Evidence map›Paper›PMID 22230825›Full record

Trial reportAnnals of family medicine

Treatment adjustment and medication adherence for complex patients with diabetes, heart disease, and depression: a randomized controlled trial.

Elizabeth H B Lin, Michael Von Korff, Paul Ciechanowski, Do Peterson, Evette J Ludman, Carolyn M Rutter, Malia Oliver, Bessie A Young, Jochen Gensichen, Mary McGregor and 3 more

Registry-linked trialAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00468676 (Randomized Trial of Liaison Psychiatry in Primary Care), which is not on this map. Cited by 68 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
68citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00468676 nacompletednot on this map

Randomized Trial of Liaison Psychiatry in Primary Care

TypeinterventionalSponsorUniversity of WashingtonRan2007 to 2012Enrolled214ConditionsDepressionArmsNurse-led case management, Treatment as usual
3 · Its place in the literature

Who cites it

68 citing papers in PubMed, 10 syntheses or guidelines pooled it.

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  15. Low-income minority patient engagement with automated telephonic depression assessment and impact on health outcomes.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2015
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8 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Elizabeth H B LinMacColl Center for Health Care Innovation, Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98101, USA. lin.e@ghc.org
Michael Von Korff
Paul Ciechanowski
Do Peterson
Evette J Ludman
Carolyn M Rutter
Malia Oliver
Bessie A Young
Jochen Gensichen
Mary McGregor
David K McCulloch
Edward H Wagner
Wayne J Katon

Funding

RANDOMIZED TRIAL OF LIAISON PSYCHIATRY IN PRIMARY CARER01MH041739 · NIMH · UNIVERSITY OF WASHINGTON · PI KATON, WAYNE J · 1987 to 2010
$6.6M
Quality Improvement of School Mental Health ServicesK08MH069741 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI KATAOKA, SHERYL H · 2004 to 2008
$769k
NIMH NIH HHS K08 MH069741NIMH NIH HHS MH041739NIMH NIH HHS MH069741NIMH NIH HHS R01 MH041739
6 · The paper itself

Abstract

purposeMedication nonadherence, inconsistent patient self-monitoring, and inadequate treatment adjustment exacerbate poor disease control. In a collaborative, team-based, care management program for complex patients (TEAMcare), we assessed patient and physician behaviors (medication adherence, self-monitoring, and treatment adjustment) in achieving better outcomes for diabetes, coronary heart disease, and depression.

methodsA randomized controlled trial was conducted (2007-2009) in 14 primary care clinics among 214 patients with poorly controlled diabetes (glycated hemoglobin [HbA(1c)] ≥8.5%) or coronary heart disease (blood pressure >140/90 mm Hg or low-density lipoprotein cholesterol >130 mg/dL) with coexisting depression (Patient Health Questionnaire-9 score ≥10). In the TEAMcare program, a nurse care manager collaborated closely with primary care physicians, patients, and consultants to deliver a treat-to-target approach across multiple conditions. Measures included medication initiation, adjustment, adherence, and disease self-monitoring.

resultsPharmacotherapy initiation and adjustment rates were sixfold higher for antidepressants (relative rate [RR] = 6.20; P <.001), threefold higher for insulin (RR = 2.97; P <.001), and nearly twofold higher for antihypertensive medications (RR = 1.86, P <.001) among TEAMcare relative to usual care patients. Medication adherence did not differ between the 2 groups in any of the 5 therapeutic classes examined at 12 months. TEAMcare patients monitored blood pressure (RR = 3.20; P <.001) and glucose more frequently (RR = 1.28; P = .006).

conclusionsFrequent and timely treatment adjustment by primary care physicians, along with increased patient self-monitoring, improved control of diabetes, depression, and heart disease, with no change in medication adherence rates. High baseline adherence rates may have exerted a ceiling effect on potential improvements in medication adherence.

Indexed as

Drug MonitoringPatient Care TeamAdultAgedAged, 80 and overAntidepressive AgentsAntihypertensive AgentsCardiovascular DiseasesComorbidityDepressive DisorderDiabetes MellitusDrug UtilizationFemaleHumansHypoglycemic AgentsInsulinAntidepressive AgentsAntihypertensive AgentsHypoglycemic AgentsInsulin

Identifiers

PMID22230825
PMCPMC3262469

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.