Summary
Lack of compliance with prescribed antihypertensive regimens is the major reason why only 20% of hypertensives are found to have adequate blood pressure control on community surveys. Research during the last few years has led to the development and testing of several simple techniques that can be applied to the detection and improvement of compliance at the primary care level. Low compliance can be detected by routine monitoring of attendance and response to therapy coupled with asking patients directly about their compliance. The keys to improving low compliance include vigorous follow-up of patients who miss appointments, increasing attention to and supervision of low compilers through more frequent appointments and recruitment of other health professionals and the patient’s family, and encouraging the patient to take an active role in his own therapy, using such measures as home self-monitoring of blood pressure.
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Blanchard, E.B. and Young, L.B.: Self-control of cardiac functioning: A promise as yet unfulfilled. Psychology Bulletin 89: 145–163 (1973).
Borhani, N.: Implementation and evaluation of community hypertension programs; in Paul (Ed.) Epidemiology and Control of Hypertension, pp. 627–661 (Symposia Specialists, Miami 1975).
Bowen, R.G.; Rich, R. and Schloteeldt, R.M.: Effects or organised instruction for patients with the diagnosis of diabetes mellitus. Nursing Research 10: 141–159 (1961).
Caldwell, R.; Cobb, S.; Dowling, M.D. and Jongh, D.: The dropout problem in antihypertensive therapy. Journal of Chronic Diseases 22: 579–592 (1970).
Caplan, R.D.; Robinson, E.; French, J.; Caldwell, J. and Shinn, M.: Adhering to medical regimens — pilot experiments in patient education and social support. Institute for Social Research, University of Michigan, Ann Arbor (1976).
Carnahan, J. and Nugent, C.: The effects of self-monitoring by patients on the control of hypertension. American Journal of Medical Science 269: 69–73 (1975).
Caron, H.S. and Roth, H.P.: Patient’s cooperation with a medical regimen. Journal of the American Medical Association 203: 922–926 (1968).
Curry, F.J.: Study of irregular discharge T.B. patients at San Francisco General Hospital. Public Health Reports 79: 277–285 (1964).
Czaczkes, J.W. and Kaplan, D.A.: Selection of patients for regular hemodialysis; in Cameron (Ed.) Dialysis and Renal Transplantation, pp. 167–172, Proceedings of the Ninth Conference, Florence, Italy (1972).
Dixon, W.M.; Stradlin, P. and Wooton, I.D.: Outpatient PAS therapy. Lancet 2: 871–872 (1957).
Eney, R.D. and Goldstein, E.O.: Compliance of chronic asthmatics with oral administration of theophylline as measured by serum and salivary levels. Pediatrics 57: 513–517 (1976).
Etzwiler, D.D. and Robb, J.R.: Evaluation of programmed education among juvenile diabetics and their families. Diabetes 21: 967–971 (1972).
Feinstein, A.R.; Wood, H.F.; Epstein, J.A.; Taranta, A.; Simpson, R. and Tursky, E.: A controlled study of three methods of prophylaxis against streptococcal infection in a population of rheumatic children. II. Results of the first three years of the study, including methods of evaluating the maintenance of oral prophylaxis. New England Journal of Medicine 260: 697–702 (1959).
Gibberd, F.B.; Dunne, J.F.; Handley, A.J. and Hazleman, B.L.: Supervision of epileptic patients taking phenytoin. British Medical Journal 1: 147–149 (1970).
Gundert-Remy, U.; Remy, C. and Weber, E.: Serum digoxin levels in patients of a general practice in Germany. European Journal of Clinical Pharmacology 10: 97–100 (1976).
Haynes, R.B.: A review of tested interventions for improving compliance with antihypertensive treatment; in Haynes and Mattson (Eds.) Patient Compliance with Antihypertensive Treatment, pp. 85–111, NIH Publication 80-2102. (US Department of Health and Human Services, Washington, D.C. 1980).
Haynes, R.B.; Sackett, D.L.; Gibson, E.S.; Taylor, D.W.; Hackett, B.C.; Roberts, R.S. and Johnson, A.L.: Improvement of medication compliance in uncontrolled hypertension. Lancet 1: 1265–1268 (1976).
Hecht, A.B.: Improving medication compliance by teaching outpatients. Nursing Forum 13: 112–129 (1974).
Hogue, C.: Nurses and compliance; in Haynes et al. (Eds.) Compliance in Health Care. (Johns Hopkins, Baltimore 1979).
Johnson, A.L.; Taylor, D.W.; Sackett, D.L.; Dunnett, C.W. and Shimizu, A.G.: Self blood pressure recording in the management of hypertension. Canadian Medical Association Journal 119: 1034–1039 (1978).
Martens, L.V.; Frazier, P.J.; Hirt, K.L.; Meskin, L.H. and Proshek, J.: Developing brushing performance in second graders through behaviour modification. Health Service Research 88: 818–823 (1973).
McKenney, J.M.; Slining, J.M.; Henderson, H.R.; Devins, D. and Barr, M.: The effect of clinical pharmacy services on patients with essential hypertension. Circulation 48: 1104–1111 (1973).
McKenney, J.: Clinical pharmacy and compliance: measuring and improving strategies; in Haynes et al. (Eds.) Compliance in Health Care. (Johns Hopkins, Baltimore 1979).
Meyer, A.J. and Henderson, J.B.: Multiple risk factor reduction in the prevention of cardiovascular disease. Preventive Medicine 3: 225–236 (1974).
Moulding, T.; Onstad, G.D. and Sbarbaro, J.A.: Supervision of outpatient drug therapy with the medication monitor. Annals of Internal Medicine 73: 559–564 (1970).
Mushlin, A.I. and Appel, F.A.: Diagnosing patient non-compliance. Archives of Internal Medicine 137: 318–321 (1977).
Oakes, T.W.; Ward, J.R.; Gray, R.M.; Klauber, M.R. and Moody, P.M.: Family expectations and arthritis patient compliance to a hand resting splint regimen. Journal of Chronic Diseases 22: 757–764 (1970).
Park, L.C. and Lipman, R.S.: A comparison of patient dosage deviation reports with pill counts. Psychopharmacologia 6: 299–302 (1964).
Sackett, D.L.; Haynes, R.B.; Gibson, E.S.; Hackett, B.C.; Taylor, D.W.; Roberts, R.S. and Johnson, A.L.: Randomized clinical trial of strategies for improving medication compliance in primary hypertension. Lancet 1: 1205–1207 (1975).
Sackett, D.L.; Haynes, R.B.; Gibson, E.S. and Johnson, A.: The problem of compliance with antihypertensive therapy. Practical Cardiology 2: 35–39 (1976).
Tagliacozzo, D.M.; Luskin, D.B.; Lashof, J.C. and Ima, K.: Nurse intervention and patient behaviour. American Journal of Public Health 64: 596–603 (1974).
Watts, T.E.: The regularity of attendance of male tuberculosis patients diagnosed at Mulago Hospital between January and July in 1968 and in 1970. Tubercle 53: 174–180 (1972).
Wilber, J.A. and Barrows, J.S.: Reducing elevated blood pressure: Experience found in a community. Minnerva Medica 52: 1303–1305 (1969).
Wilber, J.A. and Barrows, J.S.: Hypertension — a community problem. American Journal of Medicine 52: 653–663 (1972).
Zifferblatt, S.M.: Increasing patient compliance through the applied analysis of behaviour. Preventive Medicine 4: 173–182 (1975).
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Sackett, D.L., Haynes, R.B. & Taylor, D.W. The Problem of Compliance with Antihypertensive Regimens. Drugs 25 (Suppl 2), 12–18 (1983). https://doi.org/10.2165/00003495-198300252-00004
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DOI: https://doi.org/10.2165/00003495-198300252-00004