Abstract P50: Early Nonadherence to Antihypertensive Medications

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Emily B Schroeder ◽  
Jennifer L Ellis ◽  
Nikki M Carroll ◽  
Elizabeth A Bayliss ◽  
Marsha A Raebel
Keyword(s):  
Health Care ◽  
Medication Adherence ◽  
Antihypertensive Medication ◽  
Multivariate Model ◽  
Care Plan ◽  
Office Visits ◽  
Antihypertensive Medications ◽  
Kaiser Permanente ◽  
Pharmacy Claims ◽  
C Statistic

Background: Medication adherence is extremely important in the treatment of hypertension. Most medication adherence metrics are based on refill rates from pharmacy claims databases and require at least two drug dispensings for the calculations. Little is known about individuals who demonstrate early non-adherence to antihypertensive medications, either by never filling a prescription (primary non-adherence) or by filling a prescription only once (early non-persistence). Methods: We conducted a retrospective cohort study of 6,393 Kaiser Permanente Colorado enrollees with hypertension who received a first prescription for an antihypertensive medication between January 1, 2007 and June 30, 2008. We linked prescription orders to medication dispensings and then classified patients into primary non-adherent, early non-persistent, or ongoing dispensings groups. Multivariate logistic modeling was performed to investigate potential predictors of primary non-adherence compared to ongoing dispensings. Results: Five percent (331 of 6,393) of patients were primarily non-adherent, 26% (1,672 of 6,393) demonstrated early non-persistence, and 69% (4,390 of 6,393) received ongoing dispensings. In a multivariate model, the following characteristics were associated with a higher likelihood of exhibiting primary non-adherence compared to receiving ongoing dispensings: Hispanic (OR 1.74, 95% CI 1.20-2.52) or other racial/ethnic minority (1.48, 1.13-1.95), an enrollment period less than 10 years (1.28,1.00-1.62), more than four comorbidities compared to no comorbidities (1.76, 1.02-3.02), and fewer than five health care contacts in the six months after the medication was prescribed (1.31, 1.02-1.67). The copayment amount for office visits or medications was not associated with primary non-adherence. The c-statistic for the model containing demographic characteristics, comorbidities, and health care plan information was 0.63. Conclusions: A substantial number of individuals newly prescribed an antihypertensive medication exhibited early non-adherence. Our multivariate model had limited discrimination, indicating that further research is needed to better characterize these individuals and explore barriers to early adherence.

Exploring Older Adults’ Internalizations And Misconceptions Regarding Antihypertensive Medication Management

2021 ◽  
Vol 10 (1) ◽  
pp. 304-308
Author(s):  
Kenneth A. Blocker ◽  
Wendy A. Rogers
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Antihypertensive Medication ◽  
Medication Management ◽  
Illness Representation ◽  
Effective Management ◽  
Structured Interviews ◽  
Antihypertensive Medications ◽  
Hypertension Knowledge ◽  
Management Behaviors

Hypertension, or high blood pressure, is an asymptomatic cardiovascular condition common with increasing age that must be controlled with proper management behaviors, such as adherence to prescribed antihypertensive medications. Unfortunately, older adults may struggle with consistent and effective management of this medication specifically and the disease generally, which can lead to poorer health outcomes. The goal of the study was to investigate older adults’ antihypertensive medication management using the Illness Representation Model as a lens to identify potential misconceptions that may contribute to medication management. We conducted semi-structured interviews with 40 older adults regarding management routines, hypertension knowledge, perceived nonadherence contributors, and perspectives related to their illness. We identified numerous misconceptions regarding hypertension knowledge, disease severity, as well as perceived adherence performance that may contribute to challenges older adults face with maintaining antihypertensive medication adherence. Moreover, these findings inform the need for and design of effective educational tools for improving antihypertensive medication adherence.

Abstract 3016: Spirituality and Medication Adherence in Older African American Adults Diagnosed with Hypertension: A Qualitative Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lisa M Lewis
Keyword(s):  
African American ◽  
Medication Adherence ◽  
Qualitative Study ◽  
Antihypertensive Medication ◽  
Demographic Data ◽  
Patient Treatment ◽  
List Type ◽  
Medication Regimen ◽  
Antihypertensive Medications ◽  
The Mean

Background : Medication adherence (ADH) is key to decreasing hypertension (HTN)-related morbidity and mortality in older African-American (AA) adults. However, older AA adults have poorer ADH to prescribed antihypertensive medications when compared to their younger and Caucasian-American counterparts. Patient beliefs and cultural concepts about their medications influence their medication ADH. An important cultural concept in this regards is spirituality, which is a significant resource in the AA community. Thus, the purpose of this qualitative study was to explore the role of spirituality in ADH to antihypertensive medications for older AA adults. Methods: Older AA adults who were members of a Program of All Inclusive Care for the Elderly (PACE) and who were (a) diagnosed with HTN; (b) prescribed at least one antihypertensive medication; (c) self-identified as African-American or Black; and (d) self-identified as spiritual completed one in-depth individual face-to-face in this qualitative descriptive study informed by grounded theory. Demographic data were also collected. Results : Twenty-one PACE members completed the study. All of the participants were female. The mean age of participants was 73 years with most completing high school (67%). The mean HTN diagnosis was16.7 years and mean number of prescriptions for antihypertensives was 3.3. Participants indicated that their spirituality was used in a collaborative process with formal health care to manage their ADH to antihypertensive medications. This process was identified as Partnering with God to Manage My Medications. Partnering with God to Manage My Medications indicated that the PACE members acknowledged personal responsibility for adhering to their antihypertensive medication regimen but used their spirituality as a resource for making decisions to remain adherent; coping with medication side effects; and increasing their self-efficacy to deal with barriers to ADH . Conclusions : Spirituality played a positive role in medication adherence for the PACE members. Incorporating individual beliefs, such as spirituality, into patient treatment for HTN may capitalize on their inner resources for medication ADH and demonstrates culturally appropriate care.

scholarly journals The Association Between Medication Adherence for Chronic Conditions and Digital Health Activity Tracking: Retrospective Analysis

10.2196/11486 ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. e11486 ◽  
Author(s):  
Tom Quisel ◽  
Luca Foschini ◽  
Susan M Zbikowski ◽  
Jessie L Juusola
Keyword(s):  
Health Care ◽  
Medication Adherence ◽  
Health Outcomes ◽  
Fixed Effects ◽  
Digital Health ◽  
Positive Association ◽  
Activity Tracking ◽  
Pharmacy Claims ◽  
The Relationship ◽  
Age And Sex

Background Chronic diseases have a widespread impact on health outcomes and costs in the United States. Heart disease and diabetes are among the biggest cost burdens on the health care system. Adherence to medication is associated with better health outcomes and lower total health care costs for individuals with these conditions, but the relationship between medication adherence and health activity behavior has not been explored extensively. Objective The aim of this study was to examine the relationship between medication adherence and health behaviors among a large population of insured individuals with hypertension, diabetes, and dyslipidemia. Methods We conducted a retrospective analysis of health status, behaviors, and medication adherence from medical and pharmacy claims and health behavior data. Adherence was measured in terms of proportion of days covered (PDC), calculated from pharmacy claims using both a fixed and variable denominator methodology. Individuals were considered adherent if their PDC was at least 0.80. We used step counts, sleep, weight, and food log data that were transmitted through devices that individuals linked. We computed metrics on the frequency of tracking and the extent to which individuals engaged in each tracking activity. Finally, we used logistic regression to model the relationship between adherent status and the activity-tracking metrics, including age and sex as fixed effects. Results We identified 117,765 cases with diabetes, 317,340 with dyslipidemia, and 673,428 with hypertension between January 1, 2015 and June 1, 2016 in available data sources. Average fixed and variable PDC for all individuals ranged from 0.673 to 0.917 for diabetes, 0.756 to 0.921 for dyslipidemia, and 0.756 to 0.929 for hypertension. A subgroup of 8553 cases also had health behavior data (eg, activity-tracker data). On the basis of these data, individuals who tracked steps, sleep, weight, or diet were significantly more likely to be adherent to medication than those who did not track any activities in both the fixed methodology (odds ratio, OR 1.33, 95% CI 1.29-1.36) and variable methodology (OR 1.37, 95% CI 1.32-1.43), with age and sex as fixed effects. Furthermore, there was a positive association between frequency of activity tracking and medication adherence. In the logistic regression model, increasing the adjusted tracking ratio by 0.5 increased the fixed adherent status OR by a factor of 1.11 (95% CI 1.06-1.16). Finally, we found a positive association between number of steps and adherent status when controlling for age and sex. Conclusions Adopters of digital health activity trackers tend to be more adherent to hypertension, diabetes, and dyslipidemia medications, and adherence increases with tracking frequency. This suggests that there may be value in examining new ways to further promote medication adherence through programs that incentivize health tracking and leveraging insights derived from connected devices to improve health outcomes.

scholarly journals Antihypertensive Medication Adherence and Confirmation of True Refractory Hypertension

Hypertension ◽  
2020 ◽  
Vol 75 (2) ◽  
pp. 510-515 ◽  
Author(s):  
Mohammed Siddiqui ◽  
Eric K. Judd ◽  
Tanja Dudenbostel ◽  
Pankaj Gupta ◽  
Maciej Tomaszewski ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Treatment Failure ◽  
Receptor Antagonist ◽  
Mineralocorticoid Receptor ◽  
Antihypertensive Treatment ◽  
Antihypertensive Medication ◽  
Refractory Hypertension ◽  
Antihypertensive Medications ◽  
Mineralocorticoid Receptor Antagonist ◽  
Ambulatory Bp Monitoring

Refractory hypertension (RfHTN) is a phenotype of antihypertensive treatment failure defined as uncontrolled BP despite the use of effective doses of ≥5 antihypertensive medications including a long-acting thiazide-like diuretic (chlorthalidone) and a mineralocorticoid receptor antagonist. The degree of medication nonadherence is unknown among patients with RfHTN. In this prospective evaluation, 54 patients with apparent RfHTN were recruited from the University of Alabama at Birmingham Hypertension Clinic after having uncontrolled BP at 3 or more clinic visits. All patients’ BP was evaluated by automated office BP and 24-hour ambulatory BP monitoring (n=49). Antihypertensive medication adherence was determined by measuring 24-hour urine specimens for antihypertensive medications and their metabolites by high-performance liquid chromatography-tandem mass spectrometry (n=45). Of the 45 patients who completed 24-hour ambulatory BP monitoring, 40 (88.9%) had confirmed RfHTN based on an elevated automated office BP (≥130/80 mm Hg), mean 24-hour ABP (≥125/75 mm Hg), and mean awake (day-time) ABP (≥130/80 mm Hg). Out of the 40 fully evaluated patients with RfHTN, 16 (40.0%) were fully adherent with all prescribed medications. Eighteen (45.0%) patients were partially adherent and 6 (15.0%) had none of the prescribed agents detected in their urine. Of 18 patients who were partially adherent, 5 (12.5%) were adherent with at least 5 medications, including chlorthalidone and the mineralocorticoid receptor antagonist, consistent with true RfHTN. Of patients identified as having apparent RfHTN, 52.5% were adherent with at least 5 antihypertensive medications, including chlorthalidone and a mineralocorticoid receptor antagonist, confirming true RfTHN. These findings validate RfHTN as a rare, but true phenotype of antihypertensive treatment failure.

scholarly journals Impact of a Shared Medical Appointment on Hypertension Clinical Outcomes and Medication Adherence in a Veterans Affairs Health Care System

2017 ◽  
Vol 33 (5) ◽  
pp. 177-182 ◽  
Author(s):  
Cain Eric Kirk ◽  
Autumn N. Gordon ◽  
Kelly D. Mooney ◽  
Garrett B. Aikens ◽  
Michael H. Robinson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Health Care System ◽  
Antihypertensive Medications ◽  
Access And Quality ◽  
Improve Access ◽  
Care System

Background:Shared medical appointments (SMAs) are utilized across health care systems to improve access and quality of care, with limited evidence to support the use of SMAs to improve clinical outcomes and medication adherence among hypertensive patients. Objective: Improve access and quality of care provided within a Veterans Affairs health care system via implementation of a hypertension SMA to improve clinical outcomes and medication adherence. Methods: Veterans were eligible for enrollment in the SMA if they received care within the health care system, were aged ≥18 years, were receiving at least 2 antihypertensive medications, and had systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) >90 mm Hg. A pre/post cohort design was used to evaluate the improvement in antihypertensive medication adherence as well as the change in SBP and DBP for all Veterans who attended at least 2 SMAs. Results: Twenty-one Veterans participated in at least 2 SMAs and were included in the analysis; 76.2% had a reduction in SBP with an overall average decrease of −8.3 mm Hg ( P = .02). The proportion of Veterans considered to have controlled blood pressure (BP; <140/90 mm Hg) increased from 14.3% at baseline to 42.9% during the SMA period ( P = .03). There was no significant difference found for the proportion of Veterans considered adherent to their prescribed antihypertensive medications (95.2% vs 85.7%, respectively; P = .50). Conclusions: SBP significantly improved for patients enrolled in a pharmacist-led SMA at a VA health care system, and the proportion of patients considered to have controlled BP increased significantly.

scholarly journals Measuring adherence to antihypertensive medication using an objective test in older adults attending primary care: cross-sectional study

2021 ◽  
Author(s):  
James P. Sheppard ◽  
Ali Albasri ◽  
Pankaj Gupta ◽  
Prashanth Patel ◽  
Kamlesh Khunti ◽  
...  
Keyword(s):  
Primary Care ◽  
Medication Adherence ◽  
Urine Sample ◽  
Antihypertensive Medication ◽  
Cross Sectional Study ◽  
Urine Samples ◽  
Sample Collection ◽  
Antihypertensive Medications ◽  
Cross Sectional ◽  
Adherence To Medication

AbstractAnalysis of urine samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS) has previously revealed high rates of non-adherence to antihypertensive medication. It is unclear whether these rates represent those in the general population. This study aimed to investigate whether it is feasible to collect urine samples in a primary care setting and analyse them using LC-MS/MS to detect non-adherence to antihypertensive medication. This study used a prospective, observational cohort design. Consecutive patients were recruited opportunistically from five general practices in UK primary care. They were aged ≥65 years with hypertension and had at least one antihypertensive prescription. Participants were asked to provide a urine sample for analysis of medication adherence. Samples were sent to a laboratory via post and analysed using LC-MS/MS. Predictors of adherence to medication were explored with multivariable logistic regression. Of 349 consecutive patients approached for the study, 214 (61.3%) gave informed consent and 191 (54.7%) provided a valid urine sample for analysis. Participants were aged 76.2 ± 6.6 years and taking a median of 2 antihypertensive medications (IQR 1–3). A total of 27/191 participants (14.2%) reported not taking all of their medications on the day of urine sample collection. However, LC-MS/MS analysis of samples revealed only 4/27 (9/191 in total; 4.7%) were non-adherent to some of their medications. Patients prescribed more antihypertensive medications were less likely to be adherent (OR 0.24, 95%CI 0.09–0.65). Biochemical testing for antihypertensive medication adherence is feasible in routine primary care, although non-adherence to medication is generally low, and therefore widespread testing is not indicated.

Abstract P378: Current Progress of Antihypertensive Medication Use According to Healthy People 2020 Goals Among Adults With Hypertension- the National Health Interview Survey 2014-2015

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Jing Fang ◽  
Carma Ayala ◽  
Fleetwood Loustalot
Keyword(s):  
Health Care ◽  
National Health ◽  
National Health Interview Survey ◽  
Antihypertensive Medication ◽  
Medication Use ◽  
Healthy People ◽  
Antihypertensive Medications ◽  
Health Interview Survey ◽  
Interview Survey ◽  
Healthy People 2020

Background: Hypertension is a major risk factor for heart disease and stroke; yet only half of those with hypertension have it under control. One of the Healthy People 2020 goals is to increase the proportion of adults with hypertension who are taking antihypertensive medications to lower their blood pressure from a baseline of 63.2% to a target of 69.5% by 2020. The objective of this study was to examine progress towards meeting this national objective and to assess disparities mid-decade. Methods: Adult participants (≥18 years) with self-reported hypertension from the National Health Interview Survey in 2014 and 2015 were included in this study. Current antihypertensive medication use was assessed and age-standardized for analysis. Multivariable logistic regression models were used to determine the odds ratio of antihypertensive medication use, adjusting for age, sex, race/ethnicity, education and health care access status. Results: Among the 21,050 (26.7%) adults with self-reported hypertension, 69.2% reported current antihypertensive medication use and disparities were noted among subgroups. Adults with estimates of antihypertensive medication use that fell below the Healthy People 2020 goal (69.5%) included women, non-Hispanic whites, Hispanics, and those with access health care barriers (Table). Conclusion: To control hypertension, most patients require antihypertensive medications to achieve control. Understanding disparities in antihypertensive medication utilization is needed for all population to achieve Healthy People 2020 targets by the end of the decade.

scholarly journals Use of strategies to improve antihypertensive medication adherence within United States outpatient health care practices, DocStyles 2015-2016

2018 ◽  
Vol 20 (2) ◽  
pp. 225-232 ◽  
Author(s):  
Tiffany E. Chang ◽  
Matthew D. Ritchey ◽  
Carma Ayala ◽  
Jeffrey M. Durthaler ◽  
Fleetwood Loustalot
Keyword(s):  
United States ◽  
Health Care ◽  
Medication Adherence ◽  
Antihypertensive Medication ◽  
Health Care Practices ◽  
Care Practices

scholarly journals SEX DIFFERENCES BETWEEN ATTITUDES TOWARD MEDICATIONS AND POOR ANTIHYPERTENSIVE MEDICATION ADHERENCE IN ELDERLY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S260-S260
Author(s):  
Taylor Johnson ◽  
Erin Peacock ◽  
Julia Silver ◽  
James Marsh ◽  
Richard Petty ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Antihypertensive Medication ◽  
Implicit Attitudes ◽  
Pressure Control ◽  
Ordinary Least Squares ◽  
Antihypertensive Medications ◽  
Explicit Attitudes ◽  
Positive Attitudes ◽  
Attitudinal Ambivalence ◽  
Adherence Scale

Abstract Despite its importance for blood pressure control, antihypertensive medication adherence remains a challenge in older adults. Explicit and implicit attitudinal ambivalence toward medications (holding both positive and negative explicit attitudes, and discrepant explicit and implicit attitudes, respectively) may underlie low adherence. We examined whether race, age, or sex affect the associations between attitudes, ambivalence, and adherence. A questionnaire and implicit association test captured medication attitudes from hypertensive adults aged ≥55 (n=199). Adherence was measured with the Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4). Higher scores on the attitudes and adherence scales indicate more positive attitudes and worse adherence, respectively. Associations and effect modification by sex, race (white vs. nonwhite), and age (&lt;65 vs. ≥65) were tested in separate ordinary least squares regressions. The sample was 51.0% female, 43.7% nonwhite, 35.5% aged ≥65, with mean K-Wood-MAS-4 0.64 (SD=0.88). Better adherence was associated with more positive net explicit attitudes (β=-0.18, 95% CI -0.30, -0.06, p=0.003), and worse adherence with higher explicit ambivalence (β=-0.05, 95% CI 0.01, 0.09, p=0.028). The associations with explicit attitudes and explicit ambivalence were significant for men (β=-0.30, 95% CI -0.48, -0.11, p=0.002 and β=0.09, 95% CI 0.03, 0.15, p=0.005, respectively) but not for women (β=-0.07, 95% CI -0.423, 0.09, p=0.378 and β=-0.00, 95% CI -0.06, 0.05, p=0.982, respectively) (p-values for interaction=0.062 and 0.031, respectively). No race or age differences were identified. Adherence was not associated with implicit attitudes or implicit ambivalence. In conclusion, explicit attitudes and explicit attitudinal ambivalence may underlie low adherence to antihypertensive medications, particularly for older men.

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