CoChat
Sign Up
Cited by 46Medication Adherence and CompliancePharmacy and Medical PracticesPatient-Provider Communication in Healthcare

Enhancing Statin Adherence Using a Motivational Interviewing Intervention and Past Adherence Trajectories in Patients with Suboptimal Adherence

Open access
Abughosh, Susan M., Vadhariya, Aisha, Johnson, Michael L., Essien, E. James, Esse, Tara W., Serna, Omar, Gallardo, Esteban, Boklage, Susan H. +3 more·2019·Journal of Managed Care & Specialty Pharmacy
DOI 10.18553/jmcp.2019.25.10.1053PMC PMC10398332
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Statins have been shown to be effective in reducing the occurrence of cardiovascular (CV) events and are widely prescribed for the risk reduction of CV diseases and recurrent CV events. However, poor adherence prevents some patients from receiving the maximum benefit of the therapy. Motivational interviewing (MoI) is a patient-centered collaborative approach that can be used to improve medication adherence. Group-based trajectory modeling depicts patterns of adherence over time and may help tailor the MoI intervention to further enhance adherence. OBJECTIVE: To assess the effect of a phone-based MoI intervention tailored by patients' past adherence trajectory in improving adherence to statins among patients in a Medicare Advantage prescription drug plan (MAPD). METHODS: Patients continuously enrolled in an MAPD from 2013 to 2017 with a statin prescription between January and June 2015 to allow 2 years of pre-index period and 1 year of follow-up were included in the study. Adherence to statins was measured monthly during the 1-year follow-up as proportion of days covered (PDC) and incorporated into a group-based trajectory model to provide 4 distinct patterns of adherence: adherent, rapid decline, gradual decline, and gaps in adherence. Patients in the 3 nonadherent groups were randomized to either control or intervention. The intervention was an initial counseling call and up to 2 monthly follow-up calls by pharmacy students trained in MoI, providing education consistent with a previously identified pattern of use. Refill data at 6 months post-intervention were evaluated to examine the intervention's effect on PDC, as continuous and dichotomized as PDC ≥ 0.8, as well as discontinuation. Multivariable regression adjusted for baseline demographics, clinical characteristics, and past adherence trajectory. RESULTS: < 0.001) as well as in the logistic regression model (OR = 1.87; 95% CI = 1.18-2.95). Previous adherence trajectories were significantly associated with adherence in the follow-up. CONCLUSIONS: Patients who received the MoI intervention were more likely to be adherent and less likely to discontinue the statin in the 6 months follow-up compared with controls. Future research can identify other approaches to tailor interventions and expand the intervention to other languages. This intervention may also prove valuable to improve adherence to other medications for chronic and asymptomatic diseases. DISCLOSURES: This study was funded by Regeneron Pharmaceuticals, which provided critical input during study design, implementation, and manuscript preparation. Abughosh reports grants from Sanofi, BMS/Pfizer, and Valeant Pharmaceuticals, unrelated to this study. Vadhariya reports a past internship at Regeneron Pharmaceuticals, unrelated to this study. Esse, Serna, and Gallardo are employees of CareAllies, a Cigna subsidiary. Boklage is an employee of Regeneron Pharmaceuticals. Choi was an employee of Sanofi during this study. Johnson, Essien, Fleming, and Holstad have nothing to disclose. A poster based on this study was presented at AMCP Nexus 2018; October 22-25, 2018; Orlando, FL.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.18553/jmcp.2019.25.10.1053

Cites

5 of 5 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Tailored interventions targeting LLMs are more likely to improve adherence.

    “These findings suggests that tailored interventions targeting LLMs are more likely to improve adherence, as non-adherence to different classes of medication likely requires distinct, personalised approaches.”

    From Interventions to improve adherence to lipid-lowering drugs: a systematic review and meta-analysis (2025) · cites this paper as [23]

    The Conclusions describe a tailored intervention that may improve statin adherence, and the Discussion reports better adherence than in controls over six months. The study concerns statins; it does not establish that different medication classes require distinct approaches or that tailored interventions are more effective across lipid-lowering medications generally. Page numbers are not provided in the supplied passages. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 43

  1. Lopez-Jaramillo P, Lopez-Lopez J, Lopez-Lopez C, Rodriguez-Alvarez MI. The goal of blood pressure in the hypertensive patient with diabetes is defined: now the challenge is go from recommendations to practice. Diabetol Metab Syndr. 2014;6(1):31.
  2. Rodgers A, Ezzati M, Vander Hoorn S, Lopez AD, Lin RB, Murray CJL. Distribution of major health risks: findings from the Global Burden of Disease study. PLoS Med. 2004;1(1):e27.
  3. Prince MJ, Wu F, Guo Y, et al. The burden of disease in older people and implications for health policy and practice. Lancet. 2015;385(9967):549-62.
  4. Fung V, Sinclair F, Wang H, Dailey D, Hsu J, Shaber R. Patients' per- spectives on nonadherence to statin therapy: a focus-group study. Perm J. 2010;14(1):4-10.
  5. Cheung BM, Lauder IJ, Lau CP, Kumana CR. Meta-analysis of large ran- domized controlled trials to evaluate the impact of statins on cardiovascular outcomes. Br J Clin Pharmacol. 2004;57(5):640-51.
  6. Cholesterol Treatment Trialists' Collaborators, Mihaylova B, Emberson J, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. 2012;380(9841):581-90.
  7. Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol- lowering treatment: prospective meta-analysis of data from 90,056 partici- pants in 14 randomised trials of statins. Lancet. 2005;366(9493):1267-78.
  8. Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK. Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166(21):2307-13.
  9. Shalev V, Chodick G, Silber H, Kokia E, Jan J, Heymann AD. Continuation of statin treatment and all-cause mortality: a population-based cohort study. Arch Intern Med. 2009;169(3):260-68.
  10. Delahoy PJ, Magliano DJ, Webb K, Grobler M, Liew D. The relationship between reduction in low-density lipoprotein cholesterol by statins and reduction in risk of cardiovascular outcomes: an updated meta-analysis. Clin Ther. 2009;31(2):236-44.
  11. Abughosh SM, Kogut SJ, Andrade SE, Larrat EP, Gurwitz JH. Persistence with lipid-lowering therapy: influence of the type of lipid-lowering agent and drug benefit plan option in elderly patients. J Manag Care Pharm. 2004;10(5):404-11. Available at: https://www.jmcp.org/doi/10.18553/ jmcp.2004.10.5.404. · DOI
  12. Mann DM, Woodward M, Muntner P, Falzon L, Kronish I. Predictors of nonadherence to statins: a systematic review and meta-analysis. Ann Pharmacother. 2010;44(9):1410-21.
  13. Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA. 2002;288(4):462-67.
  14. Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002;288(4):455-61.
  15. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-97.
  16. Foreman KF, Stockl KM, Le LB, et al. Impact of a text messaging pilot program on patient medication adherence. Clin Ther. 2012;34(5):1084-91.
  17. Butler RJ, Davis TK, Johnson WG, Gardner HH. Effects of nonad- herence with prescription drugs among older adults. Am J Manag Care. 2011;17(2):153-60.
  18. Kripalani S, Yao X, Haynes RB. Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med. 2007;167(6):540-50.
  19. MacLaughlin EJ, Raehl CL, Treadway AK, Sterling TL, Zoller DP, Bond CA. Assessing medication adherence in the elderly: which tools to use in clinical practice? Drugs Aging. 2005;22(3):231-55.
  20. Miller WR, Rollnick S. Ten things that motivational interviewing is not. Behav Cogn Psychother. 2009;37(2):129-40.
  21. Velasquez MM, von Sternberg K, Dodrill CL, Kan L. The transtheoretical model as a framework for developing substance abuse interventions. J Addictions Nursing. 2005;16(1-2):31-40.
  22. Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55(513):305-12.
  23. Ogedegbe G, Chaplin W, Schoenthaler A, et al. A practice-based trial of motivational interviewing and adherence in hypertensive African Americans. Am J Hypertens. 2008;21(10):1137-43.
  24. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613-19.
  25. Johnson ML, Parikh N, Kunik ME, et al. Antihypertensive drug use and the risk of dementia in patients with diabetes mellitus. Alzheimers Dement. 2012;8(5):437-44.
  26. Parikh NM, Morgan RO, Kunik ME, et al. Risk factors for dementia in patients over 65 with diabetes. Int J Geriatric Psychiatry. 2011;26(7):749-57.
  27. Holstad MM, DiIorio C, Kelley ME, Resnicow K, Sharma S. Group motivational interviewing to promote adherence to antiretroviral medica- tions and risk reduction behaviors in HIV infected women. AIDS Behavior. 2011;15(5):885-96.
  28. Turner AP, Sloan AP, Kivlahan DR, Haselkorn JK. Telephone counseling and home telehealth monitoring to improve medication adherence: results of a pilot trial among individuals with multiple sclerosis. Rehabil Psychol. 2014;59(2):136-46.
  29. Abrons J, Vadala T, Miller S, Cerulli J. Encouraging safe medication disposal through student pharmacist intervention. J Am Pharm Assoc (2003). 2010;50(2):169-73.
  30. Low KG, Giasson H, Connors S, Freeman D, Weiss R. Testing the effectiveness of motivational interviewing as a weight reduction strategy for obese cardiac patients: a pilot study. Int J Behav Med. 2013;20(1):77-81.
  31. Rolnick SJ, Pawloski PA, Hedblom BD, Asche SE, Bruzek RJ. Patient characteristics associated with medication adherence. Clin Med Res. 2013;11(2):54-65.
  32. Chan DC, Shrank WH, Cutler D, et al. Patient, physician, and payment predictors of statin adherence. Med Care. 2010;48(3):196-202.
  33. VanBuskirk KA, Wetherell JL. Motivational interviewing with primary care populations: a systematic review and meta-analysis. J Behav Med. 2014;37(4):768-80.
  34. Abughosh S, Wang X, Serna O, et al. A motivational interviewing inter- vention by pharmacy students to improve medication adherence. J Manag Care Spec Pharm. 2017;23(5):549-60. Available at: https://www.jmcp.org/ doi/10.18553/jmcp.2017.23.5.549. · DOI
  35. Halterman JS, Szilagyi PG, Fisher SG, et al. Randomized controlled trial to improve care for urban children with asthma: results of the school-based asthma therapy trial. Arch Pediatr Adolesc Med. 2011;165:262-68.
  36. DiIorio C, McCarty F, Resnicow K, et al. Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study. AIDS Care. 2008;20(3):273-83.
  37. Peterson AM, Nau DP, Cramer JA, Benner J, Gwadry-Sridhar F, Nichol M. A checklist for medication compliance and persistence studies using retrospective databases. Value Health. 2007;10(1):3-12.
  38. Franklin JM, Shrank WH, Pakes J, et al. Group-based trajectory models: a new approach to classifying and predicting long-term medication adher- ence. Med Care. 2013;51(9):789-96.
  39. Franklin JM, Krumme AA, Tong AY, et al. Association between tra- jectories of statin adherence and subsequent cardiovascular events. Pharmacoepidemiol Drug Saf. 2015;24(10):1105-13.
  40. Choudhry NK, Glynn RJ, Avorn J, et al. Untangling the relationship between medication adherence and post-myocardial infarction outcomes: medication adherence and clinical outcomes. Am Heart J. 2014;167(1):51-58.e5.
  41. Vadhariya A, Fleming ML, Johnson ML, et al. Group-based trajectory models to identify sociodemographic and clinical predictors of adherence patterns to statin therapy among older adults. Am Health Drug Benefits. 2019;12(4):202-11.
  42. Vadhariya A, Abughosh SM. A review of patient related barriers to statin adherence. J Epidemiol Public Health Rev. 2017;2(3).
  43. Rollnick S, Miller WR, Butler CC, Aloia MS. Motivational interviewing in health care: helping patients change behavior. COPD: J Chron Obstruct Pulmon Dis. 2008;5(3):203.

Cited by

Sorted by citations

Authors
Abughosh, S. M., Vadhariya, A., Johnson, M. L., Essien, E. J., Esse, T. W., Serna, O., Gallardo, E., Boklage, S. H., Choi, J., Holstad, M. M., & Fleming, M. L.
Affiliations
Emory University (US)
Corresponding author
Abughosh, Susan M.
ORCID
Venue
Journal of Managed Care & Specialty Pharmacy
Publisher
Academy of Managed Care Pharmacy
Published
2019-10
Volume
25
Issue
10
Pages
1053-1062
ISSN
  • 2376-0540 (ISSN-L)
  • 2376-1032
DOI
10.18553/jmcp.2019.25.10.1053
PMC
PMC10398332
OpenAlex
W2975482595
Cited by
46
References
5
Citations by year
2026: 3 · 2025: 7 · 2024: 7 · 2023: 3 · 2022: 11 · 2021: 9 · 2020: 6
FWCI
6.69
Type
journal article
Language
en
Open access
Locations
  • Journal of Managed Care & Specialty Pharmacy (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Keywords
statin adherence, medication adherence, motivational interviewing, adherence trajectories, group-based trajectory modeling, telephone counseling, pharmacy students, Medicare Advantage prescription drug plans, proportion of days covered, drug discontinuation, personalized interventions, cardiovascular disease prevention, chronic disease management, language barriers, culturally diverse patients, patient-centered care, adverse drug reactions
MeSH terms
Assessment of Medication Adherence, Aged, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Hyperlipidemias, Male, Middle Aged, Prospective Studies, Retrospective Studies, Students, Pharmacy, Telephone, United States, Program Evaluation, Drug Monitoring, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medicare Part C, Medication Adherence, Motivational Interviewing

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review