Roger Ruiz Moral1, Luis Angel Pérula de Torres2, Laura Pulido Ortega3, Margarita Criado Larumbe4, Ana Roldán Villalobos5, Jose Angel Fernández García6, Juan Manuel Parras Rejano7. 1. Faculty of Medicine, Francisco de Vitoria University, Madrid, Spain. Electronic address: r.ruiz.prof@ufv.es. 2. Teaching Unit of Family and Community Medicine of Córdoba (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Cordoba, Reina Sofia University Hospital, Cordoba, Spain. Electronic address: luisangel.perula@gmail.com. 3. Teaching Unit of Family and Community Medicine of Córdoba (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Cordoba, Reina Sofia University Hospital, Cordoba, Spain. Electronic address: laurapulidoortega@yahoo.es. 4. Teaching Unit of Family and Community Medicine of Córdoba (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Cordoba, Reina Sofia University Hospital, Cordoba, Spain. Electronic address: margarita.criado.exts@juntadeandalucia.es. 5. Teaching Unit of Family and Community Medicine of Córdoba (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Cordoba, Reina Sofia University Hospital, Cordoba, Spain. Electronic address: anab.roldan.sspa@juntadeandalucia.es. 6. Villarrubia Health Center, UGC Occidente (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Córdoba/Reina Sofia University Hospital, Córdoba, Spain. Electronic address: joseangelfernandezgarcia@hotmail.com. 7. Villanueva del Rey Health Center, UGC-Pueblonuevo Penyarroya (Northern Córdoba Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Córdoba/Reina Sofia University Hospital, Córdoba, Spain. Electronic address: juanprj@gmail.com.
Abstract
OBJECTIVE: To evaluate the effectiveness of motivational interviewing (MI) in improving medication adherence in older patients being treated by polypharmacy. METHODS: Cluster randomized clinical trial in 16 primary care centers with 27 health care providers and 154 patients. Thirty-two health care providers were assigned to an experimental (EG) or control group (CG). INTERVENTIONS: MI training program and review of patient treatments. Providers in the EG carried out MI, whereas those in the CG used an "advice approach". Three follow-up visits were completed, at 15 days and at 3 and 6 months. Medication adherence in both groups was compared (p<0.05). RESULTS:Patients recruited: 70/84 (EG/CG). Mean age: 76 years; female: 68.8%. The proportion of subjects changing to adherence was 7.6% higher in the EG (p<0.001). Therapeutic adherence was higher for patients in the EG (OR=2.84), women (OR=0.24) and those with high educational levels (OR=3.93). CONCLUSION: A face-to-face motivational approach in primary care helps elderly patients with chronic diseases who are being treated by polypharmacy to achieve an improved level of treatment adherence than traditional strategies of providing information and advice. PRACTICE IMPLICATIONS: MI is a patient-centered approach that can be used to improve medication adherence in primary care. TRIAL REGISTRATION: This trial is registered at ClinicalTrials.gov (NCT01291966).
RCT Entities:
OBJECTIVE: To evaluate the effectiveness of motivational interviewing (MI) in improving medication adherence in older patients being treated by polypharmacy. METHODS: Cluster randomized clinical trial in 16 primary care centers with 27 health care providers and 154 patients. Thirty-two health care providers were assigned to an experimental (EG) or control group (CG). INTERVENTIONS: MI training program and review of patient treatments. Providers in the EG carried out MI, whereas those in the CG used an "advice approach". Three follow-up visits were completed, at 15 days and at 3 and 6 months. Medication adherence in both groups was compared (p<0.05). RESULTS:Patients recruited: 70/84 (EG/CG). Mean age: 76 years; female: 68.8%. The proportion of subjects changing to adherence was 7.6% higher in the EG (p<0.001). Therapeutic adherence was higher for patients in the EG (OR=2.84), women (OR=0.24) and those with high educational levels (OR=3.93). CONCLUSION: A face-to-face motivational approach in primary care helps elderly patients with chronic diseases who are being treated by polypharmacy to achieve an improved level of treatment adherence than traditional strategies of providing information and advice. PRACTICE IMPLICATIONS: MI is a patient-centered approach that can be used to improve medication adherence in primary care. TRIAL REGISTRATION: This trial is registered at ClinicalTrials.gov (NCT01291966).
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