1062-P: Peer Coaching Reduces Medication Barriers in African American Patients with Comorbid Diabetes and Hypertension—Results from the SEC Study

Introduction: Both uncontrolled diabetes and hypertension are more common among rural African Americans, and both rely on proper medication adherence for control. Patient reported medication barriers may impede medication adherence, but optimal strategies for reducing medication barriers in this population are unknown.

Methods: In a cluster randomized trial designed to improve BP control, we evaluated the impact of using trained peer coaches vs. practice-based facilitation, and the combination, compared to usual care on changes in 19 self-reported barriers to medication taking using analysis of variance. Medication barriers were computed as the total number of positive reports from a total of 19 possible barriers and this was assessed at baseline, 6-, and 12-month follow-up.

Results: The study included n=734 African American individuals with diabetes and persistently uncontrolled hypertension (SBP >140mmHg); 60% female; mean age = 59 ± 11.5 yr. The most common barriers reported included not liking to take medications in general (38%), hearing about medication side effects that they were afraid of (31%), allowing medications to run out (29%) or forgetting to fill their prescription(s) on time (28%). Participants randomized to the peer coaching arm reported a significantly greater reduction in the number of medication barriers at 6-month follow-up than did those in the usual care arm (-1.08; p = 0.03). However, this difference was no longer statistically significant at 12 mo. follow-up and was not different when stratified by age (<60 yrs. and ≥60 yrs.). Although systolic BP was lowered more in the peer coaching arm at 6 months than in usual care, there was no statistically significant association with changes in medication barriers.

Conclusion: These findings suggest that patients with diabetes and uncontrolled hypertension report multiple barriers with medications and that peer coaching may reduce self-reported medication barriers.