← Digital & care-delivery × quality of life & behaviour

TrialJAMA network open2025

Clinical Decision Support and Cardiometabolic Medication Adherence: A Randomized Clinical Trial.

Patrick J O'Connor et al.PubMed ↗Full text ↗Publisher ↗

  • Algorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreachlooks good hereHigher adherence to BP medications, no clear effect on adherence to statins, no clear effect on adherence to noninsulin diabetes medications.Randomised, large.
  • Algorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach (eligible for pharmacist outreach)looks good hereLower long-term blood sugar.Weak evidence: one subgroup.
  • Algorithmic identification of low medication adherence, clinical decision support to physicians (not eligible for pharmacist outreach)no clear effectNo clear effect on long-term blood sugar.Nothing cleared the noise.

What the trial testedrandomised · 5,421 people · 2025

Randomised vs usual care

Raised adherence to BP medications

+29%+6% to +56%

algorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach vs usual care

Bigger than 5 in 10 on the map

As reported

OR 1.29, 95% CI 1.06–1.56

One subgroup

May have lowered long-term blood sugar in patients eligible for pharmacist outreach

−0.40percentage points−0.80 to −0.10

algorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach (eligible for pharmacist outreach) vs usual care, in patients eligible for pharmacist outreach

As reported

difference −0.4 %, 95% CI −0.80 to −0.10 · the paper's word: HbA1c

Range includes no effect

No clear effect on adherence to statins

+18%−1% to +41%

algorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach vs usual care

Bigger than 3 in 10 on the map

As reported

OR 1.18, 95% CI 0.99–1.41

Range includes no effect

No clear effect on adherence to noninsulin diabetes medications

+3%−18% to +30%

algorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach vs usual care

Bigger than 1 in 10 on the map

As reported

OR 1.03, 95% CI 0.82–1.30

+4 more in the walkthrough ↓

Who was studied, and how

5,421people with hypertension, in this paper

The trial randomly assignedassigned by chance

algorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach
usual care

Raised adherence to BP medications+29%

No clear effect on adherence to statins+18%

randomised

Among patients eligible for pharmacist outreach, the trial randomly assignedassigned by chance

algorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach (eligible for pharmacist outreach)
usual care

May have lowered long-term blood sugar−0.40

randomised · one subgroup

the abstract, start to end

… medications (adjusted odds ratio [AOR], 1.29; 95% CI, 1.06-1.56), but no better adherence to statins (AOR, 1.18; 95% CI, 0.99-1.41) or noninsulin diabetes medications (AOR, 1.03; 95% CI, 0.82-1.30) compared …

… intervention did not improve mean HbA1c (-0.2%; 95% CI, -0.4 to 0.1), systolic BP (1.4 mm Hg; 95% CI, -0.8 to 3.5 mm Hg), or LDL-C (-1.8 mg/dL; 95% CI, -6.5 to 2.8 …

… pharmacist outreach had improved HbA1c (-0.4%; 95% CI, -0.8% to -0.1%) compared with those not eligible for outreach (-0.0; 95% CI, -0.3% to 0.3%).

← favours treatmentfavours comparator →
could be chance
Adherence to BP medicationsalgorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach vs usual care
OR 1.291.06–1.56
Adherence to statinsalgorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach vs usual care
OR 1.180.99–1.41
Adherence to noninsulin diabetes medicationsalgorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach vs usual care
OR 1.030.82–1.30
Mean HbA1calgorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach vs usual care
−0.2−0.40 to 0.10
Systolic BPalgorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach vs usual care
1.4−0.80 to 3.50
LDL-Calgorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach vs usual care
−1.8−6.50 to 2.80
HbA1calgorithmic identification of low medication adherence, clinical decision support to physicians, and pharmacist outreach (eligible for pharmacist outreach) vs usual care, in patients eligible for pharmacist outreach
−0.4−0.80 to −0.10
HbA1calgorithmic identification of low medication adherence, clinical decision support to physicians (not eligible for pharmacist outreach) vs usual care, in patients not eligible for pharmacist outreach
0.0−0.30 to 0.30
Digital & care-deliveryGlycemic controlLipidsBlood pressureQuality of life & behaviour

Digital & care-delivery × quality of life & behaviourhelps?no deciding trial

unlikelylikely
0.25only evidence

Digital & care-delivery × glycemic controlhelps?no deciding trial

unlikelylikely
0.25only evidence

Digital & care-delivery × blood pressurehelps?no deciding trial

unlikelylikely
0.25only evidence
← favours treatmentfavours comparator →
this papermore certainless certain
1 / 6

3 papers cite it

2025
2026
this papercites it

The trial

NCT037484205,421 enrolled2020
Full record →Abstract, authors, funding and every citing paper · PMID 39786775