title: Osteoporosis telephonic intervention to improve medication regimen adherence: a large, pragmatic, randomized controlled trial.
abstract: BACKGROUND
  Multiple studies demonstrate poor adherence to medication regimens prescribed for chronic illnesses, including osteoporosis, but few interventions have been proven to enhance adherence. We examined the effectiveness of a telephone-based counseling program rooted in motivational interviewing to improve adherence to a medication regimen for osteoporosis.
  
  
  METHODS
  We conducted a 1-year randomized controlled clinical trial. Participants were recruited from a large pharmacy benefits program for Medicare beneficiaries. All potentially eligible individuals had been newly prescribed a medication for osteoporosis. Consenting participants were randomized to a program of telephone-based counseling (n = 1046) using a motivational interviewing framework or a control group (n = 1041) that received mailed educational materials. Medication regimen adherence was the primary outcome compared across treatment arms and was measured as the median (interquartile range) medication possession ratio, calculated as the ratio of days with filled prescriptions to total days of follow-up.
  
  
  RESULTS
  The groups were balanced at baseline, with a mean age of 78 years; 93.8% were female. In an intention-to-treat analysis, median adherence was 49% (interquartile range, 7%-88%) in the intervention arm and 41% (2%-86%) in the control arm (P = .07, Kruskal-Wallis test). There were no differences in self-reported fractures.
  
  
  CONCLUSIONS
  In this randomized controlled trial, we did not find a statistically significant improvement in adherence to an osteoporosis medication regimen using a telephonic motivational interviewing intervention.
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA. dsolomon@partners.org.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.forename: Maura D
authors.initials: MD
authors.lastname: Iversen
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.forename: Timothy
authors.initials: T
authors.lastname: Gleeson
authors.forename: M Alan
authors.initials: MA
authors.lastname: Brookhart
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Patrick
authors.forename: Laura
authors.initials: L
authors.lastname: Rekedal
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
authors.forename: Joyce
authors.initials: J
authors.lastname: Lii
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000188:drug therapy*; D016037:Single-Blind Method; D013689:Telephone; D016903:Drug Monitoring