The following is a summary of “Randomized prospective trial to detect and distinguish between medication nonadherence, drug-drug interactions, and disease progression in chronic cardiometabolic disease,” published in the April 2023 issue of Primary Care by Peabody, et al.

A major clinical problem for doctors caring for patients with cardiometabolic disorders is untangling the interconnectedness of nonadherence (NA), drug-drug interactions (DDIs), and disease progression. Both NAs and DDIs are common but frequently need to be considered. Intending to identify medication non-compliance and the presence/severity of DDIs, researchers analyzed a novel chronic disease management (CDM) test. In addition, they measured clinical care with and without access to the CDM test in a prospective, randomized, controlled experiment involving 236 primary care physicians using computer-based, simulated patients. 

The key outcomes were the efficacy of the intervention materials in encouraging participants to request the CDM test and whether or not the use of the CDM test improved the accuracy of diagnoses and the ordering of better treatments. Providing the CDM test findings, doctors improved their diagnosis and treatment quality-of-care scores by (+13.2%) in the cases of NA patients and by (+13.6%) in the cases of DDI patients (P<0.001). Between the treatment and control groups, the difference-in-difference was (+10.4%) for NA and (+10.8%) for DDI (P<0.01 for both). 

Intervention was 50.4% more likely to recognize medication NAthan control and 3.3% more likely to correctly treat it after adjusting for physician and practice co-factors. 26.9 times more probable DDIs were identified with intervention, and 15.7 times more likely the interacting medicine was discontinued or substituted for another. There were no appreciable benefits for patients whose diseases were progressing. Using a reliable test, such as the CDM test, greatly improves the ability to differentiate between nonadherence, drug-drug interactions, and disease progression; improved diagnostic accuracy and treatment can enhance patient quality of life, medication safety, clinical outcomes, and efficiency of health delivery.

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02042-4