ABSTRACT
Objectives: Angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs) are recommended for patients with comorbid diabetes mellitus and hypertension due to their favorable impact on microvascular and macrovascular events, cardiovascular outcomes, and mortality. Poor adherence to ACEI/ARB is a major public health concern. Motivational interviewing (MI) intervention is an effective patient-centered approach to improve adherence. The objective of this study was to evaluate the effectiveness of a telephonic MI intervention conducted by pharmacy students, tailored by the past ACEI/ARB adherence trajectories among nonadherent patients with comorbid diabetes mellitus and hypertension. Methods: Patients continuously enrolled in a Medicare Advantage Plan from July 2017-July 2021 with an ACEI/ARB prescription between July 2017-December 2017 were identified. Group-based trajectory modeling (GBTM) was used to identify 4 distinct patterns of ACEI/ARB adherence: adherent, gaps in adherence, gradual decline, and rapid decline in adherence. Patients from the 3 nonadherent trajectories were randomized either into MI intervention or control group. The intervention group received an initial call followed by 5 follow-up calls. The primary outcome was adherence measured as proportion of days covered (PDC) ≥ 0.80 for 1-year post-MI implementation. Multivariable logistic regression model evaluated the effect of the intervention on ACEI/ARB adherence. Results: This study included 240 patients who received intervention and 480 randomly selected controls. Patients who had received ≥ 4 calls were more likely to be adherent than those who received ≤ 3 follow-up calls (OR=2.01;P=0.01) despite the gaps in follow-up calls due to the COVID-19 outbreak. Other significant predictors of adherence were baseline adherence trajectories, number of other medications on the index date, prevalent users, regimen complexity, and CMS risk score. Conclusions: At 1 year, patients who received ≥ 4 calls had significantly better adherence than controls. MI intervention by pharmacy students has been demonstrated to improve adherence on a long-term basis.
ABSTRACT
Objectives: The outbreak of COVID-19 may increase the risk of depression among Middle Eastern and North African (MENA) community given the additional stressors they face including immigration, encountering a new culture, and language barrier. We aimed to assess depression and its predictors during COVID-19 among MENA community in Houston, Texas. Methods: A cross-sectional study was conducted using a validated survey consisted of sociodemographic, general health, and COVID-19 questions. A multivariable logistic regression model was used to determine predictors of depression. The outcome of interest was “moderate/severe” versus “no/mild” depression and measured using the validated Patient Health Questionnaire (PHQ-9). Results: A total of 368 individuals completed the survey. The overall prevalence of “moderate/severe” and “mild” depression was 31.79% and 68.21%, respectively. Multivariable regression analysis revealed that people with self-reported depression (OR=2.76, 95%CI=1.15-6.65) and those expressed "I don't know” for having depression (OR=9.03, 95%CI=1.55-52.62) were more likely to have “moderate/severe” depression compared to participants reported no depression. Individuals who said “Yes” to the question "Has the COVID-19 outbreak been so frightening/upsetting that you tried hard not to think about it, or tried to avoid situations that reminded of it?” were more likely to have “moderate/severe” depression compared to those who said “No”. (OR=3.63, 95%CI=1.64-8.03). In addition, those having "no difficulty” (OR=0.13, 95%CI=0.03-0.51) and those having “some difficulty” (OR=0.20, 95%CI=0.07-0.56) doing errands alone because of a physical, mental, or emotional condition were less likely to have “moderate/severe” depression compared to those with "a lot of difficulty/can't do at all". Conclusions: Depression in the MENA community may be predicted by social and physical wellbeing, self-reported symptoms of depression and COVID-19 related factors. Predictors identified should be considered when designing interventions to improve the social and health needs of MENA group in the context of the existing racial and immigrant health in the US.