Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What evidence exists to support interventions to increase medications adherence of prescription medications by low-income and vulnerable populations? What are the behavioral factors, in addition to access barriers (care management, medication costs, transportation, etc) that might improve medications compliance by insured and uninsured patients who have established medical homes?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

--peer educators and case management strategies vs written material provided by physicians --difference of effectiveness strategies for community-based clinics vs. FQHC’s --community health worker vs clinic-based peer educator?

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

In particular, African Americans with hypertension (could be men or women or both).

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improved health outcomes for the patients who increase adherence.

Improved patient activation and understanding of importance of taking medications Positive relationship with health care system Improved blood pressure Improved refill rates of patients Decreased phone calls and office visits.

Describe any health-related risks, side effects, or harms that you are concerned about.

Increased blood pressure

Increased risk of stroke and heart disease.

Increased medications side effects. Increased phone calls and office visits.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cardiovascular disease, including stroke and hypertension

AHRQ Priority Populations

• Low income groups
• Minority groups
• Elderly

Federal Health Care Program

• Medicaid
• Medicare
• Other

Importance

Describe why this topic is important.

We only see uninsured patients at our clinic. Our clinic has worked actively to remove barriers for patients with the medications. Anecdotally, the staff has experienced that (1) providing patients free medications and (2) physicians handing the patient written material about the importance of taking medication regularly has limited results. We are interested in a review of what interventions are proven to increase adherence for low-income and underserved patients.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

We provide all treatments free of charge, utilizing volunteer clinicians, donated lab services and medications purchased with privately donated funds. Despite this, we found that our rates of blood pressure control were below goal and many patients were not taking medications as directed. We are seeking to improve the health outcomes among an underserved population and would like to utilize the most effective strategies to improve adherence.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

See above.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

The answer can help identify successful strategies to increase adherence for patients, and to identify delivery system and reimbursement strategies that might increase adherence rates.

Describe the timeframe in which an answer to your question is needed.

When possible.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

The heart failure rates of African American men are 20 times greater than in Caucasian men. See the lead article in NEJM 3/19/09.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

The answer can help identify successful strategies to increase adherence for patients, and to identify delivery system and reimbursement strategies that might increase adherence rates.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program