; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents