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Achieving Patient Buy-In and Long Term Compliance with Antihypertensive Treatment

  • Practical Disease Management
  • Published:
Disease Management and Health Outcomes

Abstract

Noncompliance is a major problem in antihypertensive treatment. Up to 50% of patients are noncompliant after 1 year and 85% after 5 years. Current approaches for predicting compliance are based on patient demographics, medication characteristics and clinical factors, health beliefs and the quality of patient-provider communication. All of these factors together predict compliance only less than half the time, indicating that over half of the patients in disease management programmes may not buy-in to their treatment.

A new approach views compliance as behaviour change that takes place over time. Patients move through 5 stages in their ‘readiness to comply’. Our study of over 700 patients with hypertension using brief self-report measures to assess their ‘readiness to comply’ found a highly significant relationship between ‘readiness to comply’ and reported compliance. Clinicians can increase patient buy-in and long term compliance by assessing their patients ’stage-of-change’ using validated measures and then matching their interventions to each patient’s ‘readiness to comply’.

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References

  1. Haynes RB, McKibbon KA, Kanani R. Systematic review of randomised trials of interventions to assist patients to follow prescriptions for medications. Lancet 1996; 348: 383–6

    Article  PubMed  CAS  Google Scholar 

  2. Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther 1999; 21: 1074–90

    Article  PubMed  CAS  Google Scholar 

  3. Pullar T, Birtwell AJ, Wiles PG, et al. Use of a pharmacologic indicator to compare compliance with tablets prescribed to be taken once, twice, or three times daily. Clin Pharmacol Ther 1988; 44: 540–5

    Article  PubMed  CAS  Google Scholar 

  4. Rudd P, Ahmed S, Zachary V, et al. Antihypertensive drug trials, contributions from medication monitors. In: Cramer JA, Spilker B, editors. Patient compliance in medical practice and clinical trials. New York (NY): Raven Press, Ltd., 1991: 283–99

    Google Scholar 

  5. Backes JM, Schentag JJ. Partial compliance as a source of variance in pharmacokinetic and therapeutic drug monitoring. In: Cramer JA, Spilker B, editors. Patient compliance in medical practice and clinical trials. New York (NY): Raven Press Ltd, 1991: 27–36

    Google Scholar 

  6. Nagy VT, Wolfe GR. Cognitive predictors of compliance in chronic disease patients. Med Care 1984; 22: 912–21

    Article  PubMed  CAS  Google Scholar 

  7. Nides MA, Tashkin DP, Simmons MS, et al. Improving inhaler adherence in a clinical trial through the use of the nebulizer chronolog. Chest 1993; 104: 501–7

    Article  PubMed  CAS  Google Scholar 

  8. Urquhart J, Chevalley C. Impact of unrecognized dosing errors on the reckoning of both cost and effectiveness of pharmaceuticals. Drug Info J 1988; 22: 363–78

    Google Scholar 

  9. Ménard J, Chatellier G. Limiting factors in the control of BP: why is there a gap between theory and practice? J Hum Hypertens 1995; 9: 519–23

    Google Scholar 

  10. Haynes RB, Taylor DW, Sackett DL, et al. Can simple clinical measurements detect patient noncompliance? Hypertension 1980; 2: 757–64

    Article  PubMed  CAS  Google Scholar 

  11. Cramer JA, Mattson RH, Prevey ML, et al. How often is medication taken as prescribed? A novel assessment technique. JAMA 1989; 261: 3273–7

    Article  PubMed  CAS  Google Scholar 

  12. Cramer JA. Overview of methods to measure and enhance patient compliance. Cramer JA, Spilker B, editors. Patient compliance in medical practice and clinical trials. New York (NY): Raven Press Ltd, 1991: 3–10

    Google Scholar 

  13. Dahlström B, Eckernäs S. Patient computers to enhance compliance with completing questionnaires: a challenge for the 1990s. In: Cramer JA, Spilker B, editors. Patient compliance in medical practice and clinical trials. New York (NY): Raven Press Ltd, 1991: 233–42

    Google Scholar 

  14. Eichert JH, Wong H, Smith DR. The disease management development process. In: Todd WE, Nash D, editors. Disease Management, a systems approach to improving patient outcomes. Chicago (IL): American Hospital Publishing Inc., 1997: 27–60

    Google Scholar 

  15. Bittar N. Maintaining long-term control of blood pressure: the role of improved compliance. Clin Cardiol 1995; 18: III-12-6

  16. Urquhart J. When outpatient drug treatment fails: identifying noncompliers as a cost containment tool. Med Interface 1993; 6: 65–73

    Google Scholar 

  17. Clark LT. Improving compliance and increasing control of hypertension: needs of special hypertensive populations. Am Heart J 1991; 121: 664–9

    Article  PubMed  CAS  Google Scholar 

  18. Sullivan SD, Kreling DH, Hazlet TK. Noncompliance with medication regimens and subsequent hospitalizations: a literature analysis and cost of hospitalization estimate. J Res Pharm Econ 1990; 2: 19–33

    Google Scholar 

  19. Stason WB. Opportunities to improve the cost-effectiveness of treatment for hypertension. Hypertension 1991; 18: 161–6

    Article  Google Scholar 

  20. Juncos LI. Patient compliance and angiotensin converting enzyme inhibitors in hypertension. J Cardiovasc Pharmacol 1990; 15s3: s22–5

    Article  Google Scholar 

  21. National High Blood Pressure Program Coordinating Committee. The sixth report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure, (JNC VI). Arch Intern Med 1997; 157: 2413–46

    Article  Google Scholar 

  22. American Heart Association. 1998 Heart and stroke statistical Update. Dallas (TX): American Heart Association, 1997

    Google Scholar 

  23. Roter DL, Hall JA. Patient-provider communication. In: Glanz K, Lewis FM, Rimer BK, editors. Health behavior and health education, theory, research and practice. San Francisco (CA): Jossey-Bass, 1997: 206–26

    Google Scholar 

  24. Nelson EC, Stason WB, Neutra RR, et al. Impact of patient perceptions on compliance with treatment for hypertension. Med Care 1978; 16: 893–906

    Article  PubMed  CAS  Google Scholar 

  25. Morris LA, Barofsky I. Impact of risk communication on accrual, regimen, and follow-up compliance. In: Cramer JA, Spilker B, editors. Patient compliance in medical practice and clinical trials. New York (NY): Raven Press Ltd, 1991: 57–69

    Google Scholar 

  26. Levine DM, Bone L. The impact of a planned health education approach on the control of hypertension in a high risk population. J Hum Hypertens 1990; 4: 317–21

    PubMed  CAS  Google Scholar 

  27. Sawicki PT, MÜhlhauser I, Didjurgert V, et al. Improvement of hypertension care by a structured treatment and teaching program. J Hum Hypertens 1993; 7: 571–3

    PubMed  CAS  Google Scholar 

  28. Becker MH, Maiman LA. Strategies for enhancing patient compliance. J Community Health 1980; 6: 113–35

    Article  PubMed  CAS  Google Scholar 

  29. Nagy VT, Wolfe GR. Cognitive predictors of compliance in chronic disease patients. Med Care 1984; 22: 912–21

    Article  PubMed  CAS  Google Scholar 

  30. Butler LE. Have all won and must all have prizes? Revisiting Luborsky, et al.’s verdict. J Consult Clin Psych 1991; 59: 226–32

    Article  Google Scholar 

  31. Prochaska JO, Clemente CC, Norcross JC. In search of how people change, applications to addictive behaviors. Am Psy-chol 1992; 47: 1102–14

    Article  CAS  Google Scholar 

  32. Willey C, Redding C, Rossi S, et al. A comparison of two methods of measuring stage of change for adherence with medication. Ann Behav Med 1998; 20 Suppl.: S027

    Google Scholar 

  33. Willey C, Stafford J, Geletko S, et al. Stages of change for adherence with medication medication. Ann Behav Med 1999; 21: S156

    Google Scholar 

  34. Prochaska JO, Velicer WF, Rossi JS, et al. Stages of change and decisional balance for 12 problem behaviors. Health Psychol 1994; 13: 39–46

    Article  PubMed  CAS  Google Scholar 

  35. Prochaska JO. Strong and weak principles for progressing from precontemplation to action on the basis of twelve problem behaviors. Health Psychol 1994; 13: 47–51

    Article  PubMed  CAS  Google Scholar 

  36. Marcus BH, Selby VC, Niaura RS, et al. Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport 1992; 63: 60–6

    PubMed  CAS  Google Scholar 

  37. Lewis BF, Garfield F, Orsini KC, et al. Walking the walk, talking the talk: implementation and process analysis issues in four residential treatment models. In: Fletcher BW, Inciardi JA, Horton AM, editors. Drug abuse treatment: the implementation of innovative approaches. Westport (CT): Greenwood Publishing Group, Inc., 1994: 45–62

    Google Scholar 

  38. Sherbourne C, Hays R, Ordway L, et al. Antecedents of adherence to medical recommendations: results from the medical outcomes study. J Behav Med 1992; 15: 447–68

    Article  PubMed  CAS  Google Scholar 

  39. Miller NH, Hill M, Kottke T, et al. The multilevel compliance challenge: recommendations for a call to action. A statement for healthcare professionals. Circulation 1997; 95: 1085–90

    Article  PubMed  CAS  Google Scholar 

  40. Winett RA. A framework for health promotion and disease prevention programs. Am Psychol 1995; 50: 341–50

    Article  PubMed  CAS  Google Scholar 

  41. Longabaugh R, Wirtz PW, DiClemente CC, et al. Issues in the development of client-treatment matching hypotheses. J Stud Alcohol 1994; S12: 46–59

    Google Scholar 

  42. Shoham-Salomon V, Hannach MT. Client-treatment interaction in the study of differential change processes. J Consult Clin Psych 1991; 59: 217–25

    Article  CAS  Google Scholar 

  43. Marcus BH, Rossi JS, Selby VS, et al. The stages and processes of exercise adoption and maintenance in a worksite sample. Health Psychol 1992; 11: 386–95

    Article  PubMed  CAS  Google Scholar 

  44. Rossi JS. Why do people fail to maintain weight loss? In: Allison DB, Pi-Sunyer FX, editors. New York (NY): Obesity Treatment Plenum Press; 1995: 97–102

    Google Scholar 

  45. Rosenstock IM. The health belief model: explaining health behavior through expectancies. Health Behav Health Educ 1989: v39-v62

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Acknowledgements

This work was supported in part from a grant from Bristol-Myers Squibb.

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Authors and Affiliations

  1. Caro Research, 336 Baker Avenue, Concord, Massachusetts, 01742, USA

    Frances B. Garfield Ph.D. (senior researcher) &  J. Jaime Caro M.D.

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  1. Frances B. Garfield Ph.D.
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  2. J. Jaime Caro M.D.
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Garfield, F.B., Caro, J.J. Achieving Patient Buy-In and Long Term Compliance with Antihypertensive Treatment. Dis-Manage-Health-Outcomes 7, 13–20 (2000). https://doi.org/10.2165/00115677-200007010-00003

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