Intentional and Unintentional Nonadherence to Antihypertensive Medication

Lowry, Kathryn P.; Dudley, Tara K.; Oddone, Eugene Z.; Bosworth, Hayden B.

doi:10.1345/aph.1e594

Cited by 170 publications

(150 citation statements)

References 25 publications

Supporting

Mentioning

128

Contrasting

Unclassified

Order By: Relevance

“…18 A secondary analysis using data from the Canadian Heart Health Survey found that hypertensive patients receiving antihypertensive treatment but not achieving the target blood pressure at the 140/90 mm Hg level were more likely to be diabetic and of lower socioeconomic status as compared with those having controlled blood pressure. 19 Previous studies also found that hypertensive patients with low education were more likely to report non-adherence than those with high education, 20 and hospitalization rate was higher for patients with low medication adherence. 21 If less educated individuals are less knowledgeable about the importance of blood pressure control for prevention of diabetic complications, they will be less likely to adherent to therapy than better educated individuals.…”

Section: Discussionmentioning

confidence: 93%

Impacts of diabetes and hypertension on the risk of hospitalization among less educated people

Chen

Sigal

2006

J Hum Hypertens

View full text Add to dashboard Cite

Coexisting hypertension increases the morbidity and mortality associated with diabetes, and may be more so in less educated people. We analysed data from 49 904 Canadians 40-64 years of age who participated in the Canadian Community Health Survey, 2000-2001. Multiple classification analysis was used to adjust for covariates. Population weight and design effect of the survey were taken into account in the analysis. The association between hypertension and hospitalization varied according to diabetes and education. The adjusted difference in hospitalization incidence attributable to hypertension was significantly higher for the lower education group than the higher education group, and such a pattern tended to be more pronounced among diabetic people. The adjusted incidence difference attributable to hypertension was higher in the diabetic group (8.8, 95% confidence interval (CI): 4.6, 13.0%) than in the non-diabetic group (4.6, 95% CI: 3.6, 5.6%) for people with low education, but was similar for those with well-educated people. Possible reasons for the modifying effect of education on the relationship among hypertension, diabetes and hospitalization were discussed.

show abstract

Section: Discussionmentioning

confidence: 93%

Impacts of diabetes and hypertension on the risk of hospitalization among less educated people

Chen

Sigal

2006

J Hum Hypertens

View full text Add to dashboard Cite

show abstract

“…The scale for each item was revised to include the response categories strongly agree, agree, disagree, and strongly disagree. Those individuals who reported strongly agree, agree, don't know, or refused to any of the four items were classified as nonadherent (67). Self-report scores as measured by the same scale used in the current study had a sensitivity of 72% and specificity of 74% for ≥80% adherence with antidepressant medication (68).…”

Section: 4mentioning

confidence: 99%

Take Control of Your Blood pressure (TCYB) study: A multifactorial tailored behavioral and educational intervention for achieving blood pressure control

Bosworth

Olsen

Neary

et al. 2008

Patient Education and Counseling

140

124

View full text Add to dashboard Cite

Objectives-Evaluating a randomized controlled trial involving a tailored behavioral intervention conducted to improve blood pressure control.Methods-Adults with hypertension from two outpatient primary care clinics were randomly allocated to receive a nurse-administered behavioral intervention or usual care. In this ongoing study, patients receive the tailored behavioral intervention bi-monthly for two years via telephone; the goal of the intervention is to promote medication adherence and improve hypertension-related health behaviors. Patient factors targeted in the tailored behavioral intervention include perceived risk of hypertension and knowledge, memory, medical and social support, patients' relationship with their health care provider, adverse effects of medication therapy, weight management, exercise, diet, stress, smoking, and alcohol use.Results-The sample randomized to the behavioral intervention consisted of 319 adults with hypertension (average age = 60.5 years; 47% African-American). A comparable sample of adults was assigned to usual care (n=317). We had a 96% retention rate for the overall sample for the first 6 months of the study (93% at 12 months). The average phone call has lasted 18 minutes (range 2 to 51 minutes). From baseline to six months, self-reported medication adherence increased by 9% in the behavioral group vs. 1% in the non-behavioral group.Conclusion-The intervention is easily implemented and is designed to enhance adherence with prescribed hypertension regimen. The study includes both general and patient-tailored information based upon need assessment. The study design ensures internal validity as well as the ability to generalize study findings to the clinic settings. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Practice Implications-Despite knowledge of the risks and acceptable evidence, a large number of hypertensive adults still do not have their blood pressure under effective control. This study will be an important step in evaluating a tailored multibehavioral intervention focusing on improving blood pressure control. NIH Public Access

show abstract

“…Further, our strategy for assessing adherence differed from prior analyses that used pharmacy refill data 10,11 or simply reported current medication use . 5,12 While these measures likely accurately reflect medication prescribing, we used a validated measure that explores patient attitudes toward medicationtaking, 21,22 which in this case may better capture true medication adherence. Though some have questioned the correlation between self-reported and objective medication adherence, 23,24 self-reporting remains among the most common strategies for assessing medication adherence because it is simple and reliable.…”

Section: Younger Agementioning

confidence: 99%

Medication Non-Adherence After Myocardial Infarction: An Exploration of Modifying Factors

et al. 2014

View full text Add to dashboard Cite

BACKGROUND: Medication non-adherence is a major impediment to the management of cardiovascular disease risk factors. A better understanding of the modifying factors underlying medication non-adherence among individuals with known cardiovascular disease may inform approaches for addressing non-adherence. OBJECTIVE: The purpose of this study was to identify demographic and patient characteristics, medical comorbidities, psychosocial factors, and health belief-related factors associated with medication non-adherence among patients with known cardiovascular disease. DESIGN: We performed secondary analysis of baseline data from a randomized trial. PATIENTS: The study included 405 patients with a diagnosis of hypertension and history of acute myocardial infarction that was diagnosed within a three-year period prior to enrollment. MAIN MEASURES: Baseline demographics and patient characteristics, medical comorbidities, psychosocial factors, health belief-related factors, and patient-reported medication non-adherence were analyzed. KEY RESULTS: Of 405 patients, 173 (42.7 %) reported medication non-adherence. Factors associated with nonadherence in bivariate analysis included younger age, non-white race, having less than 12 years of education, smoking, financial insecurity, identifying as nervous or tense, higher life chaos score, greater worry about having a myocardial infarction, and greater worry about having a stroke. Using multivariable modeling, we determined that age (OR 0.97 per additional year, 95 % CI, 0.95-0.99), life chaos (OR 1.06 per additional point, 95 % CI, 1.00-1.11), and worry about stroke (OR 1.12 per additional point, 95 % CI, 1.01-1.25) remained significantly associated with self-reported medication non-adherence. CONCLUSIONS: We found that worry about having a stroke, higher life chaos, and younger age were all significantly associated with self-reported medication nonadherence in patients with cardiovascular disease and a history of myocardial infarction. Further research exploring these factors as targets for intervention is needed, as is additional research examining modifiable causes of medication non-adherence among patients with cardiovascular disease.KEY WORDS: cardiovascular disease; medication non-adherence; psychosocial; health beliefs.

show abstract

Intentional and Unintentional Nonadherence to Antihypertensive Medication

Abstract: Both intentional and unintentional nonadherence are common and related to perceived adverse effects. Furthermore, different interventions may be necessary to improve adherence in unintentionally and intentionally nonadherent patients.

Cited by 170 publications

References 25 publications

Impacts of diabetes and hypertension on the risk of hospitalization among less educated people

Impacts of diabetes and hypertension on the risk of hospitalization among less educated people

Take Control of Your Blood pressure (TCYB) study: A multifactorial tailored behavioral and educational intervention for achieving blood pressure control

Medication Non-Adherence After Myocardial Infarction: An Exploration of Modifying Factors

Contact Info

Product

Resources

About