MAP study: RCT of a medication adherence program for patients with type 2 diabetes

Objective To evaluate the impact of a community pharmacy–based medication adherence detection and intervention protocol on medication adherence for patients with diabetes. Design Randomized controlled trial. Setting Four community chain pharmacies in the Seattle, WA, area from April 2008 to October 2009. Patients Patients with diabetes (n = 265) who were taking oral diabetes medications and late for refills by 6 days or more. Intervention Telephone-initiated adherence support by pharmacists following computer-generated missed refill alerts. Patients were randomized at the pharmacy level with pharmacists blinded to randomization. Main outcomes measures Changes in medication adherence (i.e., days late at first refill, percent with a refill gap of 6 days or more at first refill, medication possession ratio [MPR] at 6 and 12 months) measured during three time periods. Results Baseline MPR (previous 12 months) of oral diabetes medications for study versus control participants was relatively high and similar (0.86 and 0.84, respectively). At 12 months, MPR was significantly improved for the study group ( P = 0.004) compared with the control group (difference between groups, P = 0.01). The intervention showed greater effect for patients with baseline MPR less than 80% (difference between groups, P = 0.02). The likelihood of MPR above 80% at the 12-month follow-up for any patient significantly favored the intervention group (odds ratio 4.77 [95% CI 2.00–11.40]). Conclusion A brief missed refill intervention program involving urban community chain pharmacies was effective in achieving improved diabetes medication adherence, particularly among individuals with baseline MPR of 0.80 or less.