title: Randomized trial of telephone outreach to improve medication adherence and metabolic control in adults with diabetes.
abstract: OBJECTIVE
  Medication nonadherence is a major obstacle to better control of glucose, blood pressure (BP), and LDL cholesterol in adults with diabetes. Inexpensive effective strategies to increase medication adherence are needed.
  
  
  METHODS
  In a pragmatic randomized trial, we randomly assigned 2,378 adults with diabetes mellitus who had recently been prescribed a new class of medication for treating elevated levels of glycated hemoglobin (A1C) ≥8% (64 mmol/mol), BP ≥140/90 mmHg, or LDL cholesterol ≥100 mg/dL, to receive 1) one scripted telephone call from a diabetes educator or clinical pharmacist to identify and address nonadherence to the new medication or 2) usual care. Hierarchical linear and logistic regression models were used to assess the impact on 1) the first medication fill within 60 days of the prescription; 2) two or more medication fills within 180 days of the prescription; and 3) clinically significant improvement in levels of A1C, BP, or LDL cholesterol.
  
  
  RESULTS
  Of the 2,378 subjects, 89.3% in the intervention group and 87.4% in the usual-care group had sufficient data to analyze study outcomes. In intent-to-treat analyses, intervention was not associated with significant improvement in primary adherence, medication persistence, or intermediate outcomes of care. Results were similar across subgroups of patients defined by age, sex, race/ethnicity, and study site, and when limiting the analysis to those who completed the intended intervention.
  
  
  CONCLUSIONS
  This low-intensity intervention did not significantly improve medication adherence or control of glucose, BP, or LDL cholesterol. Wide use of this strategy does not appear to be warranted; alternative approaches to identify and improve medication adherence and persistence are needed.
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN patrick.j.oconnor@healthpartners.com.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
authors.affiliation: Kaiser Permanente Division of Research, Northern California, Oakland, CA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.affiliation: Marshfield Clinic, Marshfield, WI.
authors.forename: Ram D
authors.initials: RD
authors.lastname: Pathak
authors.affiliation: Geisinger Center for Health Research, Danville, PA.
authors.forename: Ronald I
authors.initials: RI
authors.lastname: Harris
authors.affiliation: Group Health Research Institute, Seattle, WA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Newton
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN.
authors.forename: Kris A
authors.initials: KA
authors.lastname: Ohnsorg
authors.affiliation: University of Michigan, Center for Clinical Management Research, Ann Arbor, MI.
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.affiliation: Institute for Health Research, Kaiser Permanente, Denver, CO.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Sterrett
authors.affiliation: Institute for Health Research, Kaiser Permanente, Denver, CO.
authors.forename: Stanley
authors.initials: S
authors.lastname: Xu
authors.affiliation: Kaiser Permanente Division of Research, Northern California, Oakland, CA.
authors.forename: Wendy T
authors.initials: WT
authors.lastname: Dyer
authors.affiliation: Institute for Health Research, Kaiser Permanente, Denver, CO.
authors.forename: Marsha A
authors.initials: MA
authors.lastname: Raebel
authors.affiliation: Henry Ford Health System, Detroit, MI.
authors.forename: Abraham
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Institute for Health Research, Kaiser Permanente, Denver, CO.
authors.forename: Emily B
authors.initials: EB
authors.lastname: Schroeder
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN.
authors.forename: Jay R
authors.initials: JR
authors.lastname: Desai
authors.affiliation: Institute for Health Research, Kaiser Permanente, Denver, CO.
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010353:Patient Education as Topic / Q000379:methods; D010595:Pharmacists; D013689:Telephone; D055815:Young Adult
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents