Does point‐of‐care testing lead to the same or better adherence to medication? A randomised controlled trial: the PoCT in General Practice Trial

Abstract

Objective: To compare the clinical effectiveness of point‐of‐care testing (PoCT) with that of pathology laboratory testing, as measured by patients’ adherence to medication. Design: Multicentre, cluster randomised controlled trial using non‐inferiority analysis. Medication adherence was assessed twice (in April 2006 and January 2007) by a self‐administered questionnaire using the five‐item Medication Adherence Report Scale (MARS‐5). Setting: 53 Australian general practices in urban, rural and remote areas across three Australian states, September 2005 to February 2007. Participants: 4968 patients with established type 1 or type 2 diabetes, established hyperlipidaemia, or requiring anticoagulant therapy were recruited to the study. Of these, 4381 were included in the analysis (2585 in the intervention group and 1796 in the control group). Intervention: The intervention group (3010 patients in 30 practices) had blood and urine samples tested using PoCT devices within their general practices. The control group (1958 patients in 23 practices) had samples tested by their usual pathology laboratories. Main outcome measures: The proportion of questionnaire responses indicating medication adherence overall and by condition. Results: PoCT was non‐inferior to pathology laboratory testing in relation to the proportion of questionnaire responses indicating medication adherence (39.3% v 37.0%) (difference, 2.3% [90% CL, – 0.1%, 4.6%]; P < 0.001). Non‐inferiority could also be concluded separately for patients with diabetes (38.5% v 37.3%) (difference, 1.2% [90% CL, – 2.5%, 5.0%]; P = 0.01); hyperlipidaemia (38.3% v 37.3%) (difference, 1.0% [90% CL, – 1.5%, 3.5%]; P < 0.001) and for patients requiring anticoagulant therapy (44.5% v 41.4%) (difference, 3.1% [90% CL, – 2.1%, 8.3%]; P = 0.01). Conclusions: Having access to immediate test results through PoCT is associated with the same or better medication adherence compared with having test results provided by a pathology laboratory. PoCT used in general practice can provide general practitioners and patients with timely and complete clinical information, facilitating important self‐management behaviours such as medication adherence. Trial registration: Australian Clinical Trials Registry ACTRN 12605000272695.

Effective interventions to improve medication adherence in Type 2 diabetes: a systematic review

“…Twenty-three of the studies used a control group for comparisons [15,17–20,22–28,30–40]. All of the studies focused on adults with T2DM [15–41], but one study also included individuals diagnosed with Type 1 diabetes [24]. Thirteen of the 27 articles were conducted in international locations [15,22–24,28–31,34–35,37–38,41].…”

“…All forms of indirect methods were used, with 18 studies measuring medication adherence by self-report [15–17,21,23–32,35,37,39–41], two by pill count [22,33], three by electronic devices [18–19,38], and three by pharmacy claims data [20,34,36]. Of the 27 studies, 13 reported statistically significant differences in medication adherence in the intervention group compared with the control group [15,17–20,22,24,28,30–31,33,36,40]. All four studies without a control group reported statistically significant changes in medication adherence [16,21,29,41].…”

“…Most studies did not employ a theoretical foundation [15–16,20–22,24–25,27–34,36,38–41], but for those that did, one study used the Theory of Planned Behavior [23], one used the Trans-theoretical Model [17], two used a self-efficacy theory [35,37], two used integrated care [18–19], and one used the Social–Cognitive Theory [26]. As for the intervention characteristics, five out of the 27 studies were culturally tailored [16,18,31,38–39], of which four were significant for changes in medication adherence and HbA1c.…”

“…Eight used monitoring data, such as providing results of self-monitored blood glucose readings to the provider [15,25,27,29,31,40– 41] and, of these, four were significant for differences in medication adherence and/or HbA1c. Fifteen studies provided one-on-one counseling to patients [17–20,22,24,28–29,31–33,35–36,40–41] and 13 studies were significant for changes in medication adherence and/or HbA1c. The study designs for most of the interventions using one-on-one interactions were RCTs.…”

Increasing the quantity and quality of searching for current best evidence to answer clinical questions: protocol and intervention design of the MacPLUS FS Factorial Randomized Controlled Trials

“…Clinicians’ uptake of validated best care procedures remains stubbornly around 50% or less for most advances in therapeutics [1],[2]. Combined with a similar rate of patient adherence with self-administered treatments [3], the average effectiveness of therapies reaches typically only about a quarter (50% - 50%) of their potential.…”