Cardiovascular disease (CVD) complications are the leading cause of diabetes mellitus (DM)-related morbidity
and mortality, creating a significant burden on the public health system. This burden is in part attributable to poor
medication adherence, with 21-42% of patients failing to properly adhere to their care. Importantly, this issue is
especially pronounced in minority and low-income populations, which show higher rates of chronic illness
and lower medication adherence. Interventions that foster and reinforce patient-centered communication
between clinicians and patients show promise in improving health outcomes. However, they have not been
widely implemented, in part due to a lack of compelling evidence for their effectiveness in real primary care
settings. Project Objective: We propose to evaluate the impact of our patient activation program: Office
Guidelines Applied to Practice (Office-GAP) combined with mobile phone text messaging reinforcement
(Care4life) on medication adherence, in minority and low-income patients with DM compared to mobile texting
alone. Office-GAP incorporates shared decision-making and a decision/support checklist to be completed during
office visits, to foster patients' investment in their own care. Care4life is a cell phone messaging service that
informs and encourages patients to adhere to goals and improve communication.
Our long-term goal is to develop a model that can reliably improve and sustain adherence and can be
successfully implemented in primary care clinics to close the morbidity and mortality gap for
minority/low-income DM patients. We hypothesize that the combined face-to-face patient activation and
mobile phone delivered reinforcement methods will facilitate communication between patients and care
providers, improving the frequency, accuracy, and timeliness of communication while reinforcing shared goals
and engendering mutual respect more than mobile phone texting alone. Improved communication between
patients and physicians may improve medication adherence, blood sugar, cholesterol, blood pressure
control, and patient satisfaction with providers, and ultimately decrease burden of illness.
Research Strategy: We will conduct a randomized community-based clinical trial in Federally-Qualified Health
Clinics (FQHCs) in Michigan. We will enroll 378 patients in 16 teams in clinics serving low-income and minority
patients. All patients will receive usual care and medication for DM and CVD prevention. Eight teams will be
randomly chosen to use mobile phone texting alone, and 8 teams will combine Office-GAP with Care4life. We
will evaluate the impact of these shared decision-making strategies for patients and providers in the clinics.
Impact: If successfully translated to clinical practice, these interventions have the potential to significantly impact
patient care in FQHCs, improving outcomes for DM and CVD. This research also paves the way for shifting
clinical practice across a spectrum of chronic disease where medication non-adherence is an issue.