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Published Online: 18 April 2006

Transtheoretical Model Intervention for Adherence to Lipid-Lowering Drugs

Publication: Disease Management
Volume 9, Issue Number 2

Abstract

An estimated 60% of individuals prescribed lipid-lowering medications are nonadherent. Failure to adhere increases morbidity, mortality, healthcare utilization, and healthcare costs. This study examined the effectiveness of a population-based, individualized Transtheoretical Model (TTM) expert system intervention to improve adherence and increase exercise and diet in a randomized 18-month trial involving 404 adults. Compared to usual care, treatment participants who started in a pre-action stage were significantly more likely to be in the Action and Maintenance (A/M) stages for adherence at end of treatment (55.3% versus 40%, z = 2.11, p < 0.05, h = 0.31) and at 18-months (56% versus 37.8%, z = 2.38, p < 0.01, h = 0.36). The treatment group scored significantly better on two measures of adherence at six and 12 months post-treatment (all p < 0.05, odds ratios [OR] 1.49–3.67). Among those who began in A/M, treatment participants were significantly more likely to remain in A/M at 18 months (85.2% versus 55.6%, z = 2.63, p < 0.01, h = 0.67). Those receiving treatment were significantly more likely to progress to A/M for exercise and dietary fat reduction (43.3% versus 24.7% for exercise, and 24.7% versus 12.5% for diet). TTM expert system interventions can have a significant impact on entire populations for adherence. Results for dietary fat and exercise suggest covariation of treatment effects. (Disease Management 2006;9:102–114)

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cover image Disease Management
Disease Management
Volume 9Issue Number 2April 2006
Pages: 102 - 114
PubMed: 16620196

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Published online: 18 April 2006
Published in print: April 2006

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Sara S. Johnson
Pro-Change Behavior Systems, Inc., West Kingston, Rhode Island.
Mary-Margaret Driskell
Pro-Change Behavior Systems, Inc., West Kingston, Rhode Island.
Janet L. Johnson
Pro-Change Behavior Systems, Inc., West Kingston, Rhode Island.
Sharon J. Dyment
Pro-Change Behavior Systems, Inc., West Kingston, Rhode Island.
James O. Prochaska
Pro-Change Behavior Systems, Inc., West Kingston, Rhode Island.
Janice M. Prochaska
Pro-Change Behavior Systems, Inc., West Kingston, Rhode Island.
Leslie Bourne
Fallon Clinic, Worcester, Massachusetts.

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