Majd Zahra, Mohan Anjana, Johnson Michael L, Essien Ekere J, Barner Jamie C, Serna Omar, Gallardo Esteban, Fleming Marc L, Ordonez Nancy, Holstad Marcia M, Abughosh Susan M
Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA.
Health Outcomes Division, The University of Texas at Austin, Austin, TX, USA.
Patient Prefer Adherence. 2022 Oct 4;16:2739-2748. doi: 10.2147/PPA.S360461. eCollection 2022.
Hypertension is a common comorbidity among type 2 diabetes mellitus (T2DM) patients, which increases the risk of cardiovascular diseases. Despite the proven benefit of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in this population, poor medication adherence is prevalent, resulting in higher complications and mortality rate. Motivational interviewing (MoI) has demonstrated effectiveness in improving medication adherence and identifying barriers. This study aimed to assess and identify patient-reported barriers to adherence to ACEI/ARB from an MoI telephonic intervention conducted by student pharmacist interns.
This retrospective study was conducted within an MoI intervention customized by past ACEI/ARB adherence trajectories for nonadherent patients with T2DM and hypertension enrolled in a Medicare Advantage Plan. Adherence barriers were extracted from the interviewers' notes by two independent researchers. Descriptive analysis was performed to summarize the overall frequency of barriers as well as across trajectory groups, identified from the initial and follow-up calls.
In total, 247 patients received the initial MoI call from which 41% did not communicate any barrier for ACEI/ARB use despite having low adherence. About 59% of the patients reported at least one barrier during the initial call. The most common barriers included forgetfulness, discontinuation by physicians, side effects, multiple comorbidities, polypharmacy, lack of knowledge about disease/medication, and cost issues. The follow-up calls helped with uncovering at least one new barrier for 28 patients who previously communicated a different issue with their medication during the first call. Additionally, 18 patients with initial denial for having any barrier to adherence reported at least one barrier throughout the follow-up calls.
This study summarized patient-reported barriers to ACEI/ARB adherence from an MoI telephonic intervention performed among nonadherent patients. Identifying specific barriers for patients may help to further design tailored interventions that address the barriers and improve adherence.
高血压是2型糖尿病（T2DM）患者中常见的合并症，会增加心血管疾病风险。尽管血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）在该人群中已证实有益，但药物依从性差很普遍，导致并发症和死亡率更高。动机性访谈（MoI）已证明在改善药物依从性和识别障碍方面有效。本研究旨在评估并识别通过学生药剂实习生进行的MoI电话干预中患者报告的ACEI/ARB依从性障碍。
本回顾性研究在一项针对参加医疗保险优势计划的T2DM和高血压非依从患者的MoI干预中进行，该干预根据过去的ACEI/ARB依从轨迹进行定制。两名独立研究人员从访谈记录中提取依从性障碍。进行描述性分析以总结障碍的总体频率以及不同轨迹组的障碍频率，这些障碍是从初次和随访电话中识别出来的。
共有247名患者接到了初次MoI电话，其中41%尽管依从性低，但未提及任何使用ACEI/ARB的障碍。约59%的患者在初次电话中报告了至少一个障碍。最常见的障碍包括遗忘、医生停药、副作用、多种合并症、多种药物治疗、对疾病/药物缺乏了解以及费用问题。随访电话帮助28名在初次电话中报告了不同用药问题的患者发现了至少一个新障碍。此外，18名最初否认有任何依从性障碍的患者在整个随访电话中报告了至少一个障碍。
本研究总结了在非依从患者中通过MoI电话干预患者报告的ACEI/ARB依从性障碍。识别患者的特定障碍可能有助于进一步设计针对性的干预措施，以解决这些障碍并提高依从性。
