Abstract 4430: A Culturally-Adapted Automated Telecommunications System Improves Medication Adherence and Blood Pressure Control in Urban African Americans
Background: Hypertension (HTN) is 50% more prevalent in African Americans (AA) than whites, and at every level of elevated blood pressure (BP) AA experience greater end organ damage. Poor adherence to the antihypertensive medication regimen impairs BP control. We conducted a randomized, controlled trial of a culturally-adapted, automated, telephone coach system to help hypertensive, urban AA adults improve their BP control by improving adherence to their medication regimen, to diet, and to exercise recommendations. We report results of the intervention on adherence to the BP medication regimen.
Methods: Subjects (N =337) were drawn from the adult primary care practices of a large urban teaching hospital and 4 affiliated health centers, and were randomly assigned to the intervention or an education-only control. Inclusion criteria were
a diagnosis of HTN in the health record;
≥1 active BP medication prescription; and
≥2 elevated BP values within 6 months of randomization.
The intervention lasted 8 months. Medication adherence was assessed at baseline and every 4 months for 1 year using the 7-item version of the Morisky survey, a validated measure of adherence to medication regimens. SBP and DBP were also measured at each time point using a standard protocol. Data were analyzed using mixed effects regression modeling.
Results: The sample was 70% female, had a mean age of 56 years, and 84% earned under $30K per year. On average, subjects had 2 active BP prescriptions at baseline. Mean BP at study entry was 131/81 in both groups, and the mean medication adherence score was 12.0, suggesting high baseline adherence. The intervention was associated with a 2.6 point improvement (p=.01) in the medication adherence score controlling for age, sex, number of BP medications, health literacy level, financial status and marital status. Being in the intervention group was also associated with a mean SBP reduction of 3.3 mmHg vs. controls (p=.15).
Conclusions: The intervention improved medication adherence scores and produced a trend toward lower SBP vs. controls. Given their low program costs, versatility and reach, automated telecommunications systems can potentially enhance BP management in AA populations.