A Randomized, Controlled Pilot Study of an Intervention for Medication Adherence

Duke University, Durham NC

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Abstract

DESCRIPTION (provided by applicant): The importance of adherence to treatment for chronic heart failure (CHF) has been demonstrated by both large clinical trials and community-based studies. However, adherence rates continue to hover at 50%. Many interventions, predominantly education initiatives and frequent reminder strategies, have been developed to improve patients'ability to adhere to medications;however these interventions have been successful only in short term applications. In heart failure patients, the importance of knowing and being reminded about medications pales in the context of debilitating symptoms such as fatigue. An intervention is needed to help patients integrate the expectation for life-long medication-taking as a meaningful and necessary part of meaning chronic illness, particularly during intervals of symptoms exacerbation such as fatigue. Development of positive meaning-associations with a treatment regimen has been associated with adherence to the regimen, at least in the short term. Meaning-association interventions, however, have not been developed or evaluated in longer-term, chronic illnesses such as CHF. The goal of the proposed research is to test the efficacy of a novel intervention for long-term medication adherence by using the constructs of Meaning-Response Theory to build realistic patient expectations around medicines, symptoms and the work required for life-long adherence. The efficacy of the intervention will be tested in a short-term (12 month) study in a clinical setting with 80 randomized CHF patients screened as "poor adherers" using the Medication Adherence Scale (MAS). If the intervention appears to be feasible and efficacious in this sample, funding will be pursued for testing the intervention on a larger scale to evaluate long- term medication adherence and related clinical outcomes. Data from this preliminary project will be used to determine appropriate effect size for the larger study. PUBLIC HEALTH RELEVANCE: Chronic heart failure is one of the major causes of debilitation and death in older adults. Although medication adherence improves CHF outcomes, adherence rates remain around 50%. The intervention to be tested in these projects has the potential to improve CHF outcomes by improving adherence rates.