Improving Adherence to Statins Among Minority Populations
Condition: Dyslipidemia
MeSH terms: Dyslipidemias
Study type: Interventional

Summary: 
      Statins are cholesterol lowering medications that reduce the risk of cardiovascular events.
      However adherence to these medications has been found to be lower among minorities, a group
      particularly vulnerable for heart disease.

      The purpose of this study is to compare the efficacy of a phone based behavioral intervention
      to mailed educational materials regarding how to control cholesterol and other risk factors.
      We hypothesized that the behavioral intervention will improve adherence to statins by 15%.
    

Detailed description: 
      Cardiovascular disease (CVD) disproportionately affects members of certain racial/ethnic
      minority groups.Further in spite of a reduction in rates of cardiovascular events,the gap
      between certain minority groups and non-minority groups has not diminished. Cholesterol
      lowering medications are a medically proven intervention that dramatically reduces the risk
      of primary and secondary cardiovascular outcomes.However, the literature shows that at one
      year only half of the patients prescribed this medication continue to take a statin. One well
      known risk factor shown to be a predictor for non adherence is belonging to a racial/ ethnic
      minority group.

      The focus of the proposed study is to examine a non-traditional care-management approach
      delivered by a large commercial health benefit carrier in the prevention of cardiovascular
      disease among minority populations who have cardiovascular risk factors and who have been
      started in cholesterol lowering therapy. In particular, we seek to determine if a culturally
      tailored phone based intervention (Motivational Interviewing) delivered to Latino and African
      American enrollees living in predominantly minority neighborhoods in Florida, is effective at
      improving adherence to Statins.

      Specific Aims

        1. To prospectively identify 1200 Latino or African American residing in Florida who have
           received a new prescription for statin therapy, evaluate their adherence to the statin
           and determine if the reasons for non-adherence are similar or different from other
           studies of adherence to cardiovascular medications.

        2. Conduct a randomized control trial to compare the effectiveness of a motivational
           interviewing telephonic intervention to usual care on the primary outcome of statin
           adherence among minority subjects living in Florida.

      In addition, among the tobacco users at baseline we will evaluate the impact of our phone
      based MINT intervention on tobacco cessation in this minority populations.

      Update: The sponsor and the IRB approved a reduction in the target number of participants to
      800. The reason was that we experienced a recruitment delay to ensure HIPAA compliant
      procedures between the University and the Health Benefits company when the Humana research
      group moved out of the University campus. Data that became available from another study
      showed 800 subjects will yield enough power for the analyses planned originally.
    

Intervention name(s): Motivational Interviewing (MINT); Usual Care
Intervention type(s): Behavioral; Other
Intervention description(s): MINT has the following basic structure and goals:
Establishing a connection and reinforcing autonomy: open ended questions regarding the health status or well being of the participant to establish an empathetic connection with the subject via reflective listening.
Empathizing with ambivalence and rolling with resistance. The counselor will help the subject express the ambivalence they may have regarding taking their statins.
Coach the subject towards expressions of commitment. Commitment is predictive of change. Speaking commitment out loud to an "other" enhances the likelihood that the commitment will be acted upon; We selected American Heart Association brochures on a variety of risk factors, including dyslipidemia and mailed them to subjects in the usual care.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Statins; Cholesterol lowering medications; Adherence; Motivational interviewing; Minority populations