From the Guidelines
The most effective way to measure compliance with prescribed antihypertensive medication in a patient with hypertension is through a combination of objective indirect methods, such as review of pharmacy records, and direct methods, like witnessed intake of medications or biochemical detection of medications in urine or blood, as recommended by the 2020 International Society of Hypertension Global Hypertension Practice Guidelines 1. To implement this approach, healthcare providers should evaluate adherence to antihypertensive treatment at each visit and prior to escalation of antihypertensive treatment. The following strategies can be considered to improve medication adherence:
- Reducing polypharmacy by using single pill combinations
- Once-daily dosing over multiple times per day dosing
- Linking adherence behavior with daily habits
- Providing adherence feedback to patients
- Home BP monitoring
- Reminder packaging of medications
- Empowerment-based counseling for self-management
- Electronic adherence aids such as mobile phones or short messages services
- Multidisciplinary healthcare team approach to improve monitoring for adherence These methods are preferred over subjective methods, such as self-reporting, which can be unreliable due to recall bias or desire to please the provider. By using a combination of objective indirect and direct methods, healthcare providers can accurately assess medication adherence and develop effective strategies to improve it, ultimately reducing morbidity, mortality, and improving quality of life for patients with hypertension.
From the Research
Methods for Measuring Compliance
- Direct measures of adherence include drug assays of blood or urine, use of drug markers with the target medication, and direct observation of the patient receiving the medication 2
- Indirect measures of adherence imply that the medication has been used by the patient; these measures include various forms of self-reporting by the patient, medication measurement (pill count), use of electronic monitoring devices, and review of prescription records and claims 2
- Computerized compliance monitors are the most recent and reliable of the indirect-detection methods 3
Strategies for Improving Compliance
- Identification of risk factors for non-compliance 3
- Development, with the patient's participation, of an individualized treatment plan that simplifies the regimen as much as possible 3
- Education of the patient, including information about his or her illness, instructions on how to take the prescribed medication correctly, and an explanation of the benefits and possible adverse effects of the therapy 3
- Use of single-pill combinations enabling simplification of treatment regimen, the implementation of a collaborative team-based approach and the development of electronic health tools also hold promise for improving adherence 4
Importance of Measuring Compliance
- Suboptimal adherence to antihypertensive medication is a major contributor to poor blood pressure control 4
- More than half of those patients failing to achieve goal blood pressure display suboptimal compliance rather than an inadequate regimen 5
- The patient-practitioner relationship is a key element both in detecting adherence and in attempting to choose interventions tailored to the patient's profile 4