A Brief Intervention to Improve Medication Knowledge and Adherence Among Family Medicine Patients in South Texas

This study examined a brief intervention to improve medication knowledge and compliance in
family medicine patients. The study was conducted in a network of six family medicine
residency programs in South Texas, funded by a grant from the Health Research Services
Administration. Family medicine patients were invited to participate in the study if they
took medicines for type 2 diabetes, hypertension, or hyperlipidemia and responded "yes" to
the screening question: "Do you sometimes have trouble taking all your medications as
prescribed?"

At enrollment, clinic staff administered a Medication Survey to patients to assess the
variables: readiness to change, reported medication knowledge; reported compliance, and
predictors of knowledge and compliance. Self-reports of compliance were validated with a
social desirability scale, and with physician impressions. Six and twelve weeks
post-enrollment, interviewers administered followup surveys by telephone to assess change
over time in medication knowledge and compliance. One year post-enrollment, investigators
conducted a chart review to examine changes in health outcomes: blood pressure or HbA1c or
cholesterol levels, and number of hospitalizations.

Three physicians per clinic site (18 total) conducted medication interventions for the
purpose of this study. This intervention was brief behavior change counseling done in the
context of a routine office visit, guided by simple strategies outlined in Rollnick et al
(1999). First, physicians reviewed subjects= medication regimen and addressed their
concerns. We selected a simple strategy from Rollnick et al. - a brainstorming session -
that built patients' confidence to change health behaviors. Afterward, physicians offered
pillboxes to patients who desired them, and reviewed potential adverse reactions to
medicines. One week after the intervention, physicians telephoned patients to reinforce
behavior change and to answer questions about the medications. Prior to training physicians
to conduct this intervention, we enrolled five subjects per physician into a control group.
We attempted to blind physicians to these patients= enrollment status; usual care was
provided to control subjects. After training, enrollees' charts were flagged so that
physicians knew to conduct the intervention. We sought five patients per physician to
receive the intervention.

Inclusion Criteria:

- Sometimes has trouble taking medicines as they're prescribed

- Has diabetes type 2, or hypertension, or high cholesterol for which they take
prescription medicines

- Is a patient of 18 doctors conducting the intervention

Exclusion Criteria:

- Subjects under age 18