Headline

Pharmacist-led telephonic motivational interviewing intervention increased medication adherence among an older adult population with chronic disease.

Context

Over 800,000 people in the U.S. die annually of cardiovascular disease. People with hypertension and diabetes are among those at the highest risk for heart disease and/or having a stroke. Pharmacotherapy lowers these risks for this population, but medication adherence among people with chronic illnesses remains a major public health concern. This study examines the impact of a phone-based motivational interviewing intervention delivered by trained pharmacist students for patients enrolled in Medicare Advantage Plans with suboptimal medication adherence.

Findings

The authors used administrative claims data to identify patients with comorbid hypertension and diabetes who were prescribed cardioprotective medications. Using group-based trajectory modeling, the authors selected patients for the randomized intervention and control groups across three problematic medication adherence trajectories (‘rapid decline,’ ‘gaps in adherence’ and ‘gradual decline’). Overall, the brief motivational interviewing intervention improved medication adherence at one-year post-intervention. Patients from the ‘rapid decline’ trajectory were less likely than the other two trajectories to be adherent, suggesting greater patient engagement is needed for this group. The study also found major predictors related to the three lower adherence trajectories including being male, having no low-income subsidy, depression, and prior hospitalizations.

Takeaways

The significantly improved medication adherence among this non-adherent, chronic disease patient population suggests that health care providers can play a role in reinforcing positive and sustainable behavior change among patients with chronic illnesses. The student pharmacists also followed up with patients’ additional health care providers, as needed. If barriers were identified (e.g., addressing increased costs, side effects, medication complexity), this suggests that health care providers can play a needed role in collaborating with one another to support patients with chronic disease.