RICH LIFE intervention did not reduce racial disparities in hypertension medication adherence

The RICH LIFE Project was a pragmatic, cluster-randomized trial in 30 primary care practices in Maryland and Pennsylvania. It compared Collaborative Care/Stepped Care (CC/SC) with Standard of Care Plus (SCP) among non-Hispanic Black and White adults with uncontrolled hypertension. This analysis examined medication adherence, a prespecified secondary outcome, at 12 months. Adherence was measured using a four-item scale adapted from Morisky, Green and Levine. The analysis included 1,555 participants with treated but uncontrolled hypertension; 64.2% were Black and 35.8% were White.

Among Black participants, adherence was 45.4% with CC/SC and 46.1% with SCP. Among White participants, it was 66.9% and 63.7%, respectively. Neither comparison between intervention arms was statistically significant. The estimated intervention effect on the racial disparity in adherence was −3.9 percentage points (95% CI, −15.8 to 9.4), indicating no significant reduction. Sensitivity analyses, including one restricted to pre-pandemic follow-up, produced similar findings.

The results do not show that this multilevel intervention reduced racial disparities in medication adherence. The analysis concerns a secondary outcome measured at 12 months, and adherence was assessed using a self-report scale. The findings do not establish which strategies would be effective in reducing these disparities.