Evidence of real-world effectiveness of a telephone quitline for smokers. Effects of telephone counseling on antipsychotic adherence and emergency department utilization. Telephone Counseling to Improve Osteoporosis Treatment Adherence: An Effectiveness Study in Community Practice Settings Effect of telephone counseling on physical activity for low-active older people in primary care: a randomized, controlled trial. Evaluation of software-based telephone counseling to enhance medication persistency among patients with multiple sclerosis. Pilot testing of an HIV medication adherence intervention in a public clinic in the Deep South A multifactorial intervention to improve blood pressure control in co-existing diabetes and kidney disease: a feasibility randomized controlled trial. Osteoporosis telephonic intervention to improve medication regimen adherence: a large, pragmatic, randomized controlled trial.
BACKGROUND Telephone services that offer smoking-cessation counseling ( quitlines ) have proliferated in recent years , encouraged by positive results of clinical trials . The question remains , however , whether those results can be translated into real-world effectiveness . METHODS We embedded a r and omized , controlled trial into the ongoing service of the California Smokers ' Helpline . Callers were r and omly assigned to a treatment group ( 1973 callers ) or a control group ( 1309 callers ) . All participants received self-help material s. Those in the treatment group were assigned to receive up to seven counseling sessions ; those in the control group could also receive counseling if they called back for it after r and omization . RESULTS Counseling was provided to 72.1 percent of those in the treatment group and 31.6 percent of those in the control group ( mean , 3.0 sessions ) . The rates of abstinence for 1 , 3 , 6 , and 12 months , according to an intention-to-treat analysis , were 23.7 percent , 17.9 percent , 12.8 percent , and 9.1 percent , respectively , for those in the treatment group and 16.5 percent , 12.1 percent , 8.6 percent , and 6.9 percent , respectively , for those in the control group ( P<0.001 ) . Analyses factoring out both the subgroup of control subjects who received counseling and the corresponding treatment subgroup indicate that counseling approximately doubled abstinence rates : rates of abstinence for 1 , 3 , 6 , and 12 months were 20.7 percent , 15.9 percent , 11.7 percent , and 7.5 percent , respectively , in the remaining subjects in the treatment group and 9.6 percent , 6.7 percent , 5.2 percent , and 4.1 percent , respectively , in the remaining subjects in the control group ( P<0.001 ) . Therefore , the absolute difference in the rate of abstinence for 12 months between the remaining subjects in the treatment and control groups was 3.4 percent . The 12-month abstinence rates for those who made at least one attempt to quit were 23.3 percent in the treatment group and 18.4 percent in the control group ( P<0.001 ) . CONCLUSIONS A telephone counseling protocol for smoking cessation , previously proven efficacious , was effective when translated to a real-world setting . Its success supports Public Health Service guidelines calling for greater availability of quitlines OBJECTIVE To determine whether ScriptAssist , a telehealth nursing program using psychological techniques , reduced emergency department ( ED ) utilization and improved adherence among Medicaid health plan members with serious and persistent mental illness ( SPMI ) . STUDY DESIGN Nonr and omized controlled trial . METHODS Of 210 eligible Medicaid health plan members with SPMI , 59 ( 28 % ) were contacted by phone and 51 ( 86 % ) participated . Participants received an average of 3.5 calls over 9 months , with 2.1 attempts per completed call . Participants had clinical ly significant levels of impairment ; medication switching , polypharmacy , and medical comorbidities were common . Intervention group participants ' results were compared with those of non participants to rule out regression to the mean , history , and maturation effects . Intervention group participants ' results also were compared with baseline data to rule out selection bias . RESULTS Program participants had fewer ED visits during the intervention than a comparison group , and reduced their ED use and hospitalization rate compared with the previous year . Participants also had better medication adherence based on pharmacy and interview data . CONCLUSIONS Cognitive-behavioral and motivational-interviewing techniques can improve antipsychotic medication adherence .  Telehealth may be a useful strategy for disseminating these evidence -based techniques . Lessons learned included the importance of real-time referral data , a need to address polypharmacy , and a need to overcome contact difficulties result ing from disease processes and " unknown caller " IDs . Despite these difficulties , using a disease management model , the program was feasible , and the reduced number of ED visits indicated potential cost-effectiveness Treatment nonadherence is a recognized problem , but most practice setting s use education alone to address it . Psychological counseling methods generate greater behavior change but are not widely used . Telehealth nursing can be used to integrate these methods into routine clinical practice . This study was a nonr and omized trial of a telehealth program that used motivational interviewing and cognitive— behavioral techniques to improve osteoporosis medication adherence .  Registered nurses delivered the intervention to 402 participants recruited from provider offices across the United States .  Initial participation rates were high in this community-based sample , although attrition also was high . Six-month adherence based on pharmacy and clinical interview data was significantly higher than the general population rate . A comparison with non participants approached significance , and there was a significant dose — response effect . Most reasons given for nonadherence were psychological . The results support the use of psychological techniques to improve adherence and the use of telehealth to disseminate evidence -based patient counseling . ( Am J Med Qual 2007;22 445 - 456 OBJECTIVES To assess the long-term effectiveness of a telephone counseling intervention on physical activity and health-related quality of life in low-active older adults recruited through their primary care physician . DESIGN R and omized , controlled trial . SETTING Three primary care practice s from different socioeconomic regions of Auckl and , New Zeal and . PARTICIPANTS One hundred and eighty-six low-active adults ( aged 65 ) recruited from their primary care physicians ' patient data bases . INTERVENTION Eight telephone counseling sessions over 12 weeks based on increasing physical activity .  Control patients received usual care . MEASUREMENTS Change in physical activity ( as measured using the Auckl and Heart Study Physical Activity Question naire ) and quality of life ( as measured using the Short Form-36 Health Survey ( SF-36 ) ) over a 12-month period . RESULTS Moderate leisure physical activity increased by 86.8 min/wk more in the intervention group than in the control group ( P=.007 ) . More participants in the intervention group reached 2.5 hours of moderate or vigorous leisure physical activity per week after 12 months ( 42 % vs 23 % , odds ratio=2.9 , 95 % confidence interval=1.33 - 6.32 , P=.007 ) . No differences on SF-36 measures were observed between the groups at 12 months . CONCLUSION Telephone-based physical activity counseling is effective at increasing physical activity over 12 months in previously low-active older adults OBJECTIVE To evaluate the effect of a software-supported intervention based on the Transtheoretical Model of Change and motivational interviewing on decreasing discontinuation ( or increasing persistency ) of Avonex ( interferon beta-1a -- Biogen ) , a medication for treatment of multiple sclerosis ( MS ) . DESIGN R and omized controlled experimental design comparison of software-based telephone counseling ( intervention group ) and st and ard care ( control group ) . SETTING United States . PARTICIPANTS 366 patients with MS . INTERVENTION Software-based telephone counseling . MAIN OUTCOME MEASURE Discontinuation of Avonex treatment and movement among stages of the Transtheoretical Model of Change . RESULTS Patients in the software intervention group demonstrated a statistically significantly lower proportion of Avonex treatment ( 1.2 % ) discontinuation than the st and ard care group ( 8.7 % ) . In addition , stage movement away from discontinuation of Avonex ( i.e. , toward continuation of therapy ) was significantly higher in the treatment group . CONCLUSION The Transtheoretical Model of Change constructs and motivational interviewing processes were effectively incorporated into a software-based intervention program , and this significantly decreased the proportion of patients who discontinued treatment of MS with Avonex . The integration of behavioral theory with information systems offers a promising approach for pharmacists and other providers to promote medication persistency Purpose : Strict adherence to HIV medications is critical to ensure long‐term disease control , and adherence interventions that are possible in a clinic setting with limited re sources are needed . Data sources : This r and omized controlled pilot study tested an adherence intervention guided by the Information‐Motivation‐Behavioral Skills ( IMB ) model . The intervention included HIV education , a peer video , motivational interviewing , and attention to behavioral skills including communication with providers and adherence‐enhancing devices . Dependent variables included 3‐4 week adherence recall , medication refill rate , changes in IMB subscale scores , appointment attendance , and HIV‐associated laboratory findings . Seventy‐three individuals starting or restarting antiretroviral therapy were enrolled and 56 were r and omized . Conclusions : Improvements were seen in most outcomes , with small to moderate effect sizes , but the study was not powered to show statistical significance . Threats to power included a 51 % attrition rate , result ing mostly from loss to clinical care or prolonged gaps in care . Implication s for practice : A telephone‐based intervention to improve HIV medication adherence shows promise . Further study is needed with greater attention to retention in care AIMS The aim of this study was to test the feasibility and impact of an intervention consisting of self-monitored blood pressure , medicine review , a Digital Versatile Disc , and motivational interviewing telephone calls to help people with diabetes and kidney disease improve their blood pressure control and adherence to prescribed medications . BACKGROUND People with co-existing diabetes , kidney disease and hypertension require multiple medications to manage their health . About 50 % of people are non-adherent to their prescribed medications with non-adherence increasing in the presence of chronic conditions . DESIGN R and omized controlled trial . METHODS Patients aged ≥18 years with diabetes , chronic kidney disease and systolic hypertension were recruited from nephrology and diabetes out patients ' clinics of an Australian metropolitan hospital between 2008 - 2009 . Participants were r and omly allocated on a 1:1 basis to one of two groups in a r and omized controlled trial : the intervention delivered over 3 months ( n = 39 ) and usual care ( n = 41 ) , with follow-up at 3 , 6 and 9 months postintervention . People collecting data and assessing outcomes were blinded to group assignment . RESULTS Seventy-five participants completed the study . The intervention was acceptable and feasible for this cohort . There were no statistically significant differences between groups , although the mean systolic blood pressure reduction in the intervention group ( n = 36 ) was -6·9 mmHg 95 % CI ( -13·8 , -0·02 ) at 9 months postintervention . CONCLUSION The study was feasible and statistically significant differences may be determinable in a larger sample to overcome the variability between groups , paying attention to recommendations for further research . TRIAL REGISTRATION The trial was prospect ively registered with the Australian and New Zeal and Clinical Trials Register ( ACTRN12607000044426 ) BACKGROUND Multiple studies demonstrate poor adherence to medication regimens prescribed for chronic illnesses , including osteoporosis , but few interventions have been proven to enhance adherence . We examined the effectiveness of a telephone-based counseling program rooted in motivational interviewing to improve adherence to a medication regimen for osteoporosis . METHODS We conducted a 1-year r and omized controlled clinical trial . Participants were recruited from a large pharmacy benefits program for Medicare beneficiaries . All potentially eligible individuals had been newly prescribed a medication for osteoporosis . Consenting participants were r and omized to a program of telephone-based counseling ( n = 1046 ) using a motivational interviewing framework or a control group ( n = 1041 )  that received mailed educational material s.  Medication regimen adherence was the primary outcome compared across treatment arms and was measured as the median ( interquartile range ) medication possession ratio , calculated as the ratio of days with filled prescriptions to total days of follow-up . RESULTS The groups were balanced at baseline , with a mean age of 78 years ; 93.8 % were female . In an intention-to-treat analysis , median adherence was 49 % ( interquartile range , 7%-88 % ) in the intervention arm and 41 % ( 2%-86 % ) in the control arm ( P = .07 , Kruskal-Wallis test ) . There were no differences in self-reported fractures . CONCLUSION In this r and omized controlled trial , we did not find a statistically significant improvement in adherence to an osteoporosis medication regimen using a telephonic motivational interviewing intervention
ABSTRACT Adherence to prescribed medications continues to be a problem in the treatment of chronic disease .
Motivational interviewing ( MI ) has been shown to be successful for eliciting patients ’ motivations to change their medication-taking behaviors .
Due to the constraints of the US healthcare system , patients do not always have in-person access to providers .
Because of this , there is increasing use of non-traditional healthcare delivery methods such as telephonic counseling .
A systematic review was conducted among published studies of telephone-based MI interventions aim ed at improving the health behavior change target of medication adherence .
The goals of this review were to ( 1 ) examine and describe evidence and gaps in the literature for telephonically delivered MI interventions for medication adherence and ( 2 ) discuss the implication s of the findings for research and practice .