Blecker Saul, Mann Devin M, Martinez Tiffany R, Belli Hayley M, Zhao Yunan, Ahmed Aamina, Fitchett Cassidy, Wong Christina, Bearnot Harris R, Voils Corrine I, Schoenthaler Antoinette M
Department of Population Health, NYU Grossman School of Medicine, New York, New York.
Department of Medicine, NYU Grossman School of Medicine, New York, New York.
JAMA Cardiol. 2025 Jul 9. doi: 10.1001/jamacardio.2025.2155.
Medication nonadherence is present in nearly half of patients with hypertension but is underrecognized in clinical care. Data linkages between electronic health records and pharmacies have created opportunities for scalable assessment of medication adherence at the point of care.
To test the effectiveness of a multicomponent intervention that identified patients with uncontrolled hypertension and medication nonadherence using linked electronic health record-pharmacy data combined with team-based care to address adherence barriers.
DESIGN, SETTING, AND PARTICIPANTS: TEAMLET (Leveraging Electronic Health Record Technology and Team Care to Address Medication Adherence) was a pragmatic, 2-arm, cluster randomized clinical trial conducted between October 2022 and November 2024 in 10 primary care sites in New York. The study included adults with uncontrolled hypertension and low medication adherence, defined as proportion of days covered (PDC) less than 80%. Data analysis was performed from November 2024 to January 2025.
The intervention consisted of the following: (1) automated identification of patients with medication nonadherence at the time of the visit; (2) prompting of medical assistants to screen for barriers to adherence; (3) clinical decision support alerting the primary care physicians and nurse practitioners to barriers to adherence; and (4) adherence discussion between the primary care physician or nurse practitioner and the patient. The comparator was usual care.
The primary outcome was change in PDC from baseline to 12 months.
Among 1726 patients (mean [SD] age, 67.2 [13.9] years; 887 [51.4%] female), the mean (SD) baseline PDC was 33.2% (30.5%) overall (32.4% [30.4%] in the intervention group and 34.0% [30.6%] in the control group). The mean (SD) PDC at 12 months was 51.1% (39.5%) for the intervention group and 53.1% (39.6%) for the control group. No difference was found in the change in PDC from baseline to 12 months between the intervention and control groups (mean [SD] absolute change in PDC, 18.5 [41.1] vs 18.2 [40.9] percentage points, respectively; adjusted difference, -0.15 percentage point; 95% CI, -4.06 to 3.76 percentage points). Change in systolic blood pressure and patients who became adherent (PDC ≥80%) at 12 months were also similar between groups.
In this pragmatic trial, an intervention that combined team-based primary care with automated identification of patients with antihypertensive medication nonadherence did not lead to improvements in adherence or blood pressure.
ClinicalTrials.gov Identifier: NCT05349422.
近一半的高血压患者存在用药不依从问题，但在临床护理中未得到充分认识。电子健康记录与药房之间的数据关联为在医疗点对用药依从性进行可扩展评估创造了机会。
测试一种多组分干预措施的有效性，该干预措施使用关联的电子健康记录 - 药房数据识别血压控制不佳和用药不依从的患者，并结合基于团队的护理来解决依从性障碍。
设计、设置和参与者：TEAMLET（利用电子健康记录技术和团队护理解决用药依从性问题）是一项务实的双臂整群随机临床试验，于2022年10月至2024年11月在纽约的10个初级保健机构进行。该研究纳入了血压控制不佳且用药依从性低的成年人，定义为覆盖天数比例（PDC）低于80%。数据分析于2024年11月至2025年1月进行。
干预措施包括以下内容：（1）在就诊时自动识别用药不依从的患者；（2）促使医疗助理筛查依从性障碍；（3）临床决策支持向初级保健医生和执业护士提醒依从性障碍；（4）初级保健医生或执业护士与患者之间进行依从性讨论。对照为常规护理。
主要结局是从基线到12个月时PDC的变化。
在1726名患者中（平均[标准差]年龄为67.2[13.9]岁；887名[51.4%]为女性），总体基线PDC平均（标准差）为33.2%（30.5%）（干预组为32.4%[30.4%]，对照组为34.0%[30.6%]）。干预组12个月时的平均（标准差）PDC为51.1%（39.5%），对照组为53.1%（39.6%）。干预组和对照组从基线到12个月时PDC的变化无差异（PDC的平均[标准差]绝对变化分别为18.5[41.1]和18.2[40.9]个百分点；调整差异为 -0.15个百分点；95%置信区间为 -4.06至3.76个百分点）。两组之间收缩压的变化以及12个月时变为依从（PDC≥80%）的患者也相似。
在这项务实试验中，将基于团队的初级保健与自动识别抗高血压药物不依从患者相结合的干预措施并未改善依从性或血压。
ClinicalTrials.gov标识符：NCT05349422。
