A routinization intervention to improve adherence to complex medication regimens Much of the today's adult population takes several medications for chronic illnesses daily, many of them with different dosing frequencies and guidelines (e..g. with or before meals). Medication adherence remains a significant world-wide problem despite decades of research. Intrapersonal interventions to improve medication adherence with informational or behavioral strategies, focused on beliefs and attitudes underlying intent, motivation, and ability, have demonstrated mixed effects on adherence and little impact on clinical outcomes. There is some emerging evidence that regularity of daily routine may be related to adherence and that capitalizing on automatic processes, or habits, can facilitate adherence to medication regimens. Focusing on external or contextual issues by capitalizing upon and strengthening regularity of every-day activities and linking medication taking to habitual behavior (routinization) rather than effortful cognitive processing may be an effective way to improve adherence. Health care resources are limited, therefore it is important to design a feasible and cost-effective intervention to improve medication adherence that will easily translate to clinical practice and be integrated into patients'lives. Because of limited clinical staff in most practices, it would also be useful to easily and quickly determine which patients are at highest risk of nonadherence. Thus, we propose to conduct a randomized controlled trial in a sample of diabetic adults with hypertension and/or hyperlipidemia who are on complex medication regimens.
The aims of the study are to 1) test direct effects of a routinization intervention on medication adherence and health outcomes among poor adherers and 2) assess how relevant trait personality and cogntive function factors impact on the treatment effect in a sample of adults on complex medication regimens for chronic illnesses. The long term goal of this research is to develop a simple, cost-effective intervention that improves medication adherence and health outcomes (biomarkers of disease control, mood, quality of life) and easily translates to clinical practice. The secondary goal is to identify trait characteristics of patients who benefit most from the interventions with brief screening measure to identify patients who are at highest risk of non-adherence.
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