michigan hypertension core curriculum - State of Michigan

Table 1: 9
Identifying indicators of poor adherence allow physicians to initiate appropriate interventions to
improve adherence. Table 1 above lists major predictors associated with poor adherence. Interventions
that successfully improve adherence include patient education, drug information, minimizing number
and frequency of pills per day, identifying daily reminders or medication aids, i.e. pillbox or bubble
packs, and more frequent clinic visits or clinic staff contact. In a scientific review of published
randomized controlled trials (RCT) of interventions to assist patient adherence, approximately 50% of
the interventions tested were associated with statistically significant increases in adherence and 17
of 39 interventions tested were associated with significantly improved treatment outcomes. 5 Complex
interventional programs integrating multiple methods were the most effective for long-term treatment.
Maintaining effective patient-provider communication, addressing adherence with understanding
and empathy, improving provider availability, and including the patient and family in health related
decision-making, helps to build patient’s trust and willingness to participate in their care. Patient
trust in their physician has been found to an important factor in predicting subsequent adherence. 11
Self-monitoring of blood pressure should be encouraged as a mechanism to monitor a patient’s
adherence, to provide positive reinforcement and to improve hypertension control. Multidisciplinary
teams including counselors, nurse practitioners, and pharmacists have also been effective in helping
improve medication adherence and HTN outcomes, as well as lowering the overall cost of care. A
NKFM & MDCH 211