Effectiveness of Counseling for Hypertensive Patients on Adherence and Blood Pressure Outcome in Primary Care Provider in Indonesia (original) (raw)
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International Journal of Pharmacy and Pharmaceutical Sciences, 2015
Objective: To analyze the impacts of pharmacist counseling on adherence to medications and reduction in systolic and diastolic blood pressures (SBP/DBP) of hypertensive outpatients. Methods: A retro-prospective cohort study was undertaken to evaluate the impacts of two-month period counseling on medication adherence and SBP/DBP of hypertensive patients (n=47) insured by Social Security Organizing Body in primary health centers (Medan Deli, Helvetia, Darussalam, and Teladan) in Medan. Inclusion criteria were patients diagnosed with hypertension, age ≥ 18 years, and under treatment of antihypertensive drugs. A questionnaire was used to assess characteristics of the patients, antihypertensive drugs provided, and BP. The eight-item Morisky Medication Adherence Scale (MMAS-8) of each patient was assessed. Characteristics of the patients and antihypertensive drugs provided were descriptively analyzed. Impacts of counseling on medication adherence and SBP/DBP of the patients were analyzed using Wilcoxon test. All analyses were performed using Statistical Package for the Social Sciences (SPSS, version 19, Chicago, IL, USA) (p value <0.05 was considered significant). Results: Characteristics of the patients: male, 23.4%, female, 76.6%, mean age, 61.22 ± 9.90 (years). MMAS-8 score improved significantly from 4.58 before counseling to 6.28 after counseling, p = 0.000. There was a reduction in SBP from 160.49±23.15 mmHg before counseling to 149.04 ± 21.02 mmHg after counseling, p = 0.001. DBP also reduced from 91.23 ± 12.82 mmHg before counseling to 87.14 ± 9.94 mmHg after counseling, p = 0.014. Conclusion: Counseling improves adherence to prescribed medications and BP in hypertensive patients.
Trials, 2016
Background: Hypertension is one of the most important and well-known risk factors for cardiovascular diseases. Unfortunately, in spite of effective treatments, adherence to the regular use of drugs and other nondrug treatments, such as lifestyle improvement, is often poor. This study evaluates the effectiveness of an educational, supportive interventionin the form of a Blood Pressure Management Application (BPMAP)on self-management in patients with primary hypertension on controlling the determinant factors of hypertension, and on adherence to treatment. Methods/design: A two-arm, parallel-design randomized controlled clinical trial will be conducted on 30 to 60 year-old patients with primary hypertension who are attending the Tehran Heart Center. One hundred and thirty-two (132) patients will be randomly assigned to the intervention and control (usual method) groups. The most important inclusion criteria are, having primary hypertension and being pharmacologically treated for it, and not having developed the complications of hypertension, such as myocardial infarction, cerebral stroke and cardiac insufficiency. The participants should be able to read Persian and be able to use the application. The most important outcomes of the study include adherence to treatment, weight control, and regular monitoring of blood pressure which are assessed in the primary assessment (baseline data questionnaire) and again at the 8 th and 24 th weeks. The intervention is a mobile application that has capabilities such as reminders and scientific and supportive information. Discussion: This application has been programmed to reduce many of the nonadherence factors of hypertension treatment. Therefore, the findings may contribute to a rise in adherence to treatment. If proven to have an appropriate impact, it may be extended for use in the national hypertension control plan. Trial registration: This study was registered in the Iran Randomized Clinical Trial Center under the number IRCT2015111712211N2 on 1 January 2016.
Improving medication adherence in patients with hypertension: a randomized trial
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, 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. RESULTS: 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 in- terval [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. 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. © 2015 Elsevier Inc. All rights reserved. The American Journal of Medicine (2015) 128, 1351-1361
Pharmaceutical Care Program for Patients With Uncontrolled Hypertension
2006
Background: Pharmaceutical care programs may be an option to improve blood pressure (BP) control in patients with uncontrolled hypertension. The aim of this study was to evaluate the efficacy of pharmaceutical care programs in treating patients with resistant hypertension. Methods: In a double-blind randomized clinical trial, 71 patients with uncontrolled BP were enrolled in a pharmaceutical care program or in a control group and underwent a series of cognitive tests. The primary outcome was change in ambulatory BP (ABP) between the baseline evaluation and the final visit 6 months later. The secondary outcomes were the frequency of drug-related problems and adherence as determined by plasma levels of hydrochlorothiazide. Results: The ␦-values between the intervention and control groups for ABP in the different daily periods, with the corresponding 95% confidence limits, adjusted for age and baseline BP were: 3 (Ϫ1 to 5), 2 (Ϫ2 to 4), and 5 (Ϫ1 to 6) mm Hg for 24 h, daily and nightly systolic BP, respectively. The corresponding values for diastolic BP were 1 (Ϫ1 to 3), 0 (Ϫ2 to 2), and 3 (Ϫ1 to 4) mm Hg, respectively. Hydrochlorothiazide was detected in the plasma in 21 of 27 patients in the intervention group that attended to all appointments and 24 of 30 patients in the control group (P ϭ .904). Conclusions: The pharmaceutical care program tested in this trial was feasible and showed a trend for better BP control in patients with uncontrolled hypertension.
Disease Management, 2004
Hypertension control is a difficult goal to achieve in common practice even when its benefits have been widely proved. We assessed the effectiveness of a Complex Antihypertensive Intervention Program in the Elderly (CAPE). A program trial of 500 elderly hypertensive patients was conducted. 250 were followed by primary care physicians and intervened by the CAPE and 250 received usual care. The program included an organizational change with the addition of an office where patients had their blood pressure measured, were appointed to join educational sessions and received verbal and printed advice before medical attendance. Data was systematically recorded in the electronic medical record which functioned as a physician reminder during the visit. Differences in systolic blood pressure level and in percentage of well-controlled (Ͻ140/90 mm Hg) patients between groups were measured after 12 months of follow-up. The difference of mean change in systolic blood pressure between groups was 7.1 mm Hg (95% confidence interval, 4-10 mm Hg). Sixty-seven percent of patients in the intervention group were well-controlled, as were 51% of patients in the control group (p Ͻ 0.001). Patients who attended educational sessions showed the lowest odd ratio (0.25; 95% confidence interval, 0.11-0.54) for blood pressure above 140/90 mm Hg in multivariate analysis after adjusting for age, sex, initial systolic blood pressure level, and changes in antihypertensive treatment. These results support the effectiveness of our complex intervention program. Routine clinical care of hypertension can be improved with simple strategies that go beyond pharmacotherapy, tending to overcome clinical inertia. (Disease Management 2004;7:235-243) 235