An explanatory randomised controlled trial of a nurse-led, consultation-based intervention to support patients with adherence to taking glucose lowering medication for type 2 diabetes

被引：49

作者：

Farmer, Andrew ^{[1
]}

Hardeman, Wendy ^{[2
]}

Hughes, Dyfrig ^{[3
]}

Prevost, A. Toby ^{[4
]}

Kim, Youngsuk ^{[2
]}

Craven, Anthea ^{[1
]}

Oke, Jason ^{[1
]}

Boase, Sue ^{[2
]}

Selwood, Mary ^{[1
]}

Kellar, Ian ^{[2
]}

Graffy, Jonathan ^{[2
]}

Griffin, Simon ^{[5
]}

Sutton, Stephen ^{[2
]}

Kinmonth, Ann-Louise ^{[2
]}

机构：

[1] Univ Oxford, Dept Primary Hlth Care Sci, Oxford, England

[2] Univ Cambridge, Gen Practice & Primary Care Res Unit, Inst Publ Hlth, Dept Publ Hlth & Primary Care, Cambridge, England

[3] Bangor Univ, Ctr Hlth Econ & Med Evaluat, Bangor, Gwynedd, Wales

[4] Kings Coll London, Dept Primary Care & Publ Hlth Sci, London WC2R 2LS, England

[5] MRC, Clin Epidemiol Unit, Cambridge, England

来源：

BMC FAMILY PRACTICE | 2012年 / 13卷

基金：

英国医学研究理事会;

关键词：

Adherence; Brief intervention; Diabetes; METFORMIN; BELIEFS; DISEASE; PEOPLE; SCALES; DRUGS;

D O I：

10.1186/1471-2296-13-30

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Background: Failure to take medication reduces the effectiveness of treatment leading to increased morbidity and mortality. We evaluated the efficacy of a consultation-based intervention to support objectively-assessed adherence to oral glucose lowering medication (OGLM) compared to usual care among people with type 2 diabetes. Methods: This was a parallel group randomised trial in adult patients with type 2 diabetes and HbA(1c)>= 7.5% (58 mmol/mol), prescribed at least one OGLM. Participants were allocated to a clinic nurse delivered, innovative consultation-based intervention to strengthen patient motivation to take OGLM regularly and support medicine taking through action-plans, or to usual care. The primary outcome was the percentage of days on which the prescribed dose of medication was taken, measured objectively over 12 weeks with an electronic medication-monitoring device (TrackCap, Aardex, Switzerland). The primary analysis was intention-to-treat. Results: 211 patients were randomised between July 1, 2006 and November 30, 2008 in 13 British general practices (primary care clinics). Primary outcome data were available for 194 participants (91.9%). Mean (sd) percentage of adherent days was 77.4% (26.3) in the intervention group and 69.0% (30.8) in standard care (mean difference between groups 8.4%, 95% confidence interval 0.2% to 16.7%, p = 0.044). There was no significant adverse impact on functional status or treatment satisfaction. Conclusions: This well-specified, theory based intervention delivered in a single session of 30 min in primary care increased objectively measured medication adherence, with no adverse effect on treatment satisfaction. These findings justify a definitive trial of this approach to improving medication adherence over a longer period of time, with clinical and cost-effectiveness outcomes to inform clinical practice.

引用

页数：9

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