Pladevall Manel, Divine George, Wells Karen E, Resnicow Ken, Williams L Keoki
Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan (Dr Pladevall, Dr Williams)
Research Triangle Institute Health Solutions, Barcelona, Spain (Dr Pladevall)
Diabetes Educ. 2015 Feb;41(1):136-46. doi: 10.1177/0145721714561031. Epub 2014 Dec 8.
The purpose of this study was to assess whether providing medication adherence information with or without motivational interviewing improves diabetes and lipid control.
Study participants were adult members of a health system in southeast Michigan, were using both oral diabetes and lipid-lowering medications, and had glycated hemoglobin (A1C) or low-density lipoprotein cholesterol (LDL-C) levels not at goal. Participants were randomly assigned to receive usual care (UC), n = 567; have medication adherence information (AI) provided to their physician, n = 569; or have AI and receive motivational interviewing (MI) though trained staff (AI + MI), n = 556. Primary outcomes were A1C and LDL-C levels at 18 months post randomization.
Primary outcomes were not significantly different between patients in the AI or AI + MI study arms when compared with UC. Similarly, neither oral diabetes nor lipid-lowering medication adherence was significantly different between groups. Patient participation in the AI + MI arm was low and limit the interpretation of the study results, but post hoc analysis of the AI + MI study arm showed that the number of MI sessions received was positively associated with only oral diabetes medication adherence.
Neither AI nor MI significantly improved diabetes and lipid control when compared with UC. Moreover, patient participation appeared to be a particular barrier for MI.
本研究旨在评估提供药物依从性信息（无论是否采用动机性访谈）是否能改善糖尿病和血脂控制情况。
研究参与者为密歇根州东南部某医疗系统的成年成员，正在同时使用口服降糖药和降脂药，且糖化血红蛋白（A1C）或低密度脂蛋白胆固醇（LDL-C）水平未达目标值。参与者被随机分配接受常规护理（UC），n = 567；向其医生提供药物依从性信息（AI），n = 569；或通过经过培训的工作人员提供AI并接受动机性访谈（MI）（AI + MI），n = 556。主要结局为随机分组后18个月时的A1C和LDL-C水平。
与UC相比，AI或AI + MI研究组患者的主要结局无显著差异。同样，各组之间口服降糖药和降脂药的依从性也无显著差异。AI + MI组患者的参与度较低，限制了对研究结果的解读，但对AI + MI研究组的事后分析表明，接受MI的次数仅与口服降糖药的依从性呈正相关。
与UC相比，AI和MI均未显著改善糖尿病和血脂控制情况。此外，患者参与度似乎是MI的一个特殊障碍。
