Cardiovascular disease (CVD) is the leading cause of death and disability in the U.S. Evidence from randomized trials suggests that when medications for hypertension and lipid disorders are used at standard dosages, they have a significant risk-reduction effect. Yet, adherence problems to lipid management and antihypertensive medications are well known. In 2002, the National Heart Lung and Blood Institute's Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) reported that poor adherence crosses ethnic and age groups, socioeconomic strata, acute and chronic diseases, and treatment regimens. The consequences of absent or partial adherence are observed in all types of clinical settings. The ATP III also reports that there is no one cause of poor medication adherence. Since there is no single cause, there is not likely to be one approach to improve adherence in all persons. The goal of this Phase II application is to continue development and conduct efficacy testing of this practical and easily delivered intervention system to assist patients with lipid disorders and hypertension to take advantage of several strategies for improving adherence to medications. The intervention will utilize a computer-based software program during routine clinic visits to: (1) assess a patient's unique medication adherence challenges;(2) provide him or her with tailored information on adhering to medications prescribed by his or her physician;and (3) provide suggestions for that patient's physician based on the patient's medication adherence assessment. Several other approaches are available to improve medication adherence. Yet, this proposed system offers unique features. It utilizes very-low-cost technology to direct a patient to adherence enhancing strategies that fit his or her unique needs. The patient assessment occurs just prior to seeing the physician so physician efficiency in dealing with medication-related discussions can be improved. The system should increase the consistency with which physicians address key adherence issues. Additionally, the physician's influence with the patient is potentially leveraged. Because this intervention approach relies on the physician's understanding of patients'current physiologic characteristics, most recent prescribed medications, and knowledge of side effects a patient may be experiencing at that visit, this system should have a quality advantage over some competing systems. In Phase II, we will enhance the system based on Phase I results, and conduct a prospective efficacy trial to test the ability of the system to improve medication adherence using an intervention groups with 154 patients and a usual care of 154 patients being treated in internal medicine, cardiology and community health center clinical settings and their physicians (N=16). Public Health Relevance: Heart disease is the leading cause of death and disability in the U.S. Most people have problems taking their prescribed medications. If the proposed system proves to be effective in helping people take blood pressure and cholesterol-lowering medicines, it can reduce the costs of healthcare and improve the quality of life for people who have a risk for heart disease.
