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A Multi-Component Intervention to Improve Therapeutic Adherence in Uncontrolled Hypertensive Patients Within the Primary Care Level: A Before-and-After Study

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Abstract

Introduction

Non-adherence to medication severely affects chronic disease control.

Aim

To assess whether a multi-component intervention implemented at the public primary care level in Argentina improves adherence to antihypertensive medication and helps to reduce blood pressure (BP) levels in uncontrolled hypertensive patients.

Methods

A before-and-after study was conducted in five public primary care clinics located in the city of Almirante Brown, Argentina. One hundred and twenty-five uncontrolled hypertensive patients received a multi-component intervention based on the Chronic Care model and the 5As strategy (Ask, Advise, Agree, Assist, and Arrange). Medication possession ratio (MPR) and BP values were assessed before and after a 6-month period.

Results

The follow-up rate was 96.8%. Main baseline characteristics were as follows, male: 44.8%, mean age: 57.1 years (± 8.1), exclusive public healthcare coverage: 83.5%, primary school level or less: 68.8%, and mean systolic/diastolic BP: 157.4 (± 13.6)/97.7 (± 8.2) mmHg. After implementing the intervention, a significant increase in the proportion of adequate adherence (MPR ≥ 80%) was observed, from 16.8% at baseline to 47.2% (p < 0.001). A significant reduction of 16.4 mmHg (CI 95%: 19.6, 13.1) was observed for systolic blood pressure (SBP) and 12.0 mmHg (CI 95%: 14.2, 9.9) for diastolic blood pressure (DBP) (p < 0.001). At 6 months, 51.2% of the population achieved blood pressure control (SBP < 140 mmHg and DBP < 90 mmHg).

Conclusions

The study intervention was associated with an increased adherence rate, achieving a significant reduction in BP values and reaching BP control in more than half of the population.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon formal request.

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Authors and Affiliations

  1. Instituto de Efectividad Clínica y Sanitaria, Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina

    Pablo Elías Gulayin, Laura Gutierrez, Diana Pinto & Vilma Irazola

  2. Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina

    Pablo Elías Gulayin

  3. Secretaría de Salud de la localidad de Almirante Brown, Pcia, Buenos Aires, Argentina

    Silvina Fontana, Mariana Ávila & Walter Gómez

  4. Comisión Nacional de Investigaciones Científico Tecnológicas, CONICET, Buenos Aires, Argentina

    Vilma Irazola

Authors
  1. Pablo Elías Gulayin
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Correspondence to Pablo Elías Gulayin.

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Funding

Salud Investiga—Ministerio de Salud de la Nación, Argentina.

Conflict of interest

The authors have no competing interests.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon formal request.

Author contributions

All authors contributed to study conception, data collection, and design. Material preparation and analysis were performed by PG, LG and VI. The first draft of the manuscript was written by PG, and all authors commented on the previous versions of the manuscript. All authors have read and approved the final manuscript.

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Gulayin, P.E., Gutierrez, L., Pinto, D. et al. A Multi-Component Intervention to Improve Therapeutic Adherence in Uncontrolled Hypertensive Patients Within the Primary Care Level: A Before-and-After Study. High Blood Press Cardiovasc Prev (2024). https://doi.org/10.1007/s40292-024-00645-1

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