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TOPLINE:

Among patients with uncontrolled hypertension whose electronic health record indicated they were not taking their medications as prescribed, an intervention by primary care teams did not lead to significantly greater adherence than usual care. Over 1 year, adherence improved by 18% with the intervention and with usual care.

METHODOLOGY:

• Investigators at 10 primary care sites in New York enrolled 1726 patients (mean age, 67.2 years; 51.4% women) with uncontrolled hypertension and low medication adherence in a cluster randomized trial. Patients were considered to have low adherence if, in the past 180 days, they possessed antihypertensive medications < 80% of the time.
• In the intervention group, clinicians received automated identification of nonadherent patients, and medical assistants screened for possible barriers to adherence, such as forgetting to take the medication. Clinicians also received clinical decision support alerts and conducted discussions about adherence with patients.

TAKEAWAY:

• At baseline, patients had medications available for about a third of the days. At 12 months, the mean proportion of days covered was 51.1% for the intervention group and 53.1% for the control group, showing no significant difference in improvement between groups.
• Changes in systolic blood pressure and the proportion of patients achieving medication adherence (proportion of days covered of at least 80%) at 12 months were comparable between the two groups: Mean change in systolic blood pressure from baseline to 12 months was -11.6 mm Hg for the intervention patients and -12.2 mmHg for control individuals.

IN PRACTICE:

“In general, addressing adherence is challenging, and most prior interventions have had limited success in improving medication adherence,” the researchers reported. “Although our intervention included team-based care, an approach that is guideline recommended for hypertension, we found potential limitations in its implementation. These findings should not imply lack of effectiveness for team-based care more generally.” 

SOURCE:

Saul Blecker, MD, MHS, with the Department of Population Health at NYU Grossman School of Medicine in New York City, was the corresponding author of the study, which was published online on July 9 in JAMA Cardiology.

LIMITATIONS:

This study was conducted within a single health system using one electronic health record vendor. In the intervention group, 11.9% of clinicians opened the order set from an automated alert, and the open rate varied by site. Half of the patients responded to a questionnaire about possible barriers with “I always take my medications,” which suggests medical assistants “may not have always asked the barrier questionnaire as intended or that patients may not always have answered accurately,” the researchers wrote. 

DISCLOSURES:

This study was supported by the National Institutes of Health. One author was supported by Veterans Affairs and has a patent for a scale to measure medication nonadherence.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.