Background
cardiometabolic diseases, DDIs
DISEASE PROGRESSION, CHRONIC DISEASE
Treating cardiometabolic diseases relies on sustained efforts ranging from lifestyle modification, public health measures, and procedural interventions to achieve better health outcomes [The physician, already challenged to prescribe the appropriate medication at the correct dose, must also hope that patients take their prescribed medication. Numerous studies indicate > 40% of patients with chronic conditions do not correctly follow their prescribed drug regimens, which is due to many factors including the sheer volume of medications they are prescribed [Adding to the challenge, physicians and other providers must not only disentangle nonadherence from DDIs but also separate these two issues from disease progression [An important reason physicians have difficulty in distinguishing nonadherence from DDIs and disease progression is lack of an effective and standardized method to test for these conditions [Prior to this study, scientists at Aegis Sciences Corporation have developed a Chronic Disease Management (CDM) test that detects medication adherence and the presence and severity of DDIs. The CDM test detects ingested substances from an oral fluid sample and tests for 150 of the most common cardiometabolic medications, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, diuretics, statins, sulfonylureas, antithrombotic agents, and vasodilators. The CDM test provides the physician with qualitative adherence data on these medications and also identifies potential DDIs. Through Aegis, we were allowed use of simulated CDM test results and funded to determine whether clinical practice change occurred.We used simulated patients in a randomized controlled intervention trial (RCT) to evaluate whether simulated results from the CDM test changed primary care physician behavior and led to better, more accurate diagnoses and treatment among patients presenting with chronic cardiometabolic diseases and improved their ability to distinguish between medication nonadherence, DDIs, or disease progression.