***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background —Hypertension is a leading mortality risk factor yet inadequately controlled in most affected subjects . Effective programs to address this problem are lacking . We hypothesized that an information technology – supported management program could help improve blood pressure ( BP ) control . Methods and Results —This r and omized controlled trial included 223 primary care hypertensive subjects with mean 24-hour BP > 130/80 and daytime BP > 135/85 mm Hg measured with ambulatory monitoring ( ABPM ) . Intervention subjects received a BP monitor and access to an information technology – supported adherence and BP monitoring system providing nurses , pharmacists , and physicians with monthly reports . Control subjects received usual care . The mean ( ±SD ) follow-up was 348 ( ±78 ) and 349 ( ±84 ) days in the intervention and control group , respectively . The primary end point of the change in the mean 24-hour ambulatory BP was consistently greater in intervention subjects for both systolic ( −11.9 versus −7.1 mm Hg ; P<0.001 ) and diastolic BP ( −6.6 versus −4.5 mm Hg ; P=0.007 ) . The proportion of subjects that achieved Canadian Guideline target BP ( 46.0 % versus 28.6 % ) was also greater in the intervention group ( P=0.006 ) . We observed similar BP declines for ABPM and self-recorded home BP suggesting the latter could be an alternative for confirming BP control . The intervention was associated with more physician-driven antihypertensive dose adjustments or changes in agents ( P=0.03 ) , more antihypertensive classes at study end ( P=0.007 ) , and a trend toward improved adherence measured by prescription refills ( P=0.07 ) . Conclusions —This multidisciplinary information technology – supported program that provided feedback to patients and healthcare providers significantly improved blood pressure levels in a primary care setting Background —The effectiveness of heart failure disease management programs in patients under cardiologists ' care over long-term follow-up is not established . Methods and Results —We investigated the effects of a disease management program with repetitive education and telephone monitoring on primary ( combined death or unplanned first hospitalization and quality -of-life changes ) and secondary end points ( hospitalization , death , and adherence ) . The REMADHE [ Repetitive Education and Monitoring for ADherence for Heart Failure ] trial is a long-term r and omized , prospect i ve , parallel trial design ed to compare intervention with control . One hundred seventeen patients were r and omized to usual care , and 233 to additional intervention . The mean follow-up was 2.47±1.75 years , with 54 % adherence to the program . In the intervention group , the primary end point composite of death or unplanned hospitalization was reduced ( hazard ratio , 0.64 ; confidence interval , 0.43 to 0.88 ; P=0.008 ) , driven by reduction in hospitalization . The quality -of-life question naire score improved only in the intervention group ( P<0.003 ) . Mortality was similar in both groups . Number of hospitalizations ( 1.3±1.7 versus 0.8±1.3 , P<0.0001 ) , total hospital days during the follow-up ( 19.9±51 versus 11.1±24 days , P<0.0001 ) , and the need for emergency visits ( 4.5±10.6 versus 1.6±2.4 , P<0.0001 ) were lower in the intervention group . Beneficial effects were homogeneous for sex , race , diabetes and no diabetes , age , functional class , and etiology . Conclusions —For a longer follow-up period than in previous studies , this heart failure disease management program model of patients under the supervision of a cardiologist is associated with a reduction in unplanned hospitalization , a reduction of total hospital days , and a reduced need for emergency care , as well as improved quality of life , despite modest program adherence over time The effect of pharmaceutical care on the prevention , detection , and resolution of medication-related problems in high-risk patients in a rural community was studied . Adult patients who received care at clinics in a medically underserved area of Alabama and who were identified as being at high risk of medication-related adverse events were r and omly assigned to a control group or an intervention group . The control group received st and ard medical care , and the intervention group received pharmaceutical care , including a medical record review , a medication history review , pharmacotherapeutic evaluation , and patient medication education and monitoring over a one-year period .  A total of 69 patients completed the study ( 33 in the intervention group and 36 in the control group ) . The percentage of patients responding to hypertension , diabetes , dyslipidemia , and anticoagulation therapy increased significantly in the intervention group and declined in the control group . Ratings for inappropriate prescribing improved in all 10 domains evaluated in the intervention group but worsened in 5 domains in the control group . There were no significant differences between the groups at 12 months in health-related quality of life or medication misadventures . Medication compliance scores improved in the intervention group but not in the control group . Medication knowledge increased in the intervention group and decreased in the control group . Pharmaceutical care in a rural , community-based setting appeared to reduce inappropriate prescribing , enhance disease management , and improve medication compliance and knowledge without adversely affecting health-related quality of life The current study presents the impact of a behavior change program to increase statin adherence using interactive voice response ( IVR ) technology .  Subjects were affiliated with a large health benefit company , were prescribed a statin ( index ) and had no lipid-lowering pharmacy cl aims in the previous 6 months , and were continuously enrolled in the plan for 12 months prior and 6 months post index statin . Potential subjects ( 1219 ) were contacted by the IVR system ; 497 gave informed consent . Subjects were asked to respond to 15 questions from the IVR that were guided by several behavior change theories . At the conclusion of the questions , subjects were r and omly assigned to either a control group ( n = 244 ) , who received generic feedback at the conclusion of the call and were then mailed a generic cholesterol guide , or an experimental group ( n = 253 ) , who received tailored feedback based on their cholesterol-related knowledge , attitudes , beliefs , and perceived barriers to medication adherence , and were mailed a tailored guide that reinforced similar themes . Subjects in the experimental group had the opportunity to participate in 2 additional tailored IVR support calls . The primary dependent variable was 6-month point prevalence , defined as cl aims evidence of a statin on days 121 - 180 post index statin . Subjects in the experimental group had a significantly higher 6-month point prevalence than the controls ( 70.4 % vs. 60.7 % , P < 0.05 ) . Results of this study suggest that a behavioral support program using IVR technology can be a cost-effective modality to address the important public health problem of patient nonadherence with statin medication OBJECTIVES to investigate the effectiveness of a  pharmacy discharge plan  in elderly hospitalized patients . DESIGN r and omized controlled trial . SUBJECTS AND SETTING S we r and omized patients aged 75 years and older on four or more medicines who had been discharged from three acute general and one long-stay hospital to a pharmacy intervention or usual care . INTERVENTIONS the hospital pharmacist developed discharge plans which gave details of medication and support required by the patient . A copy was given to the patient and to all relevant professionals and carers . This was followed by a domiciliary assessment by a community pharmacist . In the control group , patients were discharged from hospital following st and ard procedures that included a discharge letter to the general practitioner listing current medications . OUTCOMES the primary outcome was re-admission to hospital within 6 months . Secondary outcomes included the number of deaths , attendance at hospital outpatient clinics and general practice and proportion of days in hospital over the follow-up period , together with patients ' general well-being , satisfaction with the service and knowledge of and adherence to prescribed medication . RESULTS we recruited 362 patients , of whom 181 were r and omized to each group . We collected hospital and general practice data on at least 91 and 72 % of patients respectively at each follow-up point and interviewed between 43 and 90 % of the study subjects . There were no significant differences between the groups in the proportion of patients re-admitted to hospital between baseline and 3 months or 3 and 6 months . There were no significant differences in any of the secondary outcomes . CONCLUSIONS we found no evidence to suggest that the co-ordinated hospital and community pharmacy care discharge plans in elderly patients in this study influence outcomes Abstract . Objectives : To compare compliance with an antihypertensive treatment administered either twice daily or three times daily . The two formulations of the antihypertensive treatment used ( nicardipine ) “ regular tablets ” ( t.d . ) and “ slow release tablets ” ( b.d . ) are bioequivalent at the daily dosage used in the study . Study design : Open , controlled , parallel design ed study with central ised , r and omised allocation to the treatment groups : TID group : A nicardipine 20 mg tablet , three times daily for 3 months . BID group : A capsule of slow release ( SR ) nicardipine , 50 mg twice daily for 3 months . Patients : 7274 hypertensive patients were investigated by 2.651 general practitioners .  Compliance with the nicardipine was assessed by means of st and ardised interviews with the patients and by a question naire for the investigators . Results : Compliance was slightly higher in the BID than in the TID group ; 71.2 % and 24.5 % of patients in the first group declared their compliance was 100 % and 80 % compared to 82.3 % and 15 % in the second group . A statistically significant relationship was shown between compliance with nicardipine  and the decrease in blood pressure after three months of therapy . However , no significant difference was noticed between the two groups of patients in the absolute decrease in blood pressure after the treatment period : 25.7/14.7 mm Hg in the TID group compared with 25.9/15.0 mm Hg in the BID group . Conclusions : A difference in compliance between the bioequivalent BID and TID formulations of the same active agent was shown in hypertensive patients . However , the difference was not large enough to lead to a difference either in the number of controlled patients or in the decrease in blood pressure . Reducing the number of daily doses does not automatically lead to greater efficacy of treatment BACKGROUND Hospitalization and subsequent discharge home often involve discontinuity of care , multiple changes in medication regimens , and inadequate patient education , which can lead to adverse drug events ( ADEs ) and avoidable health care utilization . Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and follow-up by pharmacists on preventable ADEs . METHODS We conducted a r and omized trial of 178 patients being discharged home from the general medicine service at a large teaching hospital . Patients in the intervention group received pharmacist counseling at discharge and a follow-up telephone call 3 to 5 days later . Interventions focused on clarifying medication regimens ; review ing indications , directions , and potential side effects of medications ; screening for barriers to adherence and early side effects ; and providing patient counseling and /or physician feedback when appropriate . The primary outcome was rate of preventable ADEs . RESULTS Pharmacists observed the following drug-related problems in the intervention group : unexplained discrepancies between patients ' preadmission medication regimens and discharge medication orders in 49 % of patients , unexplained discrepancies between discharge medication lists and postdischarge regimens in 29 % of patients , and medication nonadherence in 23 % . Comparing trial outcomes 30 days after discharge , preventable ADEs were detected in 11 % of patients in the control group and 1 % of patients in the intervention group ( P = .01 ) . No differences were found between groups in total ADEs or total health care utilization . CONCLUSIONS Pharmacist medication review , patient counseling , and telephone follow-up were associated with a lower rate of preventable ADEs 30 days after hospital discharge . Medication discrepancies before and after discharge were common targets of intervention BACKGROUND St and ard office-based approaches to controlling hypertension show limited success . Such suboptimal hypertension control reflects in part the absence of both an infrastructure for patient education and frequent , regular blood pressure ( BP ) monitoring . We tested the efficacy of a physician-directed , nurse-managed , home-based system for hypertension management with st and ardized algorithms to modulate drug therapy , based on patients ' reports of home BP . METHODS We r and omized out patients requiring drug therapy for hypertension according to the Joint National Committee on Prevention , Detection , Evaluation , and Treatment of High Blood Pressure ( JNC VI ) criteria to receive usual medical care only ( UC , n = 76 ) or usual care plus nurse care management intervention ( INT , n = 74 ) over a 6-month period . RESULTS Patients receiving INT achieved greater reductions in office BP values at 6 months than those receiving UC : 14.2 + /- 18.1 versus 5.7 + /- 18.7 mm Hg systolic ( P < .01 ) and 6.5 + /- 10.0 versus 3.4 + /- 7.9 mm Hg diastolic , respectively ( P < .05 ) . At 6 months , we observed one or more changes in drug therapy in 97 % of INT patients versus 43 % of U 
    Output:
    
Reduced out-of-pocket expenses , case management , and patient education with behavioral support all improved medication adherence for more than 1 condition .
Evidence is limited on whether these approaches are broadly applicable or affect longterm medication adherence and health outcomes .