Improving Medication Adherence Rates with Telephone Counseling

Patients who are prescribed long-term medication therapy for chronic conditions often have poor rates of adherence to their medications, a trend that seems to be worse for conditions that do not have daily symptoms. A recent meta-analysis found that during the first year of treatment with a prescribed medication, patients with osteoporosis had a 48% adherence rate. Osteoporosis and osteopenia are associated with >2 million fractures each year in the United States; the estimated associated costs are $19 billion. Noting that nonadherence is a “complex behavior with many potential causes,” researchers have suggested that a successful intervention designed to improve adherence needs to be multifaceted and individually tailored. One-on-one counseling interventions meet those requirements, and counseling based on motivational interviewing has been successful in improving adherence rates in other clinical areas. The researchers recently conducted a large, 1-year randomized clinical trial designed to evaluate the effectiveness of a telephone-based counseling program in improving adherence to a medication regimen for osteoporosis. They reported trial results online in the Archives of Internal Medicine [doi:10.1001/archinternmeed.2011.1977]. The trial defined motivational interviewing as a “client-centered counseling method based on the stage-of-change model of health behavior. The counselor interacts with the patient to identify the reasons for problematic health behaviors and then shapes the counseling to address the issue most likely to help that particular person.” The researchers recruited Medicare beneficiaries who were beginning prescription medication regimens for osteoporosis. The participants were randomized to 1 of 2 trial arms: those in the intervention arm (n=1046) received telephone motivational interviewing counseling sessions and those in the control arm (n=1041) received educational materials through the mail. The primary outcome measure was medication regimen adherence compared across treatment arms, measured as the median medication possession ratio (MPR), calculated as the ratio of days with filled prescriptions to total days of follow-up. Baseline characteristics were similar in the 2 groups; mean age was 73 years, 93.8% were female, and most were single or widowed. Participants had a mean of 5.2 comorbidities and used a mean of 10.4 different medications in the year preceding the trial. Patients in both treatment arms had previous fractures, falls, activity limitations, and poor eyesight; incidence was similar in the 2 groups. There was a statistically significant difference between the groups in the distribution of races; the intervention arm included slightly more white subjects compared with the control arm. In both groups, the most common prescription osteoporosis medication was weekly bisphosphonates. During the 12-month follow-up period, the median MPR in the intervention arm was 49%, compared with 41% in the control arm (P=.07). For the secondary outcome measures, there were no statistically significant differences between the 2 arms (self-reported fractures, 10.9% in the intervention arm vs 11.2% in the control arm; poor or fair general health, 40.2% in the intervention arm vs 40.9% in the control arm). Finally, persistence with osteoporosis medication regimens appeared similar across the 2 groups. Subgroup analyses did suggest that the intervention was more effective in specific populations (patients ≥75 years of age vs those 65 to 74 years of age). The researchers commented that “further research is necessary to determine how to best target this intervention.”