Journal of General Internal Medicine

, Volume 31, Issue 11, pp 1294–1300

An Electronic Adherence Measurement Intervention to Reduce Clinical Inertia in the Treatment of Uncontrolled Hypertension: The MATCH Cluster Randomized Clinical Trial

  • Ian M. Kronish
  • Nathalie Moise
  • Thomas McGinn
  • Yan Quan
  • William Chaplin
  • Benjamin D. Gallagher
  • Karina W. Davidson
Original Research

DOI: 10.1007/s11606-016-3757-4

Cite this article as:
Kronish, I.M., Moise, N., McGinn, T. et al. J GEN INTERN MED (2016) 31: 1294. doi:10.1007/s11606-016-3757-4

ABSTRACT

BACKGROUND

To appropriately manage uncontrolled hypertension, clinicians must decide whether blood pressure (BP) is above goal due to a need for additional medication or to medication nonadherence. Yet, clinicians are poor judges of adherence, and uncertainty about adherence may promote inertia with respect to medication modification.

OBJECTIVE

We aimed to determine the effect of sharing electronically-measured adherence data with clinicians on the management of uncontrolled hypertension.

DESIGN

This was a cluster randomized trial.

PARTICIPANTS

Twenty-four primary care providers (12 intervention, 12 usual care; cluster units) and 100 patients with uncontrolled hypertension (65 intervention, 35 usual care) were included in the study.

INTERVENTIONS

At one visit per patient, clinicians in the intervention group received a report summarizing electronically measured adherence to the BP regimen and recommended clinical actions. Clinicians in the control group did not receive a report.

MAIN MEASURES

The primary outcome was the proportion of visits with appropriate clinical management (i.e., treatment intensification among adherent patients and adherence counseling among nonadherent patients). Secondary outcomes included patient-rated quality of care and communication during the visit.

KEY RESULTS

The proportion of visits with appropriate clinical management was higher in the intervention group than the control group (45 out of 65; 69 %) versus (12 out of 35; 34 %; p = 0.001). A higher proportion of adherent patients in the intervention group had their regimen intensified (p = 0.01), and a higher proportion of nonadherent patients in the intervention group received adherence counseling (p = 0.005). Patients in the intervention group were more likely to give their clinician high ratings on quality of care (p = 0.05), and on measures of patient-centered (p = 0.001) and collaborative communication (p = 0.02).

CONCLUSIONS

Providing clinicians with electronically-measured antihypertensive adherence reports reduces inertia in the management of uncontrolled hypertension.

Trial Registration

NCT01257347; http://clinicaltrials.gov/show/NCT01257347

KEY WORDS

uncontrolled hypertension medication adherence clinical inertia randomized clinical trial 

Supplementary material

11606_2016_3757_MOESM1_ESM.docx (480 kb)
Supplemental Figure 1Medication adherence report provided to clinicians in the intervention group (DOCX 479 kb)

Copyright information

© Society of General Internal Medicine 2016

Authors and Affiliations

  • Ian M. Kronish
    • 1
  • Nathalie Moise
    • 1
  • Thomas McGinn
    • 2
  • Yan Quan
    • 1
  • William Chaplin
    • 3
  • Benjamin D. Gallagher
    • 1
  • Karina W. Davidson
    • 1
  1. 1.Center for Behavioral Cardiovascular HealthColumbia University Medical CenterNew YorkUSA
  2. 2.Department of MedicineHofstra North Shore-LIJ School of MedicineManhassetUSA
  3. 3.Department of PsychologySt. John’s UniversityJamaicaUSA

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