Improving Medication Adherence in Patients with Hypertension: A Randomized Trial

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 hyper...

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Bibliographic Details
Published in:The American journal of medicine Vol. 128; no. 12; pp. 1351 - 1361
Main Authors: Hedegaard, Ulla, Kjeldsen, Lene Juel, Pottegård, Anton, Henriksen, Jan Erik, Lambrechtsen, Jess, Hangaard, Jørgen, Hallas, Jesper
Format: Journal Article
Language:English
Published: United States 01.12.2015
Subjects:
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure
Female
Humans
Hypertension - drug therapy
Hypertension - psychology
Male
Medication Adherence - psychology
Medication Adherence - statistics & numerical data
Middle Aged
Motivational Interviewing - methods
Pharmacists
Hospital outpatient clinic
Hypertension
Medication adherence
Motivational interviewing
Pharmacy services
Hospital
ISSN:1555-7162
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Summary: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. 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, and tailored adherence counseling including motivational interviewing and telephone follow-ups. The primary outcome was composite medication possession ratio (MPR) to antihypertensive and lipid-lowering agents, at 1-year follow-up, assessed by analyzing pharmacy records. Secondary outcomes at 12 months included persistence to medications, blood pressure, hospital admission, and a combined clinical endpoint of cardiovascular death, stroke, or acute myocardial infarction. At 12 months, 20.3% of the patients in the intervention group (n = 231) were nonadherent (MPR <0.80), compared with 30.2% in the control group (n = 285) (risk difference -9.8; 95% confidence interval [CI], -17.3, -2.4) and median MPR (interquartile range) was 0.93 (0.82-0.99) and 0.91 (0.76-0.98), respectively, P = .02. The combined clinical endpoint was reached by 1.3% in the intervention group and 3.1% in the control group (relative risk 0.41; 95% CI, 0.11-1.50). No significant differences were found for persistence, blood pressure, or hospital admission. 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.
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ISSN:1555-7162
DOI:10.1016/j.amjmed.2015.08.011