Outcomes/Effectiveness Research

Studies examine medication adherence and group medical visits among persons with high blood pressure

Only 37 percent of American adults have normal blood pressure (BP) or hypertension control (systolic BP less than 140 mm Hg and diastolic BP less than 90 mm Hg). Even among patients treated with antihypertensive medications, hypertension control remains suboptimal at about 54 to 59 percent. Poor medication adherence may contribute to low hypertension control rates. Certain individuals are less likely to comply with antihypertensive medication regimens than others, according to a new study. A second study indicates that underserved patients are willing to attend group visits for hypertension treatment, which may be a viable approach to their chronic disease care. Both studies were supported by the Agency for Healthcare Research and Quality (HS11834). They are briefly discussed here.

Hyre, A.D., Krousel-Wood, M.A., Muntner, P., and others (2007, March). "Prevalence and predictors of poor antihypertensive medication adherence in an urban health clinic setting." Journal of Clinical Hypertension 9(3), pp. 179-186.

Researchers found that few individuals with high blood pressure take their antihypertensive medication exactly as prescribed. A survey of 295 patients with hypertension (mean age of 56 and who were taking antihypertensive medication) from an urban medical clinic assessed patients' sociodemographics, medical history, BP knowledge, experiences with health care, and antihypertensive medication adherence.

Nearly all patients had a family history of hypertension. Only about one-third of patients had good (35.6 percent) or medium (36 percent) medication adherence, and slightly over a fourth (28.4 percent) had poor medication adherence. For example, these patients may not have taken their medicine when they weren't feeling well or forgot to take doses.

Certain individuals were less likely than others to take their medication as prescribed. Adults younger than 50 years and those ages 51 to 60 years were 39 percent and 53 percent, respectively, more likely to not follow their medication regimens compared with their counterparts who were older than 60 years. Also, blacks were 4.3 times and men were 2.4 times more likely not to follow their medication regimens. Finally, patients who cared for dependents, those initially diagnosed with hypertension within the past 10 years who were uncomfortable about asking the doctor questions, and those who wanted to spend more time with the doctor were more likely to have poor medication adherence.

People with a history of heart attack or stroke and those who could see their primary care doctor when needed were more likely to take their medication as prescribed. Also, patients reporting better access to care, satisfaction with their care, and good patient-doctor relationships were significantly less likely than their counterparts to omit taking medications.

Kawasaki, L., Muntner, P., Hyre, A.D., and others (2007, May). "Willingness to attend group visits for hypertension treatment." The American Journal of Managed Care 13(5), pp. 257-262.

Group visits for management of chronic disease have improved patient satisfaction and clinical outcomes, while reducing use of care. However, patients must be willing to attend group visits. This study found that a group of disadvantaged patients with hypertension were willing to attend group medical visits.

The patients met regularly for routine medical care in groups of 10 to 15 for visits which were led by their regular physician and a registered nurse. The group visits lasted 1 to 1.5 hours and met every 2 to 3 months.

Although the effectiveness and cost savings of these visits need further study, the researchers note that the visits may prove to be a desirable chronic disease care approach for underserved groups. They surveyed 296 patients with hypertension from an urban public hospital's primary care clinic in 2004 and 2005. Most respondents were black women with a monthly income of $1,000 or less and a mean age of 56. After a brief description of the group medical visit, 68 percent of respondents said they were willing to attend the group visits for hypertension management.

Offering three incentives—reduced waiting time to see their physicians, having more time with their physicians, and parking or transportation subsidies—increased willingness to participate to 80 percent.

In the survey, 63 percent of patients wanted to spend more time with their physician. This was significantly correlated with willingness to attend group visits, and may reflect a strong patient-physician relationship. It may also indicate patients' desire for more social or emotional support, which group visits can provide.

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