A Randomized Study of the Efficacy of a New Intervention for Medication Adherence in Chronic Illness: Medications, Meaning and Me (The 3-M Study)

Purpose of the study - The purpose of this study is to develop and evaluate the efficacy of a new, theoretically based intervention to improve medication adherence in persons with HF. The hypotheses include:

Hypothesis I. Poorly adherent patients with symptomatic HF who receive the intervention (n=40) will be more adherent to medicines during the12-month intervention than a control group (n=40) of poorly adherent patients with symptomatic HF.

Hypothesis II. Poorly adherent patients with symptomatic HF who receive the intervention (n=40) will have fewer hospital readmissions (HR) and emergency department (ED) visits during the 12-month intervention than a control group of poorly adherent patients with symptomatic HF.

Study Activities and population - A prospective, randomized controlled design will be used to pilot test the efficacy of a new intervention to promote adherence to the medication regimen in chronic heart failure in the clinical setting. The initial development and feasibility testing of the intervention is complete (Preliminary Work, Section 4.5).

Patients with HF symptom exacerbation (n = 80) who exhibit high likelihood of poor adherence, as determined by a validated screening measure, the Medication Adherence Scale (MAS)89 at baseline assessment, will be recruited and randomized to receive the intervention or usual care with attention control. Medication adherence, symptom frequency and intensity, hospital readmissions (HR) and emergency department (ED) visits will be assessed in both groups at 3, 6 and 12-month clinic visits. The intervals between visits are considered sufficient to minimize sensitization bias to psychometric measures. Longitudinal measurement is required to evaluate the magnitude of change in adherence and symptom-related events occurring over time. Efficacy will be measured as improved adherence (primary outcome) and decreased HR and ED visits (secondary outcomes) in the intervention group as compared to the attention control group at 12 months. The study will close when all patients have had a 12-month post-enrollment clinic visit.

Data Analysis & Safety/Risk Considerations - The investigators will use generalized linear models to test the primary and secondary hypotheses (McCullagh and Nelder, 1989). Logistic generalizations of the traditional, multivariate GLM are appropriate when the dependent variable is binary and the probability of an event is modeled, as is the case with adherence in this study. When the dependent variable is a count, a commonly used generalized model uses the natural logarithm of the count, as with re-hospitalizations and ED visits in this study. In compliance with NIH guidelines for data safety and monitoring activities, a number of quality control steps will be used to ensure the on-going safety of participants and the scientific integrity of this feasibility intervention study. The proposed study poses only very minimal risks to participants. All participants will receive usual care. Participation in the study will not replace patients' regular health care attention. Data safety will be monitored by the PI, the Data Safety Officer (Dr. Karl Swedberg), and the study co-investigators. Any adverse events will be reported immediately to the Duke IRB and the NIH.

Data Safety. First, a project database will be constructed, using participant ID numbers and including all demographic, pre- and post-intervention history and all assessment materials. A separate file, cross-referencing participant identification with project ID numbers, will be maintained with access limited to the PI or a designated member of the investigative team.

Study Overview

• Status: Completed
• Conditions: Self-management in Heart Failure
• Intervention / Treatment: Behavioral: CHIME 3-M; Behavioral: attention control

• Study Type: Interventional
• Enrollment (Actual): 87
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• > 18 years old
• symptomatic heart failure
• telephone required

Exclusion Criteria:

• heart failure due to congenital etiology
• patients who cannot provide self-care

Study Plan

How is the study designed?

Design Details

• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: behavioral intervention; Patient education for self-management called "CHIME 3-M" will be delivered	Behavioral: CHIME 3-M; behavioral intervention for self-management in heart failure
Active Comparator: control; attention control arm received phone calls to discuss non-heart failure related health topics	Behavioral: attention control; patients will receive phone calls regarding health-related topics not associated with heart failure

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
change in medication adherence	Nurse-observed pill count, the primary measure of adherence, was collected at baseline (0), 3, 6, and 12 months.	baseline (0), 3, 6, and 12 months
change in medication adherence based on the MAS	The study team also collected the Morisky Medication Adherence Scale (MAS) at baseline (0), 3, 6, and 12 months.	baseline (0), 3, 6, and 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
change in belief in medications	Horne "Belief in Medications Questionnaire" (BMQ) was collected at baseline (0), 3,6, and 12 months	baseline (0), 3, 6, and 12 months
change in symptom frequency	count of patient-reported symptom onset was collected at baseline (0), 3,6, and 12 months	baseline (0), 3,6, and 12 months
change in hospital readmissions	Readmissions were reviewed with patients at baseline (0), 3, 6, and 12 months.	baseline (0), 3, 6, and 12 months
change in Emergency Department visits	Emergency department visits were reviewed with patients at baseline (0), 3, 6 and 12 months.	baseline (0), 3, 6 and 12 months
change in satisfaction with Information about Medicines (SIMS)	The questionnaire "satisfaction with information about medicines" was collected at baseline (0), 3, 6, and 12 months	baseline (0), 3, 6, and 12 months
change in Kansas City Cardiomyopathy Questionnaire (KCCQ)	The questionnaire "KCCQ" was collected at baseline (0), 3, 6, and 12 months	baseline (0), 3, 6, and 12 months

Collaborators and Investigators

• Sponsor: Duke University
• Collaborators: National Institute of Nursing Research (NINR)
• Investigators: Principal Investigator: bradi b granger, PhD, Duke University School of Nursing

Publications and helpful links

General Publications

• Granger BB, Ekman I, Hernandez AF, Sawyer T, Bowers MT, DeWald TA, Zhao Y, Levy J, Bosworth HB. Results of the Chronic Heart Failure Intervention to Improve MEdication Adherence study: A randomized intervention in high-risk patients. Am Heart J. 2015 Apr;169(4):539-48. doi: 10.1016/j.ahj.2015.01.006. Epub 2015 Jan 14.

Study record dates

Study Major Dates

• Study Start: September 1, 2009
• Primary Completion (Actual): September 1, 2013
• Study Completion (Actual): September 1, 2013

Study Registration Dates

• First Submitted: October 3, 2014
• First Submitted That Met QC Criteria: October 6, 2014
• First Posted (Estimate): October 7, 2014

Study Record Updates

• Last Update Posted (Estimate): August 22, 2016
• Last Update Submitted That Met QC Criteria: August 19, 2016
• Last Verified: October 1, 2014

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Chronic Disease
• Other Study ID Numbers: Pro00019792; 1R03NR011500-01 (U.S. NIH Grant/Contract)