michigan hypertension core curriculum - State of Michigan

Learning objectives:
210 Hypertension Core Curriculum
Adherence
Crystal Martin, MD and Michael Misuraca, MD
1.) To understand the various ways to assess medication adherence.
2.) To understand the factors that reduce adherence to antihypertensive therapy.
3.) To understand strategies to improve adherence to prescribed therapies.
Pretest question:
Which of the following is true regarding patient adherence?
1) Pill counts at office visits are an accurate measure of medication adherence.
2) Once daily drug therapy does not improve adherence.
3) Most patients are compliant with their medications.
4) Medication costs and co-pays >$10 affect patient adherence. (Correct answer)
Hypertension affects an estimated 72 million adults in the U.S. (American Heart Association)
The National Health and Nutrition Examination Surveys (NHANES) have demonstrated improvements
in hypertension treatment rates from 1999 to 2004, but without similar improvements in the prevalence
of HTN control. 1 Poor medical adherence may explain much of the unacceptably low rates of blood
pressure control and clearly contributes to the increased risk of stroke, coronary heart disease,
congestive heart failure, and renal failure seen in the hypertensive population. 2-4
Adherence may be defined as the extent to which a patient’s behavior coincides with medical
or health advice. 5 Data from medication adherence studies indicate that between 20-60% of patients
fail to follow prescriptions. 6-8 Direct measures of medication adherence, such as electronic medication
monitoring, direct observation, or serum and urine drug concentration measurements are expensive
and burdensome for routine clinical use. In clinical practice, indirect measures to determining
adherence such as patient questionnaires, unstructured conversation, daily diaries, pill counts; rates of
prescription refills, and assessing clinical response are practical but may be less reliable. 9,10