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The purpose of the presentation is to describe patterns of prior medication adherence reported by patients participating in a clinical trial of varenicline for alcohol problems. Another aim is to present outcome data on medication adherence strategies employed to enhance medication adherence.
Methods: Built upon the Medication Management (MM) manual employed in the COMBINE Study (Pettinati et al, 2005) we designed an intervention manual to enhance adherence through feedback about the illness, a plan for taking medication, simple reminders, monitoring of pill counts, positive reinforcement for adherence and problem solving of nonadherence in subsequent sessions. Using feedback from the Medication Adherence Questionnaire (MAQ) we worked collaboratively with patients to devise detailed plans to address nonintentional and intentional nonadherence issues. For example, to address intentional nonadherence issues such as feeling worse after taking the medication, patients were encouraged to alert the provider to any side effects so that dose reductions can be made as needed. In subsequent sessions, the initial scores on the MAQ were reviewed to support, modify, and/or problem solve difficulties in medication adherence.
Results: Adult alcohol dependent smokers (N=125) involved in an ongoing multi-site randomized controlled trial of varenicline (Chantix) for alcohol dependence comprised the study population. Individuals who reported smoking >2 cigarettes per week, drinking >2 heavy drinking occasions per week and diagnosed as alcohol dependent (DSM-IV) were considered eligible for inclusion in the study. Patients are predominantly male (71%) with the average age of 42 years old; 59% are African-American or Hispanic; 84% were considered to be binge drinkers ( W: >4 drinks/day, M: >5 drinks/day, 3-5 times/week).
Like patients in smoking cessation studies, we discovered that intentional nonadherence is more common than unintentional nonadherence among individuals having drinking problems; 24% of the patients indicated that reasons for not taking medication were due to carelessness or forgetfulness while 47% of the patients revealed that medication nonadherence was due to intentional nonadherence (i.e., stopped taking medication when feeling better or worse). Approximately, 97% of the patients reported that the discussions of medication adherence were helpful in meeting the requirements of success in the medication regime.
Conclusions and Implications: The preliminary evidence suggests that our revised Medication Management (MM) manual was useful in detecting early warning signs of medication nonadherence, increasing clinician and patient awareness of such problems and providing directions to forestall medication nonadherence particularly as the pertain to issues associated with intentional nonadherence.