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

Figures & data

Figure 1 Trial design.

Note: The control group also received PRISMA after 6 months (wait-list control).
Abbreviations: PRISMA, Proactive Interdisciplinary Self-Management; RCT, randomized controlled trial; MPR, medication possession ratio; MARS, Medication Adherence Rating Scale.

Figure 2 Patient flowchart.

Note: Patients from the larger trial who did not use blood glucose–lowering medication (n=31) were excluded from this study.
Abbreviations: RCT, randomized controlled trial; MPR, medication possession ratio; MARS, Medication Adherence Rating Scale.

Table 1 Patient characteristics (n=108)

Characteristics	Intervention group (n=56)	Control group (n=52)
Male (%)	38 (66.7)	34 (64.2)
Age in categories (years)
50–59	12 (21.4)	6 (11.5)
60–69	18 (32.1)	15 (28.8)
70–79	21 (37.5)	21 (40.4)
≥80	5 (8.9)	10 (19.2)
Education level (%)a
Low	2 (3.6)	5 (9.6)
Moderate	26 (46.4)	27 (51.9)
High	11 (19.6)	6 (11.5)
Unknown	17 (30.4)	14 (26.9)
Diabetes duration in years (median, IQR)	6 (4–9)	7 (4–9)
Number of blood glucose–lowering medications (%)		27 (51.9)
One	36 (64.3)	24 (46.2)
Two	18 (32.1)	1 (1.9)
Three	2 (3.6)
Type of blood glucose–lowering medication(s) (%)
Metformin	53 (94.6)	48 (92.3)
Gliclazide	13 (23.2)	18 (34.6)
Tolbutamide	9 (16.1)	9 (17.3)
Other	4 (7.2)	2 (3.8)
Insulin	11 (19.6)	14 (26.9)

Notes:

a Low = no education or primary education; moderate = lower secondary education, (upper) secondary education, or post-secondary non-tertiary education (including vocational education); high = tertiary education (bachelor’s degree or higher).

Table 2 Results of MPR, drug holidays, and MARS

Adherence outcomes	0–6 months
	Intervention group (n=56)	Control group (n=52)
MPR
Median (IQR)	100.0 (98.0, 100.0)a	97.7 (94.1, 100.0)
Range	51.1–100.0	54.1–100.0
<100 (n, %)	18 (32.1)a	31 (59.6)
100 (n, %)	38 (67.9)	21 (40.4)
Drug holidays
One or more drug holidays (n, %)	14 (25.0)	28 (53.8)
Relative risk (95% CI)	0.6 (0.4–0.8)a
	6 months
	Intervention group (n=43)	Control group (n=43)
MARS (median [range])
Item 1: I forget to take medicines	4 (3–5)	4 (3–5)
Item 2: I alter the dose of my medicines	5 (3–5)	5 (3–5)
Item 3: I stop taking my medicines for a while	5 (4–5)	5 (4–5)
Item 4: I decide to miss out a dose	5 (3–5)	5 (3–5)
Item 5: I take less than instructed	5 (3–5)	5 (3–5)
Sum score	24.0 (0.9)	24.0 (1.5)

Note:

a Indicates significance.

Abbreviations: MPR, medication possession ratio; MARS, Medication Adherence Rating Scale.