A substudy evaluating treatment intensification on medication adherence among hypertensive patients receiving home blood pressure telemonitoring and pharmacist management.

WHAT IS KNOWN AND OBJECTIVE: Hypertension is a leading cause of death and major contributor to heart attacks, strokes, heart and kidney failure. Antihypertensive (HTN medication) non-adherence contributes to uncontrolled hypertension. Effective initiatives to improve uncontrolled hypertension include a team-based approach with home blood pressure (BP) monitoring. Our study objective was to evaluate whether objectively measured medication adherence was influenced by home BP telemonitoring and pharmacist management. METHODS: We analysed HTN medication adherence in 240 patients who received home BP telemonitoring and pharmacist intervention (TI). Adherence was measured based on prescription fills and the proportion of days covered (PDC). HTN medications continued pre- to post-baseline were similar for telemonitoring intervention (TI) and usual care (UC) patients (rate ratio = 1·00, P = 0·90). RESULTS AND DISCUSSION: More HTN medications were discontinued pre- to post-baseline in TI patients (rate ratio = 1·38, P = 0·04). Similarly, more HTN medications were added in TI patients (rate ratio = 2·46, P < 0·001). The proportion with a mean PDC ≥ 0·8 for HTN medications added after baseline and overall adherence did not differ between groups. WHAT IS NEW AND CONCLUSION: Medication adherence was high in both groups; however, medication adherence was not significantly altered by the intervention. There were more medication modifications and greater medication intensification among TI patients.

Outcomes monitoring in Minnesota: treatment implications, practical limitations.

Minnesota developed its treatment outcomes monitoring system to evaluate its service delivery system and to identify specific ways to enhance treatment outcomes. Standardized patient and treatment data were collected for all outpatient and inpatient admissions, and an assessment interview and weekly treatment services records were completed for 4953 adults and 387 adolescents who consented to participate in the outcomes study. Six-month follow-up interviews were completed for 64.4% of these adults and 83.5% of these adolescents. The study identified predictors of treatment completion and outcome for adults and adolescents, and predictors of outcome by setting for adults. The study also examined results for programs designed especially for adolescents, women, and culturally specific populations, as well as the relationships to outcomes of ancillary services and continuing care activities. Anticipated policy and program design changes resulting from the findings are discussed, along with the practical limitations of conducting a state outcomes monitoring system.

Comparison of substance abuse treatment outcomes for inpatients and outpatients.

This study was conducted to determine whether inpatient substance abuse treatment was associated with higher posttreatment abstinence rates than outpatient treatment. The follow-up sample of 2,476 adults represented 183 Minnesota treatment programs. Composite measures were constructed based on psychometric analyses of a modified version of the Addiction Severity Index and additional variables. A series of analyses was conducted, including hierarchical logistic regression and a contingency table analysis addressing multiple problem severity. For the total sample, setting was not significantly associated with abstinence once other outcome predictors and differences between inpatients and outpatients were controlled for. However, when the logistic regression analysis was extended to include all possible two-way interactions of setting with clinically related severity variables, recent suicidal behavior was found to be a moderator of the association between setting and outcome. Inpatient treatment significantly predicted a higher posttreatment abstinence rate than outpatient treatment for the small subset of patients (16% of the sample) who reported recent suicidal ideation or attempt.