Interventions to Improve Medication Adherence in Blacks with Diabetes, Hypertension and Kidney Disease: A Systematic Review
Desta, Russom   (Vanderbilt University)
Mentor: Umeukeje, Ebele (Vanderbilt University)
Diabetes is the leading cause of kidney failure in the U.S., closely followed by hypertension, and despite advances in care, the mortality, morbidity and hospitalization risk for people with end-stage kidney disease (ESKD) remain high largely due to challenges with medication adherence. Blacks represent 13.2% of the U.S. population but constitute >35% of ESKD patients in the U.S., and report less medication adherence than Whites, yet gaps remain in our understanding of interventions addressing adherence to antidiabetic and antihypertensive medications among Blacks. This review will focus on describing existing interventions to improve medication adherence in Blacks with diabetes, hypertension and kidney disease. Our hypothesis is that interventions incorporating strong therapeutic alliance i.e. the relationship between patients and providers on outcomes, will increase medication adherence in Blacks with diabetes, hypertension and kidney disease. We searched PUBMED, CINAHL, PSYCINFO, and Embase for randomized control trials and pre-post intervention studies that examined medication adherence in black adult patients with diabetes or hypertension. Two reviewers independently screened titles and abstracts which met the inclusion criteria to identify potential eligible studies, and the full text of any study report deemed potentially eligible was reviewed to determine final eligibility. Comprehensive searches located 1171 individual citations, which ultimately yielded 11 eligible studies reporting interventions. Interventions ranged from multidisciplinary team efforts, motivational interviewing and more intensive approaches to current teachings. All but 3 studies showed a statistically significant improvement in medication adherence; 8 out of 11 studies incorporated therapeutic alliance and only 2 of the 11 studies included patients with kidney disease. Social cognitive theory was the conceptual framework used by most interventions in the review. Interventions addressing medication adherence in Blacks with diabetes and hypertension have been largely successful, however very few trials focus exclusively on this vulnerable population, especially those with kidney disease. Future research should address this gap and should incorporate therapeutic alliance to improve medication adherence in Blacks with diabetes, hypertension and kidney disease.