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Randomized Controlled Trial
. 2023 Apr;40(4):377-390.
doi: 10.1007/s40266-023-01008-6. Epub 2023 Feb 27.

A Motivational Interviewing Intervention to Improve Adherence to ACEIs/ARBs among Nonadherent Older Adults with Comorbid Hypertension and Diabetes

Anjana Mohan #  1 , Zahra Majd #  1 , Michael L Johnson  1 , Ekere J Essien  1 , Jamie Barner  2 , Omar Serna  3 , Esteban Gallardo  3 , Marc L Fleming  4 , Nancy Ordonez  5 , Marcia M Holstad  6 , Susan M Abughosh  7
Affiliations
Randomized Controlled Trial

A Motivational Interviewing Intervention to Improve Adherence to ACEIs/ARBs among Nonadherent Older Adults with Comorbid Hypertension and Diabetes

Anjana Mohan et al. Drugs Aging. 2023 Apr.

Abstract

Background: Hypertension and diabetes mellitus are independent risk factors for cardiovascular diseases. Due to the cardioprotective nature of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), they are recommended for patients with comorbid hypertension and diabetes. However, poor adherence to ACEIs/ARBs among older adults is a major public health concern. This study aimed to assess the effectiveness of a telephonic motivational interviewing (MI) intervention conducted by pharmacy students among a nonadherent older population (≥ 65 years old) with diabetes and hypertension.

Methods: Patients continuously enrolled in a Medicare Advantage Plan who received an ACEI/ARB prescription between July 2017 and December 2017 were identified. Group-based trajectory modeling (GBTM) was used to identify distinct patterns of ACEI/ARB adherence during the 1-year baseline period: adherent, gaps in adherence, gradual decline, and rapid decline in adherence. Patients from the three nonadherent trajectories were randomized into MI intervention or control group. The intervention consisted of an initial call and five follow-up calls administered by MI-trained pharmacy students and tailored to the baseline ACEI/ARB adherence trajectories. The primary outcome was adherence to ACEI/ARB during the 6- and 12-month periods post-MI implementation. The secondary outcome was discontinuation, defined as no refills for ACEI/ARB during the 6- and 12-month periods post-MI implementation. Multivariable regression analyses examined the impact of MI intervention on ACEI/ARB adherence and discontinuation while adjusting for baseline covariates.

Results: A total of 240 patients in the intervention group and 480 patients as randomly selected controls were included in this study. At 6 months, patients receiving the MI intervention had significantly better adherence (β = 0.06; p = 0.03) compared with the controls. Linear and logistic regression models also showed patients in the intervention group were more likely to be adherent than controls within 12 months of intervention implementation (β = 0.06; p = 0.02 and OR: 1.46; 95% CI 1.05-2.04, respectively). MI intervention did not have any significant impact on the ACEI/ARB discontinuation.

Conclusion: Patients who received the MI intervention were more likely to be adherent at 6 and 12 months following the intervention initiation, despite gaps in the follow-up calls due to COVID-19. Pharmacist-led MI intervention is an effective behavioral strategy to improve medication adherence among older adults and tailoring the intervention to past adherence patterns may enhance the intervention effectiveness. This study was registered with the United States National Institutes of Health (ClinicalTrials.gov identifier NCT03985098).

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Conflict of interest statement

SA reports grants from CARsgen and Valeant Pharmaceuticals, outside the submitted work. JB reports personal fees from University of Houston during the conduct of the study and a grant from Centers for Disease Control, Texas Health and Human Services, and Pharmaceutical Research Manufacturers of America Foundation, outside the submitted work. MF reports grants from National Heart, Lung, and Blood Institute and National Institute on Minority Health and Health Disparities (U-54). MF also reports contracts from Texas Health and Human Services Commission and CoI funding on a grant from Texas Council for Developmental Disabilities, outside the submitted work. EG is an employee of CareAllies, a subsidiary of Cigna, outside of the submitted work. The other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Study design. GBTM group-based trajectory modeling
Fig. 2
Fig. 2
Adherence trajectory groups
Fig. 3
Fig. 3
Cohort formation
See this image and copyright information in PMC

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