title: Characteristics of diabetic patients associated with achieving and maintaining blood pressure targets in the Adherence and Intensification of Medications program.
abstract: OBJECTIVE
  To determine patient characteristics associated with achieving and sustaining blood pressure (BP) targets in the Adherence and Intensification of Medications program, a program led by pharmacists trained in motivational interviewing and authorized to make BP medication changes.
  
  
  METHODS
  We conducted a retrospective cohort study of patients with diabetes and persistent hypertension in Kaiser Permanente and the Department of Veterans Affairs. Using two-level logistic regression, baseline survey data from 458 program participants were examined to determine patient characteristics associated with (1) discharge from the program with a target BP (short-term success) and (2) maintenance of the target BP over a nine-month period (long-term success).
  
  
  RESULTS
  In multivariable analyses, patients who screened positive for depression or had a higher baseline systolic BP were less likely to achieve short-term success (adjusted odds ratio (AOR) 0.42 [95% confidence interval (CI): 0.19-0.93], p = 0.03; AOR 0.94 [0.91-0.97], p < 0.01; respectively). Patients who reported at baseline one or more barriers to medication adherence were less likely to achieve long-term success (AOR 0.50 [0.26-0.94], p = 0.03).
  
  
  CONCLUSIONS
  Although almost 90% of patients achieved short-term success, only 28% achieved long-term success. Baseline barriers to adherence were associated with lack of long-term success and could be the target of maintenance programs for patients who achieve short-term success.
authors.affiliation: 1Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI.
authors.forename: Mandi L
authors.initials: ML
authors.lastname: Klamerus
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D048909:Diabetes Complications / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000523:psychology; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D020377:Self Efficacy; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: Blood pressure; diabetes; medication adherence; questionnaires
references.citation: Med Care. 1996 Mar;34(3):220-33
references.pmid: 8628042
references.citation: J Gen Intern Med. 2003 Nov;18(11):893-902
references.pmid: 14687274
references.citation: Arch Intern Med. 2011 Jul 11;171(13):1173-80
references.pmid: 21747013
references.citation: J Clin Hypertens (Greenwich). 2007 May;9(5):345-54
references.pmid: 17485970
references.citation: Pharmacotherapy. 2006 Apr;26(4):483-92
references.pmid: 16553506
references.citation: Arch Intern Med. 2009 Nov 23;169(21):1996-2002
references.pmid: 19933962
references.citation: Circulation. 2012 Jun 12;125(23):2863-72
references.pmid: 22570370
references.citation: Health Serv Res. 2005 Dec;40(6 Pt 1):1918-30
references.pmid: 16336556
references.citation: Arch Intern Med. 2010 Oct 11;170(18):1634-9
references.pmid: 20937921
references.citation: Am J Manag Care. 2004 Nov;10(11 Pt 2):839-45
references.pmid: 15609737
references.citation: Pharmacotherapy. 2010 Mar;30(3):228-35
references.pmid: 20180606
references.citation: JAMA. 2006 Dec 6;296(21):2563-71
references.pmid: 17101639
references.citation: J Clin Hypertens (Greenwich). 2011 Jun;13(6):431-7
references.pmid: 21649843
references.citation: Am J Med. 2006 Jan;119(1):70.e9-15
references.pmid: 16431192
references.citation: J Diabetes Sci Technol. 2008 Jan;2(1):15-23
references.pmid: 19885173
references.citation: J Gen Intern Med. 2006 Feb;21(2):105-10
references.pmid: 16390512
references.citation: J Clin Hypertens (Greenwich). 2007 Mar;9(3):179-86
references.pmid: 17344769
references.citation: Circulation. 2009 Jun 16;119(23):3028-35
references.pmid: 19528344
references.citation: Fam Med. 2004 Sep;36(8):588-94
references.pmid: 15343421
references.citation: J Gen Intern Med. 2008 May;23(5):561-6
references.pmid: 18335281
references.citation: J Clin Epidemiol. 1992 Sep;45(9):941-50
references.pmid: 1432023
references.citation: Diabetes Care. 2011 Aug;34(8):1689-94
references.pmid: 21636796
references.citation: Diabetes Care. 2011 Jan;34(1):20-6
references.pmid: 20929988
references.citation: Arch Intern Med. 2000 Jul 24;160(14):2101-7
references.pmid: 10904452
references.citation: Trials. 2010 Oct 12;11:95
references.pmid: 20939913
references.citation: N Engl J Med. 2010 Dec 30;363(27):2611-20
references.pmid: 21190455
references.citation: J Gen Intern Med. 2011 Oct;26(10):1175-82
references.pmid: 21533823
references.citation: J Gen Intern Med. 2010 Jun;25(6):524-9
references.pmid: 20182815
references.citation: Ethn Dis. 2010 Summer;20(3):282-9
references.pmid: 20828103
references.citation: Diabetes Care. 2001 Mar;24(3):561-87
references.pmid: 11289485
references.citation: Am J Hypertens. 2008 Feb;21(2):159-65
references.pmid: 18188162
references.citation: Diabetes Care. 1998 Oct;21(10):1644-51
references.pmid: 9773724
references.citation: J Gen Intern Med. 2008 May;23(5):692-8
references.pmid: 18288540
references.citation: Med Care. 2003 Nov;41(11):1284-92
references.pmid: 14583691
references.citation: N Engl J Med. 2005 Aug 4;353(5):487-97
references.pmid: 16079372
references.citation: J Clin Hypertens (Greenwich). 2002 Nov-Dec;4(6):393-404
references.pmid: 12461301
references.citation: BMJ. 1998 Sep 12;317(7160):703-13
references.pmid: 9732337