Telephone program increases treatment adherence

June 10, 2009

A telephone-intervention program significantly improved oral diabetes medication adherence compared to printed patient education materials, reports Hillel W. Cohen, MD, department of epidemiology and population health, Albert Einstein College of Medicine, Bronx, NY. The improvement in medication possession ratio is associated with a decline in HbA1c, according to Dr. Cohen. A significant effect was not observed on insulin regimen adherence.

A telephone intervention program significantly improved oral diabetes medicationadherence compared to printed patient education materials, reports Hillel W. Cohen,MD, department of epidemiology and population health, Albert Einstein College ofMedicine, Bronx, NY. "The improvement in medication possession ratio is associatedwith a decline in HbA1c," according to Dr. Cohen. A significant effectwas not observed on insulin-regimen adherence.

Researchers randomized 526 patients with type 2 diabetes to receive either atailored telephone intervention consisting of 10 calls focused on self-care with ahealth educator over a one-year period, or no telephone intervention. Patients wereinsured members of a healthcare workers labor union and represented a minority,urban population, they report.

All were 30 years of age or older, had been prescribed at least one oralantidiabetic agent, and had a baseline hemoglobin A1c (HbA1c)of 7.5% or more. Mean baseline HbA1c was 8.6%, 24% were also takinginsulin, average age was 61.6 years, and baseline body mass index was 31.2kg/m².

All patients received printed self-care materials containing information onmedication adherence, diet, and exercise. Both groups received reminder itemsincluding pill boxes, lunch bags, step meters, and magnets.

The medication possession ratio was calculated as the difference in number ofpill-days supplied before the intervention versus that of the year the interventiontook place. Pharmacy refill records were used for the medication possession ratio,and patients were also asked how many days in the previous week they took theirmedication as prescribed.

After adjusting for age, sex, and baseline medication possession ratio,significantly more patients in the telephone intervention group were in the upperquartile of medication possession ratio after one year (odds ratio [OR]=1.8p<0.02). Furthermore, those in the upper quartile had a greater decreasein HbA1c of at least 0.3% for the intervention year compared with thosein lower quartiles (p=0.02), Dr. Cohen says.