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Health Services Research & Development

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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1046 — Baseline Correlates of Achieving and Maintaining Blood Pressure Targets in the Adherence and Intensification of Medications (AIM) Program

Klamerus ML (Ann Arbor HSR&D COE), Kerr EA (Ann Arbor HSR&D COE), Hofer TP (Ann Arbor HSR&D COE), Holleman R (Ann Arbor HSR&D COE), Heisler M (Ann Arbor HSR&D COE)

Objectives:
Participants in short-term programs who make significant clinical improvement during the program often do not sustain these gains over time. We examined baseline correlates of being successfully discharged (defined as having medication adherence issues addressed and achieving a blood pressure (BP) target) from a pharmacist-based clinical program, and of maintaining the target BP after discharge from the program.

Methods:
A clinical program led by pharmacists trained in motivational interviewing and authorized to make BP medication changes was implemented at 3 VA and 2 Kaiser Permanente facilities. 945 diabetic patients, with persistent poor BP and poor refill adherence or insufficient medication intensification, had one or more encounters. Patients completed a survey prior to enrollment that assessed baseline characteristics and measures of barriers to adherence, depression, activation, perceived confidence, social support, decision making, health literacy, and other related issues. Using bivariate analyses, we examined the association of the above variables with being discharged with a target BP, and then with maintaining the target BP up to six months after the intervention. Two logistic models were constructed; one for each time period. Each model included the patient’s average BP prior to enrollment, site of enrollment, and all variables that were part of our conceptual model and associated with success (p < = 0.2) in the bivariate analyses. In the model examining baseline correlates of maintaining program success, we also included variables found to be significant (p < .05) in the model examining short-term success (i.e., a target BP at discharge).

Results:
Approximately 60% of all program participants completed a baseline survey. Of these, 87% were successfully discharged from the program. In multivariate analyses, screening positive for depression (OR 0.41; 95% CI 0.19-0.89) and being African American (OR 0.33; CI 0.11-0.99) were negatively associated with being discharged from the program with a target BP. Only 29% of patients were able to maintain their BP target after the program. Those who reported one or more barriers to adherence at baseline were less likely to maintain their target BP (OR 0.52; CI 0.29-0.95). Additionally, those with more than a high school education were more likely to maintain their target BP after discharge (OR 2.28; CI 1.20-4.32).

Implications:
Barriers to adherence were not associated with being successfully discharged from the program with a target BP, suggesting that the AIM program was indeed able to address these; however, our results also indicate that once a patient is discharged from the program s/he may not be able to surmount these barriers alone. Our results also suggest that patients who screen positive for depression may need additional support in order to succeed in a clinical program such as AIM.

Impacts:
Clinical programs must both include a maintenance plan in order for patients to sustain improvements and include baseline depression screening with appropriate follow-up for those who screen positive.


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