Motivational Interviewing for Diabetes Medication Adherence in Type 1 Diabetes and Type 2 Diabetes Patients
Type of DegreePhD Dissertation
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Objectives: Medication adherence is vital towards achieving adequate glycemic control in diabetes management. Workplace Wellness Programs (WWPs) for chronic disease management offer a unique setting for employers to offer behavior change interventions towards improving employees’ health and wellbeing. Motivational Interviewing (MI) is a patient-centered counseling approach that is effective towards helping patients adopt and sustain health behaviors for chronic disease self-management. Although, studies have documented the impact of MI in diabetes management, the effectiveness of an integrated, pharmacist-delivered approach using MI-based communication tools to modify medication-taking behavior remains unknown among diabetes patients enrolled in a WWP. This study assessed a brief pharmacist-delivered MI-based intervention for diabetes medication adherence among patients with type 1diabetes (T1D) and type 2 diabetes (T2D) in a hospital-based WWP. Methods: A quasi-experimental, longitudinal, one-group study design was implemented. Pharmacists trained in MI delivered three face-to-face sessions of brief MI-based counseling using conversation tools that support patient-selected conversation topics/reasons for medication nonadherence. The three sessions were delivered over a 12-week timeline in a diabetes outpatient clinic. Study duration was six months and primary data were collected at baseline, post-intervention (3 months after baseline), and at follow-up (3 months after post-intervention) using self-report and Electronic Health Record (EHR) data. The primary outcome was change in medication adherence which was measured using self-report at each MI session (based on the Medometer) and at each primary data collection time point using the Summary of Diabetes Self-care Activities (SDSCA) medication subscale. The secondary outcomes included change in clinical outcomes (hemoglobin A1C, blood pressure, and depressive symptoms), humanistic outcomes (health-related quality of life and patient satisfaction with treatment), and economic indicators (emergency department visits and hospital admissions). Results: Of the 170 eligible participants in the WWP, 53 consented to the study (31.2%); most were female 30(56.6%), average age was 54 years, and T2D was the predominant diagnosis 48(90.6%). Medication adherence based on the Medometer showed a statistically significant change from baseline to post-intervention, t (35) = -4.485, p< 0.00; the SDSCA medication adherence measure result showed improvement but it was not statistically significant. Among the clinical variables, diastolic blood pressure showed a statistically significant improvement, F (2, 70) = 3.57, ρ = 0.034. All other clinical outcomes did not change significantly. The Physical Component Summary (PCS) score and Mental Component Summary (MCS) score on the Short Form-12 measure for health-related quality of life increased significantly from baseline to follow-up; PCS, F (2, 58) = 7.53, p = 0.003 and MCS, F (2, 58) = 3.92, p = 0.025. Diabetes treatment satisfaction and economic indicators (emergency department visits and hospital admissions) did not change significantly. Conclusions: The intervention was effective towards improving medication adherence and participants’ quality of life. These findings add to the literature on the clinical utility of MI in modifying health behaviors. Although other target variables increased after the intervention, the observed changes were not sustained through the follow-up phase. Future research activities need to employ effective strategies to sustain intervention effects during follow-up or between patient visits in clinical settings. Study findings are useful for organizational decision-making on implementing a brief, patient-centered communication strategy to modify patient health behaviors.
- Gladys Ekong_ Dissertation_7_2018.pdf