Adherence to treatment recommendations has a major impact on health outcomes and the costs of care for patients with hypertension. However, evidence to support any specific approach or intervention for improving patient adherence to antihypertensive drugs or prescribed lifestyle changes is lacking (27).
Adherence to long-term medication regimens requires behavioural change, which involves learning, adopting and sustaining a medication-taking behaviour. Strategies such as providing rewards, reminders and family support to reinforce the new behaviour have been found to improve adherence in chronic illnesses (58 - 60) (see also table 7). Such behaviour-related interventions are likely to be key to improving adherence to antihypertensive medications and should be explored rigorously in clinical trials.
Until better insight into adherence is obtained, multifaceted measures to assist patients to follow treatment with antihypertensives have to be adopted. Health care providers need to be made aware of the low rates of adherence of patients with hypertension. They should receive training on how to counsel patients in a constructive and non-judgemental manner with the primary goal of helping the patient to adhere better to the treatment schedule.
Health care providers should also be trained to make a rational selection of antihypertensive drugs. The drug selected should be available, affordable, have a simple dosing regimen, and ideally, should not interfere with the quality of life of the patient.
Wherever feasible, patients should be taught to measure and monitor their own blood pressure and to assess their own adherence. Patients need to understand the importance of maintaining blood pressure control during the day and to use their drugs rationally. Furthermore, they need to learn how to deal with missed doses, how to identify adverse events and what to do when they occur.
Table 7 Factors affecting adherence to treatment for hypertension and interventions for improving it, listed by the five dimensions and the interventions used to improve adherence
Hypertension |
Factors affecting adherence |
Interventions to improve adherence |
Socioeconomic-related factors |
(-) Poor socioeconomic status; illiteracy; unemployment; limited drug supply; high cost of medication (46,48 - 55) |
Family preparedness (58 - 60); patient health insurance; uninterrupted supply of medicines; sustainable financing, affordable prices and reliable supply systems |
Health care team/health system-related factors |
(-) Lack of knowledge and training for health care providers on managing chronic diseases; inadequate relationship between health care provider and patient; lack of knowledge, inadequate time for consultations; lack of incentives and feedback on performance
(+) Good relationship between patient and physician (46)
|
Training in education of patients on use of medicines; good patient - physician relationship; continuous monitoring and reassessment of treatment; monitoring adherence; non-judgemental attitude and assistance; uninterrupted ready availability of information; rational selection of medications; training in communication skills; delivery, financing and proper management of medicines; pharmaceuticals: developing drugs with better safety profile; pharmaceuticals: participation in patient education programmes and developing instruments to measure adherence for patients |
Condition-related factors |
(+) Understanding and perceptions about hypertension (37) |
Education on use of medicines (58) |
Therapy-related factors |
(-) Complex treatment regimens (38,46,48 - 55); duration of treatment; low drug tolerability, adverse effects of treatment (46,48 - 55)
(+) Monotherapy with simple dosing schedules; less frequent dose (56); fewer changes in antihypertensive medications (54); newer classes of drugs: angiotensin II antagonists, angiotensin converting enzyme inhibitors, calcium channel blockers (22)
|
Simplification of regimens (38,46) |
Patient-related factors |
(-) Inadequate knowledge and skill in managing the disease symptoms and treatment; no awareness of the costs and benefits of treatment; nonacceptance of monitoring
(+) Perception of the health risk related to the disease (37); active participation in monitoring (41); participation in management of disease (42)
|
Behavioural and motivational intervention (58 - 60); good patient - physician relationship; self-management of disease and treatment (58); self-management of side-effects; memory aids and reminders (58 - 60) |
(+) Factors having a positive effect on adherence; (-) factors having a negative effect on adherence.
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