Improving Medication Adherence Among Patients with Hypertension
Medication adherence is critical to successful hypertension control for many patients. However, only 51% of Americans treated for hypertension follow their health care professional’s advice when it comes to their long-term medication therapy.1
Adherence matters. High adherence to antihypertensive medication is associated with higher odds of blood pressure control, but non-adherence to cardioprotective medications increases a patient’s risk of death from 50% to 80%.1
As a health care professional, you can empower patients to take their medications as prescribed. Effective two-way communication is critical; in fact, it doubles the odds of your patients taking their medications properly. Try to understand your patients’ barriers and address them honestly to build trust.
Predictors of Non-Adherence
Patients who struggle with adherence to medication may provide predictors of non-adherence.
When discussing medications, be aware if your patient:
- Demonstrates limited English language proficiency or low literacy.
- Has a history of mental health issues like depression, anxiety, or addiction.
- Doesn’t believe in the benefits of treatment.
- Believes medications are unnecessary or harmful.
- Has a concern about medication side effects.
- Expresses concern over the cost of medications.
- Says he or she is tired of taking medications.
Use the SIMPLE Method
Use the SIMPLE method2 to help improve medication adherence among your patients:
Simplify the regimen.
- Encourage patients to use adherence tools, like day-of-the-week pill boxes or mobile apps.
- Work to match the action of taking medication with a patient’s daily routine (e.g., mealtime or bedtime, with other medications they already take properly).
- Write down prescription instructions clearly, and reinforce them verbally.
- Provide websites for additional reading and information—find suggestions at the Million Hearts®
Modify patients’ beliefs and behavior.
- Provide positive reinforcement when patients take their medication successfully, and offer incentives if possible.
- Talk to patients to understand and address their concerns or fears.
Provide communication and trust.
- Allow patients to speak freely. Time is of the essence, but research shows that most patients will talk no longer than 2 minutes when given the opportunity.
- Use plain language when speaking with patients. Say, “Did you take all of your pills?” instead of using the word “adherence.”
- Ask for patients’ input when discussing recommendations and making decisions.
- Remind patients to contact your office with any questions.
Leave the bias.
- Understand the predictors of non-adherence and address them as needed with patients.
- Ask patients specific questions about attitudes, beliefs, and cultural norms related to taking medications.
- Ask patients simply and directly whether they are sticking to their drug regimen.
- Use a medication adherence scale:
- Morisky-8 (MMAS-8)
- Morisky-4 (MMAS-4 or Medication Adherence Questionnaire)
- Medication Possession Ratio (MPR)
- Proportion of Days Covered (PDC)
- Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009;119:3028-3035.