Improving Medication Adherence In Patients With Multiple Chronic Conditions : Evaluation Of A Pilot Intervention In A Rural Primary Care Clinic

Abstract

Background: More than 25% of primary care patients are managing multiple chronic conditions (MCC) and 50% of their medications are not taken as prescribed. Self-efficacy is the foundation of many successful medication adherence and chronic disease self-management (CDSM) interventions for specific chronic conditions. Interventions designed within a self-efficacy framework and tailored for the primary care setting could improve health outcomes for patients with MCC. Primary Aims: 1) Describe demographic and psychosocial characteristics of patients with MCC, 2) Examine the relationships between number of chronic conditions, primary (medication adherence) and secondary (health literacy, self-efficacy, problem-solving, and QOL) variables, 3) Evaluate the preliminary efficacy of a medication adherence intervention for patients with MCC on improving outcomes. Methods: Adult patients presenting for care in the Family Medicine department at a rural Federally Qualified Health Center were recruited to complete a survey on CDSM and participate in the intervention. The intervention involved 4 group sessions and 2 follow-up telephone sessions. Data collection occurred at baseline and post-treatment. Results: Pilot study results indicated that MCC was prevalent in 62% of the sample (N = 53), patients and providers generally had similar perceptions of CDSM needs, and better medication adherence was among the most frequently endorsed need. The intervention study participants (N = 20) were managing on average 5 chronic conditions and 40% had less than adequate health literacy levels. Health literacy and MCC were significantly positively associated (p = 0.036). Outcomes analyses indicated that scores significantly improved on measures of Effective Problem-solving (p = .028, d = .67), Positive Transfer Problem-solving (p = .010, d = .67), Self-efficacy for managing chronic disease in general (p = .005, d = .66), and Self-efficacy for engaging in social/recreational activities (p = .005, d = .42). Self-reported medication adherence improvements fell short of significance. Conclusions: Participants reported significant improvements on factors theoretically and empirically linked to adherence and health outcomes. Research with larger samples and longer follow-up is needed in order to evaluate the efficacy of this treatment and mechanisms for change. Collaborating with patients and providers during program development could facilitate acceptability and sustainability of CDSM programs.