Patient Preference and Adherence (Nov 2022)
Interventions Incorporating Therapeutic Alliance to Improve Medication Adherence in Black Patients with Diabetes, Hypertension and Kidney Disease: A Systematic Review
Abstract
Russom Desta,1 Charlotte Blumrosen,2 Heather E Laferriere,3 Aades Saluja,4,5 Marino A Bruce,6 Tom A Elasy,7 Derek M Griffith,8,9 Keith C Norris,10 Kerri L Cavanaugh,4,5 Ebele M Umeukeje4,5 1Department of Medicine, University of Washington Medical Center, Seattle, WA, USA; 2Department of Medicine and Pediatrics, University of Rochester Medical Center, New York, NY, USA; 3Eskind Biomedical Library, Vanderbilt University, Nashville, TN, USA; 4Vanderbilt Center for Kidney Disease, Nashville, TN, USA; 5Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA; 6Department of Behavioral and Social Sciences, University of Houston, Tilman J. Fertitta Family College of Medicine, Houston, TX, USA; 7Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA; 8Department of Health Management & Policy, School of Health, Georgetown University, Washington, DC, USA; 9Center for Men’s Health Equity, Racial Justice Institute, Georgetown University, Washington, DC, USA; 10Division of General Internal Medicine & Health Services Research, UCLA, Los Angeles, CA, USACorrespondence: Ebele M Umeukeje, Division of Nephrology, Vanderbilt University Medical Center, 1161 21 st Avenue MCN S-3223, Nashville, TN, USA, Tel +1 615 936-3283, Fax +1 615 875-5626, Email [email protected]: Black Americans have a disproportionately increased risk of diabetes, hypertension, and kidney disease, and higher associated morbidity, mortality, and hospitalization rates than their White peers. Structural racism amplifies these disparities, and negatively impacts self-care including medication adherence, critical to chronic disease management. Systematic evidence of successful interventions to improve medication adherence in Black patients with diabetes, hypertension, and kidney disease is lacking. Knowledge of the impact of therapeutic alliance, ie, the unique relationship between patients and providers, which optimizes outcomes especially for minority populations, is unclear. The role and application of behavioral theories in successful development of medication adherence interventions specific to this context also remains unclear.Objective: To evaluate the existing evidence on the salience of a therapeutic alliance in effective interventions to improve medication adherence in Black patients with diabetes, hypertension, or kidney disease.Data Sources: Medline (via PubMed), EMBASE (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL) (EBSCOhost), and PsycINFO (ProQuest) databases.Review Methods: Only randomized clinical trials and pre/post intervention studies published in English between 2009 and 2022 with a proportion of Black patients greater than 25% were included. Narrative synthesis was done.Results: Eleven intervention studies met the study criteria and eight of those studies had all-Black samples. Medication adherence outcome measures were heterogenous. Five out of six studies which effectively improved medication adherence, incorporated therapeutic alliance. Seven studies informed by behavioral theories led to significant improvement in medication adherence.Discussion/Conclusion: Study findings suggest that therapeutic alliance-based interventions are effective in improving medication adherence in Black patients with diabetes and hypertension. Further research to test the efficacy of therapeutic alliance-based interventions to improve medication adherence in Black patients should ideally incorporate cultural adaptation, theoretical framework, face-to-face delivery mode, and convenient locations.Keywords: diabetes mellitus, hypertension, medication adherence, African Americans
