Improving Adherence to Cholesterol Lowering Medications among Minority Populations in Florida: A Randomized Trial

Abstract

BackgroundAdherence to Hydroxymethylglutaryl-CoA reductase inhibitors (statins) is low in spite of significantly decreasing the risk of cardiovascular events and mortality in patients with hypercholesterolemia [1]. Reasons for the low adherence are not fully understood; however, adverse events, uncertainty about benefits, and mistrust are commonly cited [2][3][4]. Minorities have a higher prevalence of cardiovascular risk factors [5] and are even less likely to use statins when prescribed [6][7][8]. This may be related to the presence of additional barriers to adherence such as social, financial, environmental, behavioral and cultural factors; thus, traditional medical models for managing Cardiovascular Disease (CVD) have met with limited success in minority populations. Increasing evidence suggests that nontraditional approaches maybe effective in these groups. Such approaches most typically involve culturally tailored behavioral interventions led by counselors, pharmacists, or lay health educators [9]. This approach may be particularly useful for improving adherence to statins, which seems to require appropriate communication, understanding and follow up [4]. Most patients that discontinue temporarily statins due to adverse events, tolerate well statins long term when rechallenged [10], highlighting the importance of helping patients make informed health decisions when concerns arise.Among minorities, Motivational Interviewing (MINT) has been shown to improve CVD health behaviors and adherence to CVD medications [11]. However, there are only a limited number of studies rigorously evaluating the effect of such non-traditional interventions on hyperlipidemia among minority groups [5]. The focus of our study to determine the efficacy of a culturally tailored phone based MINT intervention delivered to Latino and African American enrollees living in predominantly minority neighborhoods in Florida, is effective at improving adherence to statins. Methods Study subjectsSubjects were identified from a Humana claims database of approximately 3.5 million members enrolled in a commercial health maintenance organization (HMO), preferred-provider organization (PPO) or Medicare plan. The database includes a member file containing demographic information such as age, gender, type of insurance, surname, address, Medicare demographic information for each member; a medical file containing up to nine recorded International Classification of Diseases, ninth revision (ICD-9) codes per encounter; a pharmacy file containing all Generic Product Identifier (GPI) numbers of pharmacy-dispensed medications per claim; and a laboratory file which includes results of all laboratory tests performed Abstract Background: Lipid-lowering therapy, particularly with hydroxymethylglutaryl-CoA reductase inhibitors (statins), has been shown to significantly reduce morbidity and mortality in patients with and without known coronary artery disease; however adherence is poor particularly among racial/ethnic minorities. Motivational interviewing (MINT) is...