The Team Education and Adherence Monitoring (TEAM) Trial

Abstract

Abstract-Recent studies suggest that involving pharmacists is an effective strategy for improving patient adherence and blood pressure (BP) control. To date, few controlled studies have tested the cost-effectiveness of specific models for improving patient adherence and BP control in community pharmacies, where most Americans obtain prescriptions. We hypothesized that a team model of adherence monitoring and intervention in corporately owned community pharmacies can improve patient adherence, prescribing, and BP control among hypertensive black patients. The Team Education and Adherence Monitoring (TEAM) Trial is a randomized controlled trial testing a multistep intervention for improving adherence monitoring and intervention in 28 corporately owned community pharmacies. Patients in the 14 control pharmacies received "usual care," and patients in the 14 intervention pharmacies received TEAM Care by trained pharmacists and pharmacy technicians working with patients and physicians. Data collectors screened 1250 patients and enrolled 597 hypertensive black patients. The primary end points were the proportion of patients achieving BP control and reductions in systolic and diastolic BP measured after 6 and 12 months. Secondary end points were changes in adherence monitoring and intervention, patient adherence and barriers to adherence, prescribing, and cost-effectiveness. Researchers also will examine potential covariates and barriers to change. Involving pharmacists is a potentially powerful means of improving BP control in blacks. Pharmacists are in an excellent position to monitor patients between clinic visits and to provide useful information to patients and physicians. T he global prevalence of hypertension, and the associated morbidity and mortality rates, is among the highest for blacks in the United States. 1 Barriers to hypertension control in blacks have been identified at multiple levels, including: patient nonadherence to regimens, 2 suboptimal prescribing, 3-4 and ineffective health systems. 5 A recent review of quality improvement strategies 5 suggests that a team change involving pharmacists may be one of the most effective quality improvement strategies for improving blood pressure (BP) control. However, it is not known whether pharmacy interventions can be implemented successfully in corporately owned pharmacies, where most Americans now obtain their prescriptions. Barriers to Adherence in Black PatientsAlthough nonadherence with antihypertensive regimens is found in all groups, blacks often have higher nonadherence according to objective measures. 6 Studies show that minority populations experience more barriers to adherence, even after controlling for socioeconomic status. For example, blacks are more likely than whites to experience the "core" barriers to adherence, including: problematic side effects, difficulty remembering, doubts or concerns about drug efficacy, and difficulty paying for drugs. 2 Higher priority must be placed on better tools or models of care for detecting and reducing these ...

Improving refill adherence and hypertension control in black patients: Wisconsin TEAM trial

“…2–7 Studies also demonstrate that blacks experience significantly more barriers to antihypertensive medication adherence than whites, including greater concerns about drug efficacy, greater concerns about adverse effects, forgetting to take medications, and difficulty paying for medications. 8,9 Effective interventions are needed to address these barriers to medication adherence in this vulnerable population. 6,9 …”

“…8,9 Effective interventions are needed to address these barriers to medication adherence in this vulnerable population. 6,9 …”

3Ps-Pharmacist, Physician and Patient: Proposal for Joint Cooperation to Increase Adherence to Medication

“…According to the pharmacists' experience, fear of disease, type of disease and patient's mental profile were the major factors which influenced patient adherence to prescribed therapy (Table 4). A higher proportion of the patients believed that pharmacists were interested in their attitude toward adherence to the therapy prescribed, as compared with the answers to the same question given by the pharmacists who have a great advantage to monitor patients between clinic visits and to provide useful information to patients and physicians (16). The relationship between the patient and his/her family physician is especially important in improving adherence to medication.…”

The Pennsylvania Project: Pharmacist Intervention Improved Medication Adherence And Reduced Health Care Costs

“…14 Several authors have recommended a model that uses a broad screening tool (which would effectively assign patients into adherence risk strata) coupled with an individually tailored intervention for improving population adherence. 15 We applied this model, called screening and brief intervention, within community pharmacies. The model involves a brief universal screen that indicates patient adherence risk, followed by a pharmacist-led brief intervention provided to patients at elevated risk.…”