Evidence-Based Behavioral Interventions to Improve Medication Adherence

Saturday at the American Diabetes Association’s 72^nd Scientific Sessions featured a presentation on evidence-based behavioral interventions in delivering clinical care. Presenter Elizabeth A. Walker, PhD, RN, CDE, Director of the Prevention and Control Core, Einstein Diabetes Research and Training Center, Albert Einstein College of Medicine, Bronx, New York, began by telling the audience that in order to truly make any progress in improving medication adherence, the term "adherence" must be clearly defined. Doing so enables researchers and providers to measure adherence reliably and accurately.

Dr. Walker then presented some studies showing the correlation between nonadherence/missed appointments and mortality before shifting to some of the variables that can make medication adherence a complicated topic. For instance, clinicians need to determine a number of things in order to know how to proceed with patients that are struggling with adherence. Is the nonadherence intentional or unintentional? Should clinical adherence intervention measures be specific to a particular medical condition or should strategies be more general? Since often times patient self-reporting can be inaccurate and overestimated (ie, patients truly believe they are adhering to medications much more than they actually are), what are some clinical interventions and steps that can be taken to improve adherence?

Dr. Walker presented one study that took a multi-pronged approach to improving medication adherence in diabetes patients. The goal of the study was to get patients to lower their A1C levels. One (control) group relied on peer-to-peer interaction and the other was given a financial incentive — those patients that were able to achieve .01 decrease in A1C levels over a certain period of time were rewarded with $100 and those that achieved a .02 decrease were rewarded with $200. Surprisingly, the group with the peer-to-peer interaction showed better overall progress.

Although Dr. Walker admitted that she did not have the answers to solving medication adherence, she did have some suggestions for attendees who were interested in starting some kind of adherence improvement program but did not know where to begin. She mentioned that a multi-component (“toolbox”) approach is advantageous because it can help determine what variables might or might not be working. Additionally, she suggested early intervention in order to achieve better behavioral change, as well as eHealth, mHealth, and peer-to-peer interventions.

Medication adherence is complex topic that involves many barriers and obstacles; however, as Walker told the audience, “we must do something.” Standing by idly is not an option; researchers and providers must continue to find ways to improve this problem. She was optimistic that, given the multitude of studies dedicated to various ways to improve medical adherence, that there would be continued progress in this area over time.

To read more about this study, please visit the American Diabetes Association’s website.