Improving Medication Adherence Among Patients with Hypertension

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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.

A physician speaking to her patient about the medication she's prescribing to her.

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).

Impart knowledge.

  • 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.

Evaluate adherence.

  • 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)

Additional Resources

Reference

  1. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009;119:3028-3035.