51成人动漫

LAS VEGAS -- Getting physicians to focus on patients' medication adherence may result in more patients taking their medicines, but it does not necessarily lead to improved health outcomes, a small pilot study has found.

"If you put physicians' attention on adherence, adherence goes up," , of the Regenstrief Institute in Indianapolis, Ind., said here Tuesday at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS). "However, we didn't observe many changes in clinical outcomes in terms of HbA1c, blood pressure, or BMI [body mass index]."

That may be because the study, which was published in , was only 9 months long, he continued. "That may not be long enough to observe meaningful changes" in those parameters.

"Globally, the prevalence of type 2 diabetes continues to rise at nearly epidemic rates, driven by urbanization, growing increases in obesity, and aging of populations," the researchers noted in the study's introduction. "Findings from several studies investigating the quality of type 2 diabetes care reveal a discrepancy between system-level disease management strategies and outcomes."

To see if improving medication adherence would also improve patients' health, the investigators studied 96 type 2 diabetes patients in a large safety-net health system who had at least one active prescription for either biguanides, sulfonylureas, or thiazolidinediones (diabetic drug therapies), as well as a history of primary care visits with one of the 15 providers enrolled in the study. Many of the patients had co-morbid conditions such as hypertension and hypercholesterolemia.

Patient data -- including blood pressure, HbA1c level, cholesterol level, and body mass index -- was entered into a "dashboard" that was made available to participating providers. At baseline, patients also filled out a 20-item questionnaire designed to assess the barriers to medication adherence; they were asked to repeat the questionnaire every 2-3 months.

After 9 months, investigators found no significant differences in any of the parameters they measured before and after the study. Among the 24 patients who completed all of the questionnaires, the average HbA1c declined slightly, from 8.71% to 8.66% (P<0.29). LDL cholesterol actually rose, from 100.55 mg/dL to 100.71 (P<.06), and BMI also rose, from 40.41 kg/m² to 44.43 (P<0.29).

Non-adherent patients gave a variety of reasons for not taking their medication. Among the most common ones: "I don't like taking medicine in general," "I forgot to take them," "I can't afford them," "I ran out before I could call the doctor," and "My medicines make me feel bad or have side effects I don't like."

Overcoming these barriers requires different types of solutions, according to study co-author . "[For] 'I forget to take my meds, give them memory aids and there's improvement,'" said Marrero, director of the Diabetes Translational Research Center at the Indiana University School of Medicine, in Bloomington. "But 'I just don't like taking medicines', it's a tough challenge. That's an educational thing and may best be addressed by fairly complex therapeutic interventions."

The researchers also found that the six providers who gave feedback about the dashboard had a mixture of views, with only four of them using it at least once during the pilot study. In addition, "When asked about whether the dashboard was useful to patient-provider conversations about adherence and helpful to improving medication adherence or helpful to improving medication adherence, half of the providers responded negatively (e.g., Disagree) and half were neutral," they wrote.

"The providers who responded negatively to questions about the dashboard's usefulness provided interesting open-ended comments. A provider reported that she was 'not confident' regarding the quality of the information on the dashboard. Another respondent indicated he wasn't sure if the dashboard contained data from outside pharmacies."

Tools like the dashboard "are challenging for providers to fit into their workflow," Dixon said in an interview with 51成人动漫. The challenge for us all to work on is to figure out the best pathway to get it into the workflow. Some physicians like to review charts before the patient even gets into the room, and others like to review them while the patient is sitting in front of them."

On the other hand, Marrero said, "the good news here for me is that there's a signal suggesting that in fact facilitated dialogue between [the provider] and the patient seems to result in greater medication use ... It's pretty phenomenal, actually."

And including other members of the medical team may also be of benefit, he noted. "We focused on doctors because they write the script, but they're not the ones necessarily talking to the patient about medication or discussing changes or titration or a whole bunch of other stuff. Realistically, nurses, medical assistants, and other people really need to be part of this discussion."

Limitations of the study included the small size of the cohort and limited duration of the study, according to the authors. In addition, "given mixed participation and limited use, the intervention may not be directly responsible for changes in adherence especially since our model did not control for other factors. A future trial of such an intervention in the larger health system would need to control for patient as well as provider and clinic factors to be more confident in stating the effect of the informatics intervention."

Comment