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Effects of a Proactive Interdisciplinary Self-Management (PRISMA) program on medication adherence in patients with type 2 diabetes in primary care: a randomized controlled trial

Authors du Pon E, El Azzati S, van Dooren A, Kleefstra N, Heerdink E, van Dulmen S

Received 25 September 2018

Accepted for publication 11 December 2018

Published 10 May 2019 Volume 2019:13 Pages 749—759

DOI https://doi.org/10.2147/PPA.S188703

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 5

Editor who approved publication: Dr Johnny Chen


Esther du Pon,1,2 Siham El Azzati,1 Ad van Dooren,1 Nanne Kleefstra,3,4 Eibert Heerdink,1,5 Sandra van Dulmen6–8

1Research Group Process Innovations in Pharmaceutical Care, Utrecht University of Applied Sciences, Utrecht, the Netherlands; 2Diabetes Centre, Isala Clinics, Zwolle, the Netherlands; 3Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 4Medical Research Group, Langerhans, Ommen, the Netherlands; 5Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; 6NIVEL (Netherlands Institute for Health Services Research), Department of Communication in Healthcare, Utrecht, the Netherlands; 7Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community care, Nijmegen, the Netherlands; 8Faculty of Health and Social Sciences, University of Southeast Norway, Drammen, Norway

Purpose: The present study aims to investigate the effect of the group-based Proactive Interdisciplinary Self-Management (PRISMA) training program on medication adherence in patients with type 2 diabetes (T2DM) treated in primary care.
Patients and methods: The current study is a two-arm, parallel group, randomized, open label trial (1:1) of 6-month duration with a 6-month extension period in which both groups received the intervention (wait-list control). People 18 years old or older who were diagnosed with T2DM were included. The intervention consisted of two group meetings about T2DM guided by care providers. The control group received usual care only (visits at the general practice). The primary outcome was adherence based on pharmacy refill data and was measured using medication possession ratio (MPR). The secondary outcomes were the number of drug holidays and self-reported adherence, measured by the 5-item Medication Adherence Rating Scale (MARS-5).
Results: Of the total sample (n=108), 66.6% were male. The mean age was 69.3 years (SD=9.1). In the 6-month period, patients were more adherent in the intervention group (n=56) (median MPR =100.0 [51.1–100.0]) than in the control group (n=52) (median MPR =97.7 [54.1–100.0]) (U=1,042, z=-2.783, P=0.005). The intervention group had less drug holidays than the control group (relative risk 0.55, 95% CI, 0.37–0.80). The sum scores of the MARS did not differ between the intervention group (median =23.98, SD=0.91) and the control group (median =24.00, SD=1.54).
Conclusion: The PRISMA program resulted in a small improvement in MPR and fewer drug holidays, while no improvement has been found in self-reported adherence. However, health care providers and policy makers could take into account that adherence might be influenced by PRISMA.

Keywords: MPR, refill data, drug holidays, MARS, group education


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