Improving Medication Adherence in Comorbid Conditions: Approximately 50 percent of persons on prescribed pharmacological therapy have difficulty adhering to their regimen. This difficulty contributes significantly to such adverse outcomes as hospitalization, the development of complications, disease progression, premature disability or death. The costs of poor adherence have been estimated to approach $100 billion dollars a year. Little effort, however, has been directed to the evaluation of adherence intervention strategies and few of those to remedial efforts. A population at particular risk for poor adherence and resulting untoward outcomes are those persons with co-morbid chronic conditions. No efforts have been directed to the remediation of pharmacological adherence problems in this group. It is the aim of this proposed study to evaluate an intervention developed within a problem-solving framework, which has been shown to be effective for a single pharmacological regimen for a single chronic disorder, within a sample on multiple pharmacological therapies for co-morbid conditions. The model for co-morbidity with multiple therapies that we have chosen is Type 2 diabetes with concurrent hypertension and hyperlipidemia. This is a prevalent co-morbid condition with high risk for multiple adverse clinical outcomes. Using a randomized, controlled design, we propose to examine the impact of a telephone delivered counseling intervention among 198 poor adherers who are being treated with oral medications for each of these disorders. Subjects receiving adherence counseling will be further randomized into a maintenance arm and an observation arm for an additional six months. All subjects will have adherence and clinical outcomes assessed at baseline (t1), the end of the 6-month intervention (t2), and again after the six-month follow-up period (t3). Potential predictors of adherence and responsiveness to intervention will be examined, including such factors as cognitive and physical function, quality of life, social support, and perceived problem solving ability, and sociodemographic as well as psychosocial factors. Secondarily, we propose to explore the cost-effectiveness of improving adherence with this intervention. A sample of approximately 198 good adherers, identified during screening, will also be invited to continue adherence monitoring for a 12 month period of time to identify the stability of good adherence levels as well as to identify factors that influence that stability.
| Jiang, Yun; Sereika, Susan M; Lingler, Jennifer H et al. (2018) Health literacy and its correlates in informal caregivers of adults with memory loss. Geriatr Nurs 39:285-291 |
| Luyster, Faith S; Dunbar-Jacob, Jacqueline (2011) Sleep quality and quality of life in adults with type 2 diabetes. Diabetes Educ 37:347-55 |
| Stilley, Carol S; Bender, Catherine M; Dunbar-Jacob, Jacqueline et al. (2010) The impact of cognitive function on medication management: three studies. Health Psychol 29:50-5 |
