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ADHERENCE

Improving Adherence and Reducing Medication Discrepancies in Patients with Diabetes

Assistant in Medicine, General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA

Nicole G Devita, BSPharm MHP

Director of Pharmacy, Partners Community HealthCare, Inc., Needham, MA

Daniel E Singer, MD

Professor of Medicine, General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School

James B Meigs, MD MPH

Assistant Professor of Medicine, General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School

Reprints: Richard W Grant MD MPH, General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford St., Boston, MA 02114-2517, FAX 617/724-3544, E-mail rgrant{at}partners.org

OBJECTIVE: To improve medication adherence by reducing self-reported adherence barriers, and to identify medication discrepancies by comparing physician-prescribed and patient-reported medical regimens.

DESIGN: Prospective, randomized, controlled trial.

SETTING AND PARTICIPANTS: A single academically affiliated community health center. Eligible patients had type 2 diabetes, had undergone laboratory testing in the year preceding the study, and had visited the clinic in the 6 months preceding the study.

INTERVENTION: A pharmacist administered detailed questionnaires, provided tailored education regarding medication use and help with appointment referrals, and created a summary of adherence barriers and medication discrepancies that was entered into the medical record and electronically forwarded to the primary care provider.

MEASUREMENTS: Changes in self-reported adherence rates and barriers were compared 3 months after the initial interview. Intervention patients with medication discrepancies at baseline were assessed for resolution of discrepancies at 3 months.

RESULTS: Rates of self-reported medication adherence were very high and did not improve further at 3 months (6.9 of 7 d, with all medicines taken as prescribed; p = 0.3). Medical regimen discrepancies were identified in 44% of intervention patients, involving 45 doses of medicines. At 3-month follow-up, 60% of discrepancies were resolved by corrections in the medical record, while only 7% reflected corrections by patients.

CONCLUSIONS: In this community cohort, patients reported few adherence barriers and very high medication adherence rates. Our patient-tailored intervention did not further reduce these barriers or improve self-reported adherence. The high prevalence of medication discrepancies appeared to mostly reflect inaccuracies in the medical record rather than patient errors.

Key Words: adherence, randomized controlled trial, type 2 diabetes mellitus

Published Online, May 23, 2003. www.theannals.com, DOI 10.1345/aph.1C452

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