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. 2024 Jan:136:107385.
doi: 10.1016/j.cct.2023.107385. Epub 2023 Nov 11.

Protocol of a patient randomized clinical trial to improve medication adherence in primary care

JoAnn M Sperl-Hillen  1 , Jacob L Haapala  2 , Steven P Dehmer  2 , Lilian N Chumba  2 , Heidi L Ekstrom  2 , Anjali R Truitt  3 , Stephen E Asche  2 , Ann M Werner  2 , Dan J Rehrauer  4 , Melissa A Pankonin  5 , Pamala A Pawloski  2 , Patrick J O'Connor  2
Affiliations

Protocol of a patient randomized clinical trial to improve medication adherence in primary care

JoAnn M Sperl-Hillen et al. Contemp Clin Trials. 2024 Jan.

Abstract

Background: Enhanced awareness of poor medication adherence could improve patient care. This article describes the original and adapted protocols of a randomized trial to improve medication adherence for cardiometabolic conditions.

Methods: The original protocol entailed a cluster randomized trial of 28 primary care clinics allocated to either (i) medication adherence enhanced chronic disease care clinical decision support (eCDC-CDS) integrated within the electronic health record (EHR) or (ii) usual care (non-enhanced CDC-CDS). Enhancements comprised (a) electronic interfaces printed for patients and clinicians at primary care encounters that encouraged discussion about specific medication adherence issues that were identified, and (b) pharmacist phone outreach. Study subjects were individuals who at an index visit were aged 18-74 years and not at evidence-based care goals for hypertension (HTN), diabetes mellitus (DM), or lipid management, along with low medication adherence (proportion of days covered [PDC] <80%) for a corresponding medication. The primary study outcomes were improved medication adherence and clinical outcomes (BP and A1C) at 12 months. Protocol adaptation became imperative in response to major implementation challenges: (a) the availability of EHR system-wide PDC calculations that superseded our ability to limit PDC adherence information solely to intervention clinics; (b) the unforeseen closure of pharmacies committed to conducting the pharmacist outreach; and (c) disruptions and clinic closures due to the Covid-19 pandemic.

Conclusion: This manuscript details the protocol of a study to assess whether enhanced awareness of medication adherence issues in primary care settings could improve patient outcomes. The need for protocol adaptation arose in response to multiple implementation challenges.

Trial registration: ClinicalTrials.gov NCT03748420.

Keywords: Chronic disease; Clinical decision support; Medication adherence; Pharmacist outreach; Primary care.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1:
Figure 1:
Cluster Randomized Study Design (Original Protocol)
Figure 2:
Figure 2:
Examples of eCDC-CDS displays: (a) printed for study eligible patients, (b) printed for PCCs, and (c) viewable by PCCs within the EHR
Figure 2:
Figure 2:
Examples of eCDC-CDS displays: (a) printed for study eligible patients, (b) printed for PCCs, and (c) viewable by PCCs within the EHR
Figure 2:
Figure 2:
Examples of eCDC-CDS displays: (a) printed for study eligible patients, (b) printed for PCCs, and (c) viewable by PCCs within the EHR
Figure 3:
Figure 3:
Adherence Intervention Workflow
See this image and copyright information in PMC

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