Document Detail


Treatment adjustment and medication adherence for complex patients with diabetes, heart disease, and depression: a randomized controlled trial.
MedLine Citation:
PMID:  22230825     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Medication nonadherence, inconsistent patient self-monitoring, and inadequate treatment adjustment exacerbate poor disease control. In a collaborative, team-based, care management program for complex patients (TEAMcare), we assessed patient and physician behaviors (medication adherence, self-monitoring, and treatment adjustment) in achieving better outcomes for diabetes, coronary heart disease, and depression.
METHODS: A randomized controlled trial was conducted (2007-2009) in 14 primary care clinics among 214 patients with poorly controlled diabetes (glycated hemoglobin [HbA(1c)] ≥8.5%) or coronary heart disease (blood pressure >140/90 mm Hg or low-density lipoprotein cholesterol >130 mg/dL) with coexisting depression (Patient Health Questionnaire-9 score ≥10). In the TEAMcare program, a nurse care manager collaborated closely with primary care physicians, patients, and consultants to deliver a treat-to-target approach across multiple conditions. Measures included medication initiation, adjustment, adherence, and disease self-monitoring.
RESULTS: Pharmacotherapy initiation and adjustment rates were sixfold higher for antidepressants (relative rate [RR] = 6.20; P <.001), threefold higher for insulin (RR = 2.97; P <.001), and nearly twofold higher for antihypertensive medications (RR = 1.86, P <.001) among TEAMcare relative to usual care patients. Medication adherence did not differ between the 2 groups in any of the 5 therapeutic classes examined at 12 months. TEAMcare patients monitored blood pressure (RR = 3.20; P <.001) and glucose more frequently (RR = 1.28; P = .006).
CONCLUSIONS: Frequent and timely treatment adjustment by primary care physicians, along with increased patient self-monitoring, improved control of diabetes, depression, and heart disease, with no change in medication adherence rates. High baseline adherence rates may have exerted a ceiling effect on potential improvements in medication adherence.
Authors:
Elizabeth H B Lin; Michael Von Korff; Paul Ciechanowski; Do Peterson; Evette J Ludman; Carolyn M Rutter; Malia Oliver; Bessie A Young; Jochen Gensichen; Mary McGregor; David K McCulloch; Edward H Wagner; Wayne J Katon
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Annals of family medicine     Volume:  10     ISSN:  1544-1717     ISO Abbreviation:  Ann Fam Med     Publication Date:    2012 Jan-Feb
Date Detail:
Created Date:  2012-01-10     Completed Date:  2012-05-23     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  101167762     Medline TA:  Ann Fam Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  6-14     Citation Subset:  IM    
Affiliation:
MacColl Center for Health Care Innovation, Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98101, USA. lin.e@ghc.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Antidepressive Agents / therapeutic use
Antihypertensive Agents / therapeutic use
Cardiovascular Diseases / drug therapy
Comorbidity
Depressive Disorder / drug therapy
Diabetes Mellitus / drug therapy
Drug Utilization / statistics & numerical data*
Female
Humans
Hypoglycemic Agents / therapeutic use
Insulin / therapeutic use
Male
Medication Adherence / statistics & numerical data*
Middle Aged
Patient Care Team*
Physician-Patient Relations
Professional Practice
Regression Analysis
Self Care / methods*,  statistics & numerical data
Grant Support
ID/Acronym/Agency:
MH041739/MH/NIMH NIH HHS; MH069741/MH/NIMH NIH HHS
Chemical
Reg. No./Substance:
0/Antidepressive Agents; 0/Antihypertensive Agents; 0/Hypoglycemic Agents; 0/Insulin
Comments/Corrections
Comment In:
Ann Fam Med. 2012 Jan-Feb;10(1):3-5   [PMID:  22230824 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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