Abstract
BackgroundLatinos experience disproportionately higher rates of uncontrolled hypertension as compared to Blacks and Whites. While poor adherence is a major contributor to disparities in blood pressure control, data in Latino patients are scant. More importantly, translation of interventions to improve medication adherence in community-based primary care practices, where the majority of Latino patients receive their care is non-existent.MethodsUsing a randomized controlled design, this study evaluates the effectiveness of a culturally tailored, practice-based intervention compared to usual care on medication adherence, among 148 Latino patients with uncontrolled hypertension who are non-adherent to their antihypertensive medications. Bilingual medical assistants trained as Health Coaches deliver the intervention using an electronic medical record system-embedded adherence script. Patients randomized to the intervention group receive patient-centered counseling with a Health Coach to develop individualized self-monitoring strategies to overcome barriers and improve adherence behaviors. Health Coach sessions are held biweekly for the first 3 months (6 sessions total) and then monthly for the remaining 3 months (3 sessions total). Patients randomized to the usual care group receive standard hypertension treatment recommendations as determined by their primary care providers. The primary outcome is the rate of medication adherence at 6 months. The secondary outcome is reduction in systolic and diastolic blood pressure at 6 months.DiscussionIf successful, findings from this study will provide salient information on the translation of culturallytailored, evidence-based interventions targeted at medication adherence and blood pressure control into practice-based settings for this high-risk population.Trial registrationNCT01643473 on 16 July 2012.
Highlights
Latinos experience disproportionately higher rates of uncontrolled hypertension as compared to Blacks and Whites
The Ayudando Latinos Hipertensos Para Mejorar Adherencia a los Medicamentos (ALMA) trial addresses this gap in the literature by evaluating the effect of a culturally tailored, practice-based intervention on medication adherence in 148 Latino patients with uncontrolled HTN, who are non-adherent to their antihypertensive medications and followed in a medical clinic in New York City
Study aims The primary aim of the ALMA trial is to evaluate the effect of a culturally tailored, evidence-based adherence intervention (AI), delivered by bilingual Health Coaches versus usual care (UC), on medication adherence at 6 months among 148 Latino patients with uncontrolled HTN, who are non-adherent to their anti-hypertensive medications
Summary
The ACA Board provided feedback on the cultural appropriateness of the AI and offered insight into the logistical and administrative barriers that can impede adherence in this population Together, these data were used to further refine the AI to match the literacy and cultural needs of the Latino patient population at the clinic, and to inform important intervention messages during the delivery of the counseling sessions. The EMR-embedded AI allows Health Coaches to systematically record patients’ responses and retrieve information and progress from previous sessions It includes tips for using MINT strategies to address patient barriers such as eliciting and responding to patients’ understanding of the causes, complications and treatment of HTN; perceived barriers to taking medications; and strategies for adoption of adherence behaviors. Primary outcome Medication adherence The primary outcome is the rate of medication adherence at the 6-month study visit, assessed using electronic drug monitoring devices
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
