A routinization intervention to improve adherence to complex medication regimensMuch of the today's adult population takes several medications for chronic illnesses daily, many of them withdifferent dosing frequencies and guidelines (e..g. with or before meals). Medication adherence remains asignificant world-wide problem despite decades of research. Intrapersonal interventions to improvemedication adherence with informational or behavioral strategies, focused on beliefs and attitudes underlyingintent, motivation, and ability, have demonstrated mixed effects on adherence and little impact on clinicaloutcomes. There is some emerging evidence that regularity of daily routine may be related to adherenceand 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-dayactivities and linking medication taking to habitual behavior (routinization) rather than effortful cognitiveprocessing may be an effective way to improve adherence. Health care resources are limited, therefore it isimportant to design a feasible and cost-effective intervention to improve medication adherence that will easilytranslate to clinical practice and be integrated into patients' lives. Because of limited clinical staff in mostpractices, 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 withhypertension and/or hyperlipidemia who are on complex medication regimens.
The aims of the study are to1) test direct effects of a routinization intervention on medication adherence and health outcomes amongpoor adherers and 2) assess how relevant trait personality and cogntive function factors impact on thetreatment effect in a sample of adults on complex medication regimens for chronic illnesses. The long termgoal of this research is to develop a simple, cost-effective intervention that improves medication adherenceand health outcomes (biomarkers of disease control, mood, quality of life) and easily translates to clinicalpractice. The secondary goal is to identify trait characteristics of patients who benefit most from theinterventions with brief screening measure to identify patients who are at highest risk of non-adherence.
