Improving medication adherence in patients with hypertension: a randomized trial

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Abstract

BACKGROUND: and Purpose: In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention.

METHODS: Patients (N=532) were recruited from 3 hospital outpatient clinics and randomized to usual care or a 6-month pharmacist intervention comprising collaborative care, medication review, tailored adherence counselling including motivational interviewing and telephone follow-ups. The primary outcome was composite medication possession ratio (MPR) to antihypertensive and lipid-lowering agents, at one-year follow-up, assessed by analyzing pharmacy records. Secondary outcomes at 12 months included persistence to medications, blood pressure, hospitals admission and a combined clinical endpoint of cardiovascular death, stroke or acute myocardial infarction.

RESULTS: At 12 months, 20.3% of the patients in the intervention group (N=231) were non-adherent (MPR < 0.80) compared with 30.2% in the control group (N=285) (RD -9.8 (95% CI -17,3;-2.4) and median MPR (IQR) was 0.93 (0.82-0.99) and 0.91 (0.76-0.98), p=0.02. The combined clinical endpoint was reached by 1.3% in the intervention group and 3.1% in the control group (RR 0.41 [95% CI, 0.11-1.50]. No significant differences were found for persistence, blood pressure or hospital admission.

CONCLUSIONS: A multifaceted pharmacist intervention in a hospital setting led to a sustained improvement in medication adherence for patients with hypertension. The intervention had no significant impact on blood pressure and secondary clinical outcomes.

Original languageEnglish
JournalAmerican Journal of Medicine
Volume128
Issue number12
Pages (from-to)1351-1361
ISSN0002-9343
DOIs
Publication statusPublished - Dec 2015

Keywords

  • Hospital
  • Hospital outpatient clinic
  • Hypertension
  • Medication adherence
  • Motivational interviewing
  • Pharmacy services
  • Antihypertensive Agents/therapeutic use
  • Blood Pressure
  • Humans
  • Middle Aged
  • Male
  • Medication Adherence/psychology
  • Motivational Interviewing/methods
  • Female
  • Aged
  • Pharmacists
  • Hypertension/drug therapy

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