A Systems-Level Approach to Improving Medication Adherence in Hypertensive Latinos: a Randomized Control Trial
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Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine , New York , NY , USA; 2Union Health Center , New York , NY , USA; 3Department of Psychology, St. Johns University , Jamaica , NY , USA; 4Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School , Worcester , MA , USA.
BACKGROUND: Despite numerous interventions targeting medication adherence in patients with uncontrolled hypertension, practice-based trials in Latino patients are scant. OBJECTIVE: To evaluate the effect of a systems-level adherence intervention, delivered by medical assistants (MAs), versus a comparison condition on medication adherence and blood pressure (BP) in 119 hypertensive Latino patients who were initially non-adherent to their antihypertensive medications. STUDY DESIGN: Randomized control trial. PARTICIPANTS: Patients (50% women; mean age, 61 years) were recruited from April 2013 to August 2015 in a community-based practice in New York. INTERVENTION: Systems-level approach that included an office system component built into the electronic health record and a provider support component consisting of nine MA-delivered health coaching sessions for improving medication adherence. The comparison group received the standard health coaching procedures followed at the clinic. MAIN OUTCOME MEASURES: The primary outcome was rate of medication adherence measured by an electronic monitoring device (EMD) across 6 months. The secondary outcomes were self-reported medication adherence measured by the eight-item Morisky Medication Adherence Scale (MMAS-8) and BP reduction from baseline to 6 months. KEY RESULTS: Adherence as measure by EMD worsened for both groups (p = 0.04) with no between-group difference (− 9.6% intervention and − 6.6% control, p = 0.66). While systolic BP improved in both groups, the difference between groups was not significant (− 6 mmHg in intervention vs. − 2.7 mmHg in control, p = 0.34). In contrast, the intervention group had a greater improvement in self-reported adherence (mean change 1.98 vs. 1.26, p = 0.03) when measured using the MMAS-8. CONCLUSIONS: Among Latinos with poorly controlled BP who were non-adherent to their antihypertensive medications, a systems-level intervention did not improve
Received November 19, 2018 Revised July 8, 2019 Accepted August 21, 2019
adherence as measured by EMD nor blood pressure. However, many patients reported challenges to using the EMD. Improvements in self-reported adherence suggest that this measure captures different aspects of adherence behavior than EMD. CLINICAL TRIAL REGISTRATION: NCT03560596 KEY WORDS: medication adherence; hypertension; Latino; team care. J Gen Intern Med DOI: 10.1007/s11606-019-05419-3 © Society of General Internal Medicine 2019
INTRODUCTION
Latinos have the lowest blood pressure (BP) control rates in the USA (34% vs. 53% and 43% in white and black adults).1, 2 Data from the Hispanic Community Health Study/Study of Latino
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