Osteoporosis Telephonic Intervention to Improve Medication Regimen Adherence

Abstract

Background Multiple studies demonstrate poor adherence to medications prescribed for chronic illnesses, including osteoporosis, but few interventions have been proven to enhance adherence. We examined the effectiveness of a telephone-based counseling program rooted in motivational interviewing to improve medication adherence for osteoporosis. Methods We conducted a one year randomized controlled clinical trial. Participants were recruited from a large pharmacy benefits program for Medicare beneficiaries. All potentially eligible individuals had been newly prescribed a medication for osteoporosis. Consenting persons were randomized to either a program of telephone-based counseling (n = 1,046) using a motivational interviewing framework or a control group (n = 1,041) that received mailed educational materials. Medication adherence was the primary outcome compared across treatment arms and was measured as the median (interquartile range, IQR) medication possession ratio (MPR), calculated as the ratio of days with filled prescriptions to total days of follow-up. Results The groups were balanced at baseline, with a mean age of 78 years; 94% were female. In an intention-to-treat analysis, median adherence was 49% (IQR 7, 88) in the intervention arm and 41% (1.5, 86.0) in the control arm (P = 0.074 by Kruskal-Wallis test). There were no differences in self-reported fractures. Conclusions In this randomized controlled trial, we did not find a statistically significant improvement in osteoporosis medication adherence using a telephonic motivational interviewing intervention.

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

“…Our meta-analyses found phone-based MI to be superior to usual care among RCTs only among studies reporting a categorical adherence measure, which had a more consistent effect size. The significantly larger effect size of Solomon et al, 32 which reported a continuous measure, created heterogeneity that led to nonsignificant results. Similar limitations occurred in the in-person and group analyses in which Interian et al 19 and Holstad et al 26 also had larger effect sizes.…”

“…This was due to the variability in adherence measures that required further stratification of the (26,32,50), continuous (27); mixed MI: continuous (15,25); fidelity assessment: categorical (22,24,27,28,30,32), continuous (15, 15, 17-20, 22, 25, 27, 28, 33); no fidelity assessment: categorical (21,23,26,29), continuous (29); fidelity-based feedback: categorical (28,30,33), continuous (15,18,20,33,51); no fidelity-based feedback: categorical (21-24, 26, 27, 29, 32), continuous (19,22,25,27,29,34) Background of counselors: nurses: categorical (23,26,28,29), continuous (15,20,28,29); psychologist: continuous (17)(18)(19); pharmacists: categorical (32); master level: categorical (22,24), continuous ...…”

“…It is important to clarify the efficacy of different MI delivery modes 36 since they could improve MI's cost-effectiveness and reach among populations with access barriers. Solomon and Palacio et al 27,32 used administrative pharmacy claims and a phone-based delivery mode to identify and reach a large number of eligible subjects over wide geographic areas. Group-or peer-led MI could offer a more comfortable environment for subjects reluctant to participate in one-on-one sessions.…”

“…Studies that used telephone-based MI exclusively identified eligible subjects from either a registry 21 or from health or pharmacy benefit programs. 27,32 The most commonly evaluated medications were highly active antiretroviral therapy (HAART). Among the 13 studies that reported race/ethnicity, 12 focused on minorities and 1963 individuals (48 %) belonged to a racial minority.…”

“…The same nurse delivered all nursing interventions and, after each session, recorded if the pre-specified components of the adherence intervention had been delivered. No independent MI fidelity assessment mentioned A nurse experienced in HIV and substance abuse observed 3 sessions to give feedback on the pre-specified elements of the intervention but not on MI skills Solomon 32 Half-day training at baseline, including role-playing and lectures. MI reinforced via 1-2 teleconferences a month with a behavioral scientist Yes, but unknown tool.…”