{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:21:43Z","timestamp":1793834503660,"version":"4.6.1"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"\n Importance<\/jats:title>\n Medication nonadherence is present in nearly half of patients with hypertension but is underrecognized in clinical care. Data linkages between electronic health records and pharmacies have created opportunities for scalable assessment of medication adherence at the point of care.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To test the effectiveness of a multicomponent intervention that identified patients with uncontrolled hypertension and medication nonadherence using linked electronic health record\u2013pharmacy data combined with team-based care to address adherence barriers.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n TEAMLET (Leveraging Electronic Health Record Technology and Team Care to Address Medication Adherence) was a pragmatic, 2-arm, cluster randomized clinical trial conducted between October 2022 and November 2024 in 10 primary care sites in New York. The study included adults with uncontrolled hypertension and low medication adherence, defined as proportion of days covered (PDC) less than 80%. Data analysis was performed from November 2024 to January 2025.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n The intervention consisted of the following: (1) automated identification of patients with medication nonadherence at the time of the visit; (2) prompting of medical assistants to screen for barriers to adherence; (3) clinical decision support alerting the primary care physicians and nurse practitioners to barriers to adherence; and (4) adherence discussion between the primary care physician or nurse practitioner and the patient. The comparator was usual care.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was change in PDC from baseline to 12 months.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 1726 patients (mean [SD] age, 67.2 [13.9] years; 887 [51.4%] female), the mean (SD) baseline PDC was 33.2% (30.5%) overall (32.4% [30.4%] in the intervention group and 34.0% [30.6%] in the control group). The mean (SD) PDC at 12 months was 51.1% (39.5%) for the intervention group and 53.1% (39.6%) for the control group. No difference was found in the change in PDC from baseline to 12 months between the intervention and control groups (mean [SD] absolute change in PDC, 18.5 [41.1] vs 18.2 [40.9] percentage points, respectively; adjusted difference, \u22120.15 percentage point; 95% CI, \u22124.06 to 3.76 percentage points). Change in systolic blood pressure and patients who became adherent (PDC \u226580%) at 12 months were also similar between groups.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this pragmatic trial, an intervention that combined team-based primary care with automated identification of patients with antihypertensive medication nonadherence did not lead to improvements in adherence or blood pressure.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05349422<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamacardio.2025.2155","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T15:00:41Z","timestamp":1752073241000},"page":"914","source":"Crossref","is-referenced-by-count":12,"title":["Medication Adherence in Hypertension"],"prefix":"10.1001","volume":"10","author":[{"given":"Saul","family":"Blecker","sequence":"first","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, New York"},{"name":"Department of Medicine, NYU Grossman School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devin M.","family":"Mann","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, New York"},{"name":"Department of Medicine, NYU Grossman School of Medicine, New York, New York"},{"name":"Medical Center Information Technology, NYU Langone Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany R.","family":"Martinez","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley M.","family":"Belli","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aamina","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassidy","family":"Fitchett","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Wong","sequence":"additional","affiliation":[{"name":"Medical Center Information Technology, NYU Langone Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harris R.","family":"Bearnot","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrine I.","family":"Voils","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Utah, Salt Lake City"},{"name":"William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoinette M.","family":"Schoenthaler","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, New York"},{"name":"Department of Medicine, NYU Grossman School of Medicine, New York, New York"},{"name":"Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"6","key":"hoi250035r1","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1161\/HYPERTENSIONAHA.119.13616","article-title":"National rates of nonadherence to antihypertensive medications among insured adults with hypertension, 2015.","volume":"74","author":"Chang","year":"2019","journal-title":"Hypertension"},{"issue":"23","key":"hoi250035r2","doi-asserted-by":"publisher","first-page":"2461","DOI":"10.1001\/jama.2018.19271","article-title":"Interventions to improve medication adherence: a review.","volume":"320","author":"Kini","year":"2018","journal-title":"JAMA"},{"issue":"9","key":"hoi250035r3","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1016\/j.amjmed.2011.12.013","article-title":"Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients.","volume":"125","author":"Naderi","year":"2012","journal-title":"Am J Med"},{"issue":"2","key":"hoi250035r4","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1111\/j.1524-6175.2003.00495.x","article-title":"Improving patient compliance: a major goal in the management of hypertension.","volume":"5","author":"Neutel","year":"2003","journal-title":"J Clin Hypertens (Greenwich)"},{"issue":"6","key":"hoi250035r5","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1007\/s11606-009-1240-1","article-title":"Antihypertensive medication adherence, ambulatory visits, and risk of stroke and death.","volume":"25","author":"Bailey","year":"2010","journal-title":"J Gen Intern Med"},{"issue":"4","key":"hoi250035r6","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1016\/j.ahj.2007.12.011","article-title":"Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease.","volume":"155","author":"Ho","year":"2008","journal-title":"Am Heart J"},{"issue":"2","key":"hoi250035r7","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.pec.2008.09.018","article-title":"Provider communication effects medication adherence in hypertensive African Americans.","volume":"75","author":"Schoenthaler","year":"2009","journal-title":"Patient Educ Couns"},{"issue":"1","key":"hoi250035r8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4172\/2376-0419.1000202","article-title":"Physicians\u2019 assessment of medication adherence: a systematic review.","volume":"6","author":"Heeb","year":"2019","journal-title":"J Pharm Care Health Syst"},{"issue":"5","key":"hoi250035r9","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1370\/afm.1965","article-title":"Discordance between drug adherence as reported by patients and drug importance as assessed by physicians.","volume":"14","author":"Sidorkiewicz","year":"2016","journal-title":"Ann Fam Med"},{"issue":"9","key":"hoi250035r10","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1291\/hypres.31.1765","article-title":"Physicians\u2019 ability to predict patients\u2019 adherence to antihypertensive medication in primary care.","volume":"31","author":"Zeller","year":"2008","journal-title":"Hypertens Res"},{"issue":"6","key":"hoi250035r11","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1111\/j.1525-1497.2006.00397.x","article-title":"How do providers assess antihypertensive medication adherence in medical encounters?","volume":"21","author":"Bokhour","year":"2006","journal-title":"J Gen Intern Med"},{"issue":"1","key":"hoi250035r12","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1186\/1472-6963-12-270","article-title":"Physician assessments of medication adherence and decisions to intensify medications for patients with uncontrolled blood pressure: still no better than a coin toss.","volume":"12","author":"Meddings","year":"2012","journal-title":"BMC Health Serv Res"},{"issue":"6","key":"hoi250035r13","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1111\/j.1532-5415.2012.03969.x","article-title":"Provider views about responsibility for medication adherence and content of physician-older patient discussions.","volume":"60","author":"Tarn","year":"2012","journal-title":"J Am Geriatr Soc"},{"issue":"1","key":"hoi250035r14","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/s11606-016-3851-7","article-title":"Recommendations for providers on person-centered approaches to assess and improve medication adherence.","volume":"32","author":"Bosworth","year":"2017","journal-title":"J Gen Intern Med"},{"issue":"10","key":"hoi250035r15","doi-asserted-by":"publisher","first-page":"1482","DOI":"10.18553\/jmcp.2021.27.10.1482","article-title":"Validation of EHR medication fill data obtained through electronic linkage with pharmacies.","volume":"27","author":"Blecker","year":"2021","journal-title":"J Manag Care Spec Pharm"},{"issue":"4","key":"hoi250035r16","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1007\/s11606-024-09216-5","article-title":"Approach to estimating adherence to heart failure medications using linked electronic health record and pharmacy data.","volume":"40","author":"Blecker","year":"2025","journal-title":"J Gen Intern Med"},{"key":"hoi250035r17","doi-asserted-by":"publisher","DOI":"10.2196\/47930","article-title":"Leveraging electronic health record technology and team care to address medication adherence: protocol for a cluster randomized controlled trial.","volume":"12","author":"Blecker","year":"2023","journal-title":"JMIR Res Protoc"},{"issue":"6","key":"hoi250035r18","first-page":"23","article-title":"Team-based care: saving time and improving efficiency.","volume":"21","author":"Hopkins","year":"2014","journal-title":"Fam Pract Manag"},{"issue":"2","key":"hoi250035r19","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1001\/jamainternmed.2013.12944","article-title":"Multifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge: a randomized clinical trial.","volume":"174","author":"Ho","year":"2014","journal-title":"JAMA Intern Med"},{"issue":"7","key":"hoi250035r20","first-page":"457","article-title":"Measuring concurrent adherence to multiple related medications.","volume":"15","author":"Choudhry","year":"2009","journal-title":"Am J Manag Care"},{"issue":"1","key":"hoi250035r21","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1345\/aph.1K671","article-title":"Contrasting measures of adherence with simple drug use, medication switching, and therapeutic duplication.","volume":"43","author":"Martin","year":"2009","journal-title":"Ann Pharmacother"},{"issue":"1","key":"hoi250035r22","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/1748-5908-6-42","article-title":"The behaviour change wheel: a new method for characterising and designing behaviour change interventions.","volume":"6","author":"Michie","year":"2011","journal-title":"Implement Sci"},{"issue":"12","key":"hoi250035r23","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1097\/MLR.0b013e318269e121","article-title":"Initial validation of a self-report measure of the extent of and reasons for medication nonadherence.","volume":"50","author":"Voils","year":"2012","journal-title":"Med Care"},{"issue":"1","key":"hoi250035r26","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1186\/s13063-020-4114-9","article-title":"The mixed model for repeated measures for cluster randomized trials: a simulation study investigating bias and type I error with missing continuous data.","volume":"21","author":"Bell","year":"2020","journal-title":"Trials"},{"issue":"1","key":"hoi250035r27","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1186\/s12874-023-02107-z","article-title":"Analysing cluster randomised controlled trials using GLMM, GEE1, GEE2, and QIF: results from four case studies.","volume":"23","author":"Offorha","year":"2023","journal-title":"BMC Med Res Methodol"},{"issue":"1","key":"hoi250035r28","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s13012-022-01199-3","article-title":"Do providers use computerized clinical decision support systems? a systematic review and meta-regression of clinical decision support uptake.","volume":"17","author":"Kouri","year":"2022","journal-title":"Implement Sci"},{"key":"hoi250035r29","doi-asserted-by":"publisher","first-page":"m3216","DOI":"10.1136\/bmj.m3216","article-title":"Computerised clinical decision support systems and absolute improvements in care: meta-analysis of controlled clinical trials.","volume":"370","author":"Kwan","year":"2020","journal-title":"BMJ"},{"issue":"1","key":"hoi250035r30","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1161\/HYP.0000000000000203","article-title":"Medication adherence and blood pressure control: a scientific statement from the American Heart Association.","volume":"79","author":"Choudhry","year":"2022","journal-title":"Hypertension"},{"issue":"9","key":"hoi250035r31","doi-asserted-by":"publisher","first-page":"1624","DOI":"10.1177\/09622802241267808","article-title":"Accounting for regression to the mean under the bivariate t-distribution.","volume":"33","author":"Umair","year":"2024","journal-title":"Stat Methods Med Res"},{"issue":"8","key":"hoi250035r32","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1001\/archinte.167.8.847","article-title":"Physician follow-up and provider continuity are associated with long-term medication adherence: a study of the dynamics of statin use.","volume":"167","author":"Brookhart","year":"2007","journal-title":"Arch Intern Med"},{"key":"hoi250035r33","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.ahj.2024.04.003","article-title":"Association between visit frequency, continuity of care, and pharmacy fill adherence in heart failure patients.","volume":"273","author":"Hamo","year":"2024","journal-title":"Am Heart J"},{"issue":"2","key":"hoi250035r34","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1001\/jamacardio.2016.0001","article-title":"Timing of first postdischarge follow-up and medication adherence after acute myocardial infarction.","volume":"1","author":"Faridi","year":"2016","journal-title":"JAMA Cardiol"},{"issue":"11","key":"hoi250035r35","article-title":"Interventions for enhancing medication adherence.","volume":"2014","author":"Nieuwlaat","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"hoi250035r36","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012042.pub2","article-title":"Providing physicians with feedback on medication adherence for people with chronic diseases taking long-term medication.","volume":"1","author":"Zaugg","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"6","key":"hoi250035r37","first-page":"e13","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines.","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"issue":"4","key":"hoi250035r38","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1159\/000525135","article-title":"Which electronic health record system should we use? a systematic review.","volume":"31","author":"Al Ani","year":"2022","journal-title":"Med Princ Pract"},{"key":"hoi250035r40","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2023.107177","article-title":"Practice facilitation for scale up of clinical decision support for hypertension management: study protocol for a cluster randomized control trial.","volume":"129","author":"Blecker","year":"2023","journal-title":"Contemp Clin Trials"},{"issue":"12","key":"hoi250035r41","doi-asserted-by":"publisher","first-page":"781","DOI":"10.7326\/0003-4819-154-12-201106210-00005","article-title":"Measuring blood pressure for decision making and quality reporting: where and how many measures?","volume":"154","author":"Powers","year":"2011","journal-title":"Ann Intern Med"},{"issue":"2","key":"hoi250035r42","doi-asserted-by":"publisher","first-page":"110","DOI":"10.7326\/M17-1805","article-title":"Comparative effectiveness of implementation strategies for blood pressure control in hypertensive patients: a systematic review and meta-analysis.","volume":"168","author":"Mills","year":"2018","journal-title":"Ann Intern Med"},{"key":"hoi250035r24","unstructured":"Agency for Healthcare Research and Quality. Comorbidity Software: ICD-10-CM\/PCS. Healthcare Cost and Utilization Project (HCUP). Accessed December 6, 2024. https:\/\/hcup-us.ahrq.gov\/toolssoftware\/comorbidityicd10\/comorbidity_icd10.jsp#archive"},{"key":"hoi250035r25","unstructured":"Chronic Conditions Data Warehouse. 30 CCW chronic conditions algorithms. Accessed July 1, 2023. https:\/\/www2.ccwdata.org\/web\/guest\/condition-categories-chronic"},{"key":"hoi250035r39","unstructured":"Insights? H. Hospitals and health systems implementing EPIC in 2024. Accessed January 21, 2025. https:\/\/www.definitivehc.com\/resources\/healthcare-insights\/hospitals-and-health-systems-implementing-epic"}],"container-title":["JAMA Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/articlepdf\/2835676\/jamacardiology_blecker_2025_oi_250035_1757354391.04891.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T15:01:06Z","timestamp":1757516466000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/fullarticle\/2835676"}},"subtitle":["A Cluster Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2025,9,1]]},"references-count":42,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamacardio.2025.2155","relation":{},"ISSN":["2380-6583"],"issn-type":[{"value":"2380-6583","type":"print"}],"subject":[],"published":{"date-parts":[[2025,9,1]]}}}