Journal of general internal medicine · 2026
Effect of a Multilevel Intervention on Racial Disparities in Medication Adherence: An Analysis of the Rich Life Project.
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Meche Aster, Cooper Lisa A, Mehta Hemalkumar B, Alexander G Caleb, Jackson John W
Аннотация
BACKGROUND: Despite advances in hypertension treatment and control, racial disparities in medication adherence persist. We evaluated whether a multilevel collaborative care team intervention reduced racial disparities in medication adherence among adults with uncontrolled hypertension.
METHODS: The RICH LIFE Project was a pragmatic, cluster-randomized trial in 30 primary care practices in Maryland and Pennsylvania, comparing Collaborative Care/Stepped Care (CC/SC) and Standard of Care Plus (SCP) arms. Its primary outcomes were blood pressure control (systolic BP ≤ 140 mm Hg, diastolic BP ≤ 90 mm Hg) and patient activation at 12-months. Participants were non-Hispanic Black and non-Hispanic White adults with uncontrolled hypertension. This analysis examined medication adherence, a prespecified secondary outcome, assessed at 12-months using the 4-item scale adapted from Morisky, Green, and Levine and dichotomized into adherent or nonadherent. A weighting-based approach estimated average potential outcomes within each racial group under the assigned intervention arm and the average intervention effect on the racial disparity in adherence. Sensitivity analyses categorized adherence into high, medium, and low levels and restricted follow-up to the pre-pandemic period.
RESULTS: Among 1,555 participants with treated but uncontrolled hypertension (64.2% Black, 35.8% White), Black participants were younger (mean age: 58.0 vs. 65.2 years) and more often female compared to White participants. At 12-months, adherence was similar across arms for Black participants (CC/SC: 45.4%, SCP: 46.1%) and adherence was 66.9% for White participants in the CC/SC arm versus 63.7% in the SCP arm; neither difference was statistically significant. The average intervention effect on disparity was -3.9% (95% CI: -15.8%, 9.4%), indicating no significant disparity reduction. Sensitivity analyses yielded similar findings.
CONCLUSIONS: The RICH LIFE multilevel intervention did not reduce racial disparities in medication adherence. Evidence-based strategies are needed to reduce disparities in medication adherence.
METHODS: The RICH LIFE Project was a pragmatic, cluster-randomized trial in 30 primary care practices in Maryland and Pennsylvania, comparing Collaborative Care/Stepped Care (CC/SC) and Standard of Care Plus (SCP) arms. Its primary outcomes were blood pressure control (systolic BP ≤ 140 mm Hg, diastolic BP ≤ 90 mm Hg) and patient activation at 12-months. Participants were non-Hispanic Black and non-Hispanic White adults with uncontrolled hypertension. This analysis examined medication adherence, a prespecified secondary outcome, assessed at 12-months using the 4-item scale adapted from Morisky, Green, and Levine and dichotomized into adherent or nonadherent. A weighting-based approach estimated average potential outcomes within each racial group under the assigned intervention arm and the average intervention effect on the racial disparity in adherence. Sensitivity analyses categorized adherence into high, medium, and low levels and restricted follow-up to the pre-pandemic period.
RESULTS: Among 1,555 participants with treated but uncontrolled hypertension (64.2% Black, 35.8% White), Black participants were younger (mean age: 58.0 vs. 65.2 years) and more often female compared to White participants. At 12-months, adherence was similar across arms for Black participants (CC/SC: 45.4%, SCP: 46.1%) and adherence was 66.9% for White participants in the CC/SC arm versus 63.7% in the SCP arm; neither difference was statistically significant. The average intervention effect on disparity was -3.9% (95% CI: -15.8%, 9.4%), indicating no significant disparity reduction. Sensitivity analyses yielded similar findings.
CONCLUSIONS: The RICH LIFE multilevel intervention did not reduce racial disparities in medication adherence. Evidence-based strategies are needed to reduce disparities in medication adherence.