A 2-Arm, Randomized, Controlled Trial of a Motivational Interviewing-Based Intervention to Improve Adherence to Antiretroviral Therapy (ART) Among Patients Failing or Initiating ART

Golin, Carol E.; Earp, Jo Anne; Tien, Hsiao Chuan; Stewart, Paul W.; Porter, Carol Q.; Howie, Lynn

doi:10.1097/01.qai.0000219771.97303.0a

Cited by 127 publications

(115 citation statements)

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“…This approach may facilitate the implementation and sustainability of this intervention in real world settings. The possibility that some patients may be more open to discussing their [46][47][48] Our randomized trial study had several strengths, including a large cohort of minority subjects across several states and the use of both an objective as well as self-reported measure of medication adherence. While many of our patients had low incomes and educational attainment, they were all insured.…”

Section: Discussionmentioning

confidence: 99%

Can Phone-Based Motivational Interviewing Improve Medication Adherence to Antiplatelet Medications After a Coronary Stent Among Racial Minorities? A Randomized Trial

et al. 2014

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BACKGROUND:Minorities have lower adherence to cardiovascular medications and have worst cardiovascular outcomes post coronary stent placement OBJECTIVE: The aim of this study is to compare the efficacy of phone-delivered Motivational Interviewing (MINT) to an educational video at improving adherence to antiplatelet medications among insured minorities. DESIGN: This was a randomized study. PARTICIPANTS: We identified minorities with a recently placed coronary stent from an administrative data set by using a previously validated algorithm. INTERVENTIONS: MINT subjects received quarterly phone calls and the DVD group received a one-time mailed video. MAIN MEASURES: Outcome variables were collected at baseline and at 12-month post-stent, using surveys and administrative data. The primary outcome was antiplatelet (clopidogrel and prasugrel) adherence measured by Medication Possession Ratio (MPR) and self-reported adherence (Morisky score). We also measured appropriate adherence defined as an MPR ≥ 0.80. KEY RESULTS: We recruited 452 minority subjects with a new coronary stent (44 % Hispanics and 56 % Black). The patients had a mean age of 69.5±8.8, 58 % were males, 78 % had an income lower than $30,000 per year and only 22 % had achieved high school education or higher. The MPR for antiplatelet medications was 0.77 for the MINT group compared to 0.70 for the DVD group (p<0.05). The percentage of subjects with adequate adherence to their antiplatelet medication was 64 % in the MINT group and 50 % in the DVD group (p<0.01). Self-reported adherence at 12 months was higher in the MINT group compared to the DVD group (p<0.01). Results were similar among drug-eluting stent (DES) recipients. CONCLUSIONS: Among racial minorities, a phone-based motivational interview is effective at improving adherence to antiplatelet medications post coronary stent placement. Phone-based MINT seems to be a promising and cost-effective strategy to modify risk behaviors among minority populations at high cardiovascular risk. BACKGROUNDThe safe use of coronary stents requires the daily use of thienopyridines for 3 to 12 months after percutaneous coronary intervention (PCI). 1 The premature discontinuation of these medications 1 is associated with an increased risk of instent thrombosis, cardiovascular events and death. 2-6 Unfortunately, lack of medication adherence is common and is associated with significant health care costs and mortality. 7,8 Vulnerable groups such as racial minorities and the elderly have a higher risk of poor adherence. 5,6,9,10 In the case of antiplateletet medications, blacks are more likely to not receive a clopidogrel prescription 11 or to not fill it after PCI. Further, our prior analyses of insurer claims data showed that minority populations were less adherent to antiplatelet medications post drug-eluting stent (DES) placement. 12 The lack of appropriate use of evidence-based therapies after PCI may partially contribute to the excess morbidity and mortality reported among minorities. 13,14,6 The improvement of med...

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Section: Discussionmentioning

confidence: 99%

Can Phone-Based Motivational Interviewing Improve Medication Adherence to Antiplatelet Medications After a Coronary Stent Among Racial Minorities? A Randomized Trial

et al. 2014

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“…Interventions that used master level educators, psychologists or pharmacists did not show a significant MI effect. 17,22,24,25 Duration of MI exposure did not impact adherence. Using generalized least square regression, the exponentiated betacoefficient of change by tertiles of MI exposure was 0.90 (95 % CI 0.77-1.27; p = 0.93).…”

Section: Parsonsmentioning

confidence: 99%

“…Loss to follow-up in any arm ranged from 1 % to 33 % (Table 1) with seven studies surpassing 20 %. 16,17,18,20,22,24,25 One study did not report loss to follow-up by study arm, 21 one had differential loss, 16 and three did not comment on differences in baseline characteristics by study completion status. 16,17,21 Thirteen reported no differences in characteristics by completion status, and one reported that subjects lost to follow-up in the MI group had a trend toward more depressive symptoms.…”

Section: Quality Of the Studies And Evaluation Of Biasmentioning

confidence: 99%

“…17,18,20,22,26,30 Baseline Characteristics of the Studies Table 1 reports the baseline characteristics of the studies. The 17 studies randomized 1,376 subjects into the MI group and 1,153 subjects to the control group.…”

Section: Quality Of the Studies And Evaluation Of Biasmentioning

confidence: 99%

“…[15][16][17][18][19][20] Studies that did not mention ITT 15,16,[20][21][22][23] required followup visits for outcome ascertainment and used all available data for comparisons of the randomized arms. Loss to follow-up in any arm ranged from 1 % to 33 % (Table 1) with seven studies surpassing 20 %.…”

Section: Quality Of the Studies And Evaluation Of Biasmentioning

confidence: 99%

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Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis

et al. 2016

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BACKGROUND: Randomized clinical trials (RCTs), mostly conducted among minority populations, have reported that motivational interviewing (MI) can improve medication adherence. OBJECTIVES: To evaluate the impact of MI and of the MI delivery format, fidelity assessment, fidelity-based feedback, counselors' background and MI exposure time on adherence. DATA SOURCES: We searched the MEDLINE database for studies published from 1966 until February 2015. STUDY ELIGIBILITY CRITERIA: We included RCTs that compared MI to a control group and reported a numerical measure of medication adherence. DATA SYNTHESIS: The main outcome was medication adherence defined as any subjective or objective measure reported as the proportion of subjects with adequate adherence or mean adherence and standard deviation. For categorical variables we calculated the relative risk (RR) of medication adherence, and for continuous variables we calculated the standardized mean difference (SMD) between the MI and control groups. RESULTS: We included 17 RCTs. Ten targeted adherence to HAART. For studies reporting a categorical measure (n = 11), the pooled RR for medication adherence was higher for MI compared with control (1.17; 95 % CI 1.05-1.31; p < 0.01). For studies reporting a continuous measure (n = 11), the pooled SMD for medication adherence was positive (0.70; 95 % CI 0.15-1.25; p < 0.01) for MI compared with control. The characteristics that were significantly (p < 0.05) associated with medication adherence were telephonic MI and fidelity-based feedback among studies reporting categorical measures, group MI and fidelity assessment among studies reporting continuous measures and delivery by nurses or research assistants. Effect sizes differed in magnitude, creating high heterogeneity. CONCLUSION: MI improves medication adherence at different exposure times and counselors' educational level. However, the evaluation of MI characteristics associated with success had inconsistent results. Larger studies targeting diverse populations with a variety of chronic conditions are needed to clarify the effect of different MI delivery modes, fidelity assessment and provision of fidelity based-feedback.KEY WORDS: adherence; behavioral medicine; patient engagement.

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Standard Care Impact on Effects of Highly Active Antiretroviral Therapy Adherence Interventions

et al. 2010

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A 2-Arm, Randomized, Controlled Trial of a Motivational Interviewing-Based Intervention to Improve Adherence to Antiretroviral Therapy (ART) Among Patients Failing or Initiating ART

Abstract: Although not definitive, this study provides some evidence that MI offers an effective approach to improving adherence. Future studies able to build MI into the intervention for longer than 3 months may have a greater impact.

Cited by 127 publications

References 57 publications

Can Phone-Based Motivational Interviewing Improve Medication Adherence to Antiplatelet Medications After a Coronary Stent Among Racial Minorities? A Randomized Trial

Can Phone-Based Motivational Interviewing Improve Medication Adherence to Antiplatelet Medications After a Coronary Stent Among Racial Minorities? A Randomized Trial

Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis

Standard Care Impact on Effects of Highly Active Antiretroviral Therapy Adherence Interventions

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