Increasing the detection and response to adherence problems with cardiovascular medication in primary care through computerized drug management systems: a randomized controlled trial.
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.
Tamblyn
Robyn
R
Department of Epidemiology & Bio-statistics, McGill University, Montreal, Quebec, Canada.
Reidel
Kristen
K
Huang
Allen
A
Taylor
Laurel
L
Winslade
Nancy
N
Bartlett
Gillian
G
Grad
Roland
R
Jacques
André
A
Dawes
Martin
M
Larochelle
Pierre
P
Pinsonneault
Alain
A
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
D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents