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Sticking to Statins

Abughosh Receives $184K Grant from Regeneron to Study Impact of Motivational Interviewing on Statin Adherence Among Texas Medicare Patients

A UH College of Pharmacy researcher is investigating the factors involved in low adherence to potentially life-saving statin medications and whether pharmacist-led counseling interventions are effective helping patients improve and maintain adherence.

Supported by a two-year, $184,587 grant from Regeneron Pharmaceuticals Inc., the study by UHCOP Assistant Professor Susan Abughosh, Ph.D., will be conducted in two phases. The first involves examining a database to identify different patterns for low adherence, associated indicators and patients who fit within the parameters, then providing interventional counseling through motivational interviewing as a means of eliciting behavioral change in patients toward better adherence and ultimately improved health outcomes.

"Despite the well-documented efficacy of statins in prevention and treatment of cardiovascular disease, patient adherence – the extent to which patients take lipid-lowering medications as prescribed or recommended by a healthcare provider – remains sub-optimal, due to a variety of factors," Abughosh said. "We will endeavor to show that, with interventions customized by patient adherence patterns, medication adherence can be positively affected."

In the first phase, Abughosh and her collaborators will apply a relatively new statistical method – called group-based trajectory models – to identify similar medication-filling behavior over a 12-month period among statin users aged 65 and older who are enrolled in a Texas-based Medicare Advantage plan.

Anticipated behavior patterns include patients who completely stop taking their medications and those who miss doses while continuing to take medication. Predictors or factors associated with the adherence patterns will be identified, documented, interpreted and evaluated.

The second phase of the study will be a randomized trial to demonstrate the benefit of an intervention among 500 non-adherent patients in the health plan. Patients who fall within the model parameters will be contacted by UHCOP Pharm.D. students trained in the interventional technique of motivational interviewing, which was first developed in the 1980s, then refined and validated over the next three decades before gaining greater acceptance and utilization in the past 10 years.

The basic tenets of motivational interviewing involve exploring and resolving a patient’s ambivalence toward a specific goal – such as medication adherence – by engaging the patient’s intrinsic motivation in a non-judgmental, non-confrontational style. The student-patient interactions will be customized by the adherence patterns and conducted by telephone, with three follow-up contacts during the study. Adherence during the six months post-intervention will be evaluated for the intervention and control groups.

Other members of Abughosh’s team include fellow Pharmaceutical Health Outcomes and Policy faculty members Marc L. Fleming, Ph.D., MPH, R.Ph., E. James Essien, M.D., DrPH, and Michael L. Johnson, Ph.D., as well as Texas-based Medicare Advantage provider Cigna HealthSpring’s Omar Serna, Pharm.D., BCACP, clinical pharmacy manager and residency program director, and Tara Esse, Pharm.D., BCACP, clinical program manager.

"Enhanced patient adherence will result in improved patient outcomes, decreased healthcare expenditures associated with cardiovascular related emergency department visits and hospitalizations, as well as an overall reduction in cardiovascular-related mortality," Abughosh said. "Our future goal is to implement the interventions developed in this study to target patients before they become non-adherent, based on the adherence pattern predictors identified in this study. We have so much to gain and many lives to save."

– by Kyle Fake for UHCOP