Nurse-delivered proactive telephone support to improve medication adherence: A multi-site, randomized controlled trial

2.50
Hdl Handle:
http://hdl.handle.net/10755/160098
Type:
Presentation
Title:
Nurse-delivered proactive telephone support to improve medication adherence: A multi-site, randomized controlled trial
Abstract:
Nurse-delivered proactive telephone support to improve medication adherence: A multi-site, randomized controlled trial
Conference Sponsor:Midwest Nursing Research Society
Conference Year:2006
Author:Reynolds, Nancy, PhD, RN, ANP, FAAN
P.I. Institution Name:Ohio State University
Title:Graduate Program Director
Contact Address:Adult/Gerontology Nursing, 1585 Neil Ave., Columbus, OH, 43210, USA
Contact Telephone:614-292-4449
Background: Patients' adherence to antiretroviral (ART) medications is critical to treatment success. There is little evidence to date supporting specific approaches for improving ART adherence. Guided by self-regulation theory, this study examined whether proactive telephone support improves adherence to ART therapy and clinical outcomes as compared to standard care.

Methods: A randomized controlled trial (ACTG 731) was conducted at 5 AIDS Clinical Trials Units in the U.S. Participants (n=109) beginning antiretroviral therapy for the first time were randomly assigned to receive either standard ACTG clinic-based patient education, or, in addition to standard care, a more intensive approach that included structured telephone calls delivered by a trained study nurse over 16 weeks. Outcome measures included Adherence measured by self-report and MEMS, time to viral load < 50 c/mL and time to primary study endpoint. Data were analyzed using descriptive and regression techniques.

Results: Rates of adherence were high in both treatment groups (mean adherence score = 98.1%). However, even with a sizeable ceiling effect, the overall treatment effect was better in the group that received telephone support (p < 0.05). When the analysis was limited to persons reporting <100% adherence, the overall treatment effect among the telephone support group was significantly improved (p < 0.001). Time to HIV RNA < 50 c/mL was significantly better in the telephone group (p<0.05). Likewise, Cox PH regression model for adherence randomization (stratified by screening RNA group and controlling for baseline CD4, gender, age, ethnic group, and randomized treatment arm), showed a difference in time to primary endpoint, although the difference was not statistically significance (p<0.05).

Conclusions: Our results indicate that structured, nurse-provided, telephone calls may improve adherence behavior and clinical outcomes relative to standard care. The intervention needs to be tested in a larger sample with greater variance in rate of adherence.

(NIH, NIAID)
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Midwest Nursing Research Society

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleNurse-delivered proactive telephone support to improve medication adherence: A multi-site, randomized controlled trialen_GB
dc.identifier.urihttp://hdl.handle.net/10755/160098-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Nurse-delivered proactive telephone support to improve medication adherence: A multi-site, randomized controlled trial</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Midwest Nursing Research Society</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Reynolds, Nancy, PhD, RN, ANP, FAAN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Ohio State University</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Graduate Program Director</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Adult/Gerontology Nursing, 1585 Neil Ave., Columbus, OH, 43210, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">614-292-4449</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">reynolds.1@osu.edu</td></tr><tr><td colspan="2" class="item-abstract">Background: Patients' adherence to antiretroviral (ART) medications is critical to treatment success. There is little evidence to date supporting specific approaches for improving ART adherence. Guided by self-regulation theory, this study examined whether proactive telephone support improves adherence to ART therapy and clinical outcomes as compared to standard care. <br/><br/>Methods: A randomized controlled trial (ACTG 731) was conducted at 5 AIDS Clinical Trials Units in the U.S. Participants (n=109) beginning antiretroviral therapy for the first time were randomly assigned to receive either standard ACTG clinic-based patient education, or, in addition to standard care, a more intensive approach that included structured telephone calls delivered by a trained study nurse over 16 weeks. Outcome measures included Adherence measured by self-report and MEMS, time to viral load &lt; 50 c/mL and time to primary study endpoint. Data were analyzed using descriptive and regression techniques.<br/><br/>Results: Rates of adherence were high in both treatment groups (mean adherence score = 98.1%). However, even with a sizeable ceiling effect, the overall treatment effect was better in the group that received telephone support (p &lt; 0.05). When the analysis was limited to persons reporting &lt;100% adherence, the overall treatment effect among the telephone support group was significantly improved (p &lt; 0.001). Time to HIV RNA &lt; 50 c/mL was significantly better in the telephone group (p&lt;0.05). Likewise, Cox PH regression model for adherence randomization (stratified by screening RNA group and controlling for baseline CD4, gender, age, ethnic group, and randomized treatment arm), showed a difference in time to primary endpoint, although the difference was not statistically significance (p&lt;0.05).<br/><br/>Conclusions: Our results indicate that structured, nurse-provided, telephone calls may improve adherence behavior and clinical outcomes relative to standard care. The intervention needs to be tested in a larger sample with greater variance in rate of adherence.<br/><br/>(NIH, NIAID) <br/></td></tr></table>en_GB
dc.date.available2011-10-26T22:37:29Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T22:37:29Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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