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The Impact of CMSA's Case Management Adherence Guidelines and Guidelines Training on Case Manager—Reported Behavior Change

Aliotta, Sherry L. BSN, RN, CCM; Boling, Jeanne MSN, CRRN, CDMS, CCM; Commander, Connie RN, CCM, ABDA, CPUR; Day, David MS, RPh; Greenberg, Liza MPH, RN; Lattimer, Cheri BSN, RN; Marshall, Danielle; Rogers, Susan A. BSN, RN, CCM

doi: 10.1097/

Purpose/Objectives The Case Management Society of America (CMSA) developed evidence-based guidelines (Case Management Adherence Guidelines, CMAG) for case managers to support increased efficacy of case managers in helping patients become more adherent to medication regimens. The effort was in response to documented high levels of nonadherence, and evidence demonstrating that lack of adherence negatively impacts patient health status. The CMSA engaged in a massive training program to support case manager adoption of the CMAG tools and approaches to improve patient knowledge and motivation. This article reports on findings of a follow-up survey that evaluated case manager's use of the tools and strategies discussed in the CMAG.

Primary Practice Setting(s) Seven hundred fifty case managers from all settings were trained in the use of the CMAG.

Findings/Conclusions In a follow-up survey, 42% of respondents reported that there has been a very, or fairly, significant impact of using their new skills to increase their effectiveness in helping patients reach their outcome improvement goals. In addition, 43% reported that there has been a very, or fairly, big improvement in patient adherence since they took the training, while 39% did not see a major impact. At the time of the survey (up to 1 year after training), 43% of respondents indicated that the training was very valuable; another 39% reported that it was fairly valuable. Participants continue to use the skills and information adopted in the training sessions: 26% report that they currently use at least some of the information and skills very often, while another 49% use them fairly often. Sixty-six percent of respondents indicated that they specifically use motivational interviewing to help address patient knowledge and motivation regarding medication adherence.

Implications for Case Management Practice

  • Medication adherence is a key issue in case management practice; efforts to positively impact low patient knowledge and motivation can be frustrating for case managers.
  • The CMAG offer evidence-based assessment tools to evaluate patient knowledge of medications and their motivation to adhere, and recommend the strategy of motivational interviewing to help case managers address adherence more effectively with patients.
  • A 1-time training on the CMAG and motivational interviewing had some effect on self-reported case manager effectiveness in addressing medication adherence. Case managers appreciated the training; many reported that they continue to use skills and that they have observed changes in patient outcomes.
  • Additional training, skill building, and reinforcement may help case managers apply CMAG and motivational interviewing effectively to support patients' adherence to medication regimens. The CMSA may continue to evaluate the impact of the CMAG and CMAG training to refine the tools and the training approach.

Sherry L. Aliotta, BSN, RN, CCM, is President and CEO of S.A. Squared of Tennessee, Inc., and is 2004–05 Past President of CMSA. She continues her work in the area of Patient Adherence, Case Management Consulting, Writing, and Speaking. She remains an active member of CMSA.

Jeanne Boling, MSN, CRRN, CDMS, CCM, is former Case Management Society of America (CMSA) Executive Director. Boling serves in a variety of consulting roles in support of CMSA and the industry.

Connie Commander, RN, CCM, ABDA, CPUR, is President, Commander's Premier Consulting Corp., VP/Co. Founder of Provider Sol'ns Consultants, Inc., and President of the Case Management Society of America. She is also an independent consultant on case management best practices.

David Day, MS, RPh, is Clinical Program Manager in charge of medication safety, medication adherence, and outcomes improvement programs at CIGNA HealthCare. Earlier, he was the director of clinical applications at Pfizer, responsible for developing service partnerships.

Liza Greenberg, MPH, RN, is consultant, Health Project Consulting, working on quality improvement projects and performance measurement with national healthcare organizations. Earlier, she was Vice President at URAC.

Cheri Lattimer, BSN, RN, is the Executive Director of the Case Management Society of America (CMSA). She has responsibility for developing products and services to meet the needs of case manager members of the organization.

Susan A. Rogers, BSN, RN, CCM, is president and principal consultant for Rogers Professional Guidance and past president of CMSA (2005–2006). She is also a nurse case manager for Select Medical Corp.

Address Correspondence to Sherry L. Aliotta, BSN, RN, CCM, S.A. Squared of Tennessee, Inc., 35 Barksdale Cove, Jackson, TN 38305 (

This article was funded by Pfizer, Inc.

© 2007 Lippincott Williams & Wilkins, Inc.