Non-compliance to medication is a major barrier to the treatment of hypertension. A research study conducted by G Georgiopoulos and others found that nursing intervention increases compliance. In this research study, home visits and telephonic conversations with patients were found effective for the reduction of hypertension.
Full Answer
Does nursing intervention improve treatment adherence in hypertensive patients?
The majority of studies reported beneficial effect of nursing intervention on treatment adherence in hypertensive patients. Telephone contacts and home visits were found to be the most effective educational approaches.
Is drug adherence a major issue in hypertension management?
In the absence of new antihypertensive drugs, it is important that healthcare providers focus their attention on how to do better with the drugs they have. This is the reason why recent guidelines have emphasize the important need to address drug adherence as a major issue in hypertension management.
How can patient-health care professionals optimize patient adherence to medication?
Patient-health care professional, especially patient-physician or patient-pharmacist communication is central to optimizing patient adherence.50 Methods to measure adherence Various methods have been reported and are in use to measure adherence.
What is the best textbook for hypertension management in nursing?
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 31: Assessment and Management of Patients With Hypertension, Hypertension, p. 885.
What is the best way to get a patient to adhere to a care regimen?
Nine Tips for Improving Medication AdherenceEducate patients about what to expect. ... Nurture relationships with patients. ... Team up with prescribers. ... Engage the staff. ... Learn about and use available technologies. ... Help patients customize their support tools. ... Schedule appointments. ... Synchronize medications.More items...•
What factors would help to increase adherence in hypertensive patients?
Knowledge of hypertension significantly affected adherence in our study sample. Patients who were aware of the association between certain risk factors for hypertension, such as high salt intake, stress and a positive family history, had better adherence compared to those who with poorer knowledge.
How can nurses help patients with hypertension?
The nurse can help the patient achieve blood pressure control through education about managing blood pressure. Assist the patient in setting goal blood pressures. Provide assistance with social support.
What can the nurse do to maximize a patient's adherence to the medication regimen?
The following are ten strategies that providers can use to boost medication compliance.Understand each patient's medication-taking behaviors. ... Talk about side effects. ... Write it down. ... Collaborate with patients. ... Consider the financial burden to the patient. ... Assess health literacy. ... Reduce complexity. ... Follow up with patients.More items...•
Why is medication adherence important?
Taking your medicine as prescribed or medication adherence is important for controlling chronic conditions, treating temporary conditions, and overall long-term health and well-being. A personal connection with your health-care provider or pharmacist is an important part of medication adherence.
What is the most common reason for treatment failure of hypertension?
A frequent cause of failure to control blood pressure is the use of inappropriately low dosages of antihypertensive drugs.
What are the responsibilities of nurses in giving anti hypertensive medications?
Monitor patient response to therapy through blood pressure monitoring. Monitor for adverse effects (e.g. skin reactions, cough, headache, etc.) Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for. Monitor patient compliance to drug therapy.
What can you teach a patient with hypertension?
Lifestyle changes to help manage hypertension include losing weight, eating a healthy, low-sodium diet, exercising more, stopping smoking, and limiting alcohol.
What are some safety considerations for hypertension?
Prevent High Blood PressureEat a Healthy Diet. Choose healthy meal and snack options to help you avoid high blood pressure and its complications. ... Keep Yourself at a Healthy Weight. ... Be Physically Active. ... Do Not Smoke. ... Limit How Much Alcohol You Drink. ... Get Enough Sleep. ... References.
Which nursing intervention would the nurse expect to do during implementation?
Which nursing intervention would the nurse expect to do during implementation? Providing client teaching about a drug therapy regimen. Implementation involves planning client care and intervention. Providing client teaching would be a part of implementation.
How can you help the patients in their medication adherence thru patient counseling?
Medication education and patient counseling have shown promise as a strategy for improving patient adherence. Behavioral interventions and counseling that actively engage the patient in his or her own healthcare should be used by pharmacists when attempting to improve patients' medication knowledge and adherence.
Why is non-adherence important?
Non-adherence to medication has been shown to be an important barrier to achieving adequate blood pressure control and nurse interventions can substantially improve therapeutic compliance.
Why is it so difficult to identify specific factors that affect behavioral change in the setting of a successful intervention?
Identifying specific factors that affect behavioral change in the setting of a successful intervention was difficult due to high heterogeneity among studies regarding materials and methods. Nursing interventions were shown to alleviate non-adherence to medication in patients with hypertension.
Is hypertension a risk factor for cardiovascular events?
Purpose of review: Hypertension consist s a major risk factor for cardiovascular events. Despite the proven effectiveness of antihypertensive treatment, approximately half of hypertensive patients have inadequate blood pressure control. Non-adherence to medication has been shown to be an important barrier to achieving adequate blood pressure control ...
How to improve patient compliance with antihypertensive medication?
The most effective strategy to improve patient compliance with antihypertensive medication is to simplify the dosing regimen. There is more limited evidence to support a variety of motivational strategies. Patient education alone is ineffective.
How much does high blood pressure reduce the risk of stroke?
Treatment of high blood pressure with medication can reduce the risk of stroke by 31 to 45 percent, and myocardial infarction by 8 to 23 percent. 2, 3 Despite this benefit, control of hypertension in the ambulatory setting is suboptimal. Adherence to treatment regimens for high blood pressure is estimated to be between 50 and 70 percent. 4.
Should you take all medications at the same time?
If the patient is taking other medications, consider recommending that all be taken at the same time of day. Medications with special requirements (e.g., bedtime dosing, avoiding meals) should be used only if alternatives are unavailable or atypical circumstances exist.
Does simplification improve adherence?
No study found an improvement in diastolic blood pressure with improved adherence.
What are the barriers to adherence to medication?
Complex regimens with multiple medications, especially when paired with multiple daily doses, are long-recognized as barriers to adherence. 6, 7, 11, 18 Alternatively, fewer medications, and especially fewer pills, which can be implemented using once daily single-pill combinations are consistently associated with better adherence and hypertension control. 45, 46 Patients who reach therapeutic targets more rapidly, who require fewer adjustments in their medication regimen, and who experience no or limited adverse effects are more likely to adhere than patients with a longer period to control, who often undergo multiple changes to their medication regimens, and experience adverse effects, are less likely to adhere to treatment. 6, 7, 11, 18 Long-term chronic diseases, such as hypertension, are often associated with progressive declines in persistence on treatment with the passage of months and years. 47, 48
What are the factors that contribute to the poor control of blood pressure?
The global epidemic of hypertension is largely uncontrolled and hypertension remains the leading cause of noncommunicable disease deaths worldwide. Suboptimal adherence, which includes failure to initiate pharmacotherapy, to take medications as often as prescribed, and to persist on therapy long-term, is a well-recognized factor contributing to the poor control of blood pressure in hypertension. Several categories of factors including demographic, socioeconomic, concomitant medical-behavioral conditions, therapy-related, healthcare team and system-related factors, and patient factors are associated with nonadherence. Understanding the categories of factors contributing to nonadherence is useful in managing nonadherence. In patients at high risk for major adverse cardiovascular outcomes, electronic and biochemical monitoring are useful for detecting nonadherence and for improving adherence. Increasing the availability and affordability of these more precise measures of adherence represent a future opportunity to realize more of the proven benefits of evidence-based medications. In the absence of new antihypertensive drugs, it is important that healthcare providers focus their attention on how to do better with the drugs they have. This is the reason why recent guidelines have emphasize the important need to address drug adherence as a major issue in hypertension management.
What is an example of a common misunderstanding that adversely affects adherence?
One example of a common misunderstanding that adversely affects adherence is the term hypertension, which connotes too many patients that stress or behavioral issues are the root cause of the elevated BP. 58 In fact, patients with this perception of hypertension are less likely to take antihypertensive medications.
Why is BP control important for dementia?
Because BP control plays a role in the prevention of cognitive dysfunction and dementia, 134 a good adherence to antihypertensive should be favorable. Studies have demonstrated that it is possible to improve drug adherence in patients with cognitive dysfunction or dementia, but none has really demonstrate a clear impact on the reduction of health outcomes. 135
When was the first electronic medication monitoring system developed?
The first electronic monitoring system for medication adherence, known as the Medication Event Monitoring System (MEMS), was developed in 1977 . Its principle consisted in the incorporation of a microcircuit into medication packages such as any removal of a dose of the drug is detected in real time, time stamped, analyzed, stored, and communicated. Today, >750 articles involving over 1 million trial subjects have been published in peer-reviewed journals with this technique but its implementation in clinical practice remains limited to expert centers. The availability of dosing histories has repeatedly demonstrated that in ambulatory care, drug intake is characterized by a high irregularity with a wide spectrum of deviations from the prescribed regimen leading in general to an underdosing because of missed or delayed doses. 72 Interestingly, these observations were made across all therapeutic areas including chronic diseases, such as hypertension or dyslipidemia, but also life-threatening conditions, such as HIV, 73 organ transplantation, 74 or cancer chemotherapy. 75 Poor adherence or nonadherence was even reported in large clinical trials confounding sometimes the interpretation of the study results. 76–78 One general criticism to the electronic monitoring systems is the possibility that the system is activated while opening the pillbox but the dose is not taken. This is indeed the case, but when analyzing the data, the critical features are the nonopenings rather than the openings. In this respect, the system is analog to the determination of drug levels where the total absence of a compound is more relevant in terms of nonadherence than the actual presence of the drug. Moreover, studies comparing the MEMS data and the drug concentrations have shown that there is 97% accuracy between the 2 methods suggesting that when the pillbox is opened drugs are indeed taken. 79 Yet, in contrast to drug measurements, which are punctual, electronic monitoring systems provide additional information on drug-taking behaviors (taking, timing, frequency of omissions, compensatory intakes) based on the dosing history. Therefore, despite its limitation, electronic monitoring is one the most reliable technique to diagnose poor adherence and to follow and support adherence in chronic treatments. Several investigators have used the MEMS system to investigate the prevalence of poor adherence in hypertension. 80–82 Interestingly, in contrast to the general physicians’ perception, drug adherence was often found to be high (>90% adherence) although with a great variability and rather weak correlations between the level of adherence and that of BP. 83, 84 The main explanation for this apparent discrepancy between the perceived adherence and the measured adherence may be the measurement bias, as adherence tend to improve as soon as it is measured. The absence of strong correlation may also be because of the fact that high BP values can be found in nonadherent as well as in adherent patients if these latter are insufficiently treated. The measurement bias is particularly strong when the monitoring is of short duration and it tends to disappear over time.
Why are questionnaires used in clinical research?
Questionnaires have been developed to improve and structure self-reports. They are rarely used in everyday clinical practice mainly because they are time consuming . Nonetheless, questionnaires represent a good choice in clinical research, a context in which forms can be filled in by the patients themselves or by trained nurses or other healthcare professionals. Today, Nguyen et al 69 have identified >40 English-written adherence questionnaires, the most well-known being undoubtedly the Morisky questionnaire. 70 In general, questionnaires tend to overestimate true adherence and when compared with methods providing a complete dosing history, the correlation is rather low (well below 0.5) even for the Morisky questionnaire, although adherence determined by questionnaires tend to correlate with BP control. Yet, questionnaires are useful as a complement to more objective measures as they may provide additional information on the reasons why patients do not adhere or on the barriers encountered by patients during their medication-taking process. 69
Is LVH a stepped care?
Incident LVH by electrocardiography did not occur in either black or white adults with hypertension during the 5 years of stepped-care therapy in the Hypertension Detection and Follow-Up Study. However, in the 7 years of follow after completing stepped-care therapy, LVH was a relatively common occurrence, especially among black adults. 121 The authors noted specifically that adherence to antihypertensive medications declined substantially among black men during the follow-up period and viewed that fact as contributing to incident LVH. In another report, LVH by electrocardiography was significantly associated with poor adherence to antihypertensive medications before stroke among patients that suffered an acute stroke. 122
What is medication adherence?
Medication adherence is defined by the World Health Organization as "the degree to which the person’s behavior corresponds with the agreed recommendations from a health care provider.". 1Though the terms adherence and compliance are synonymously used adherence differs from compliance.
What is non adherence?
A second type of non adherence is called non persistence in which patients decide to stop taking a medication after starting it, without being advised by a health professional to do so . Non persistence is rarely intentional and happens when patients and providers miscommunication about therapeutic plans.
What are the disadvantages of the adherence method?
The disadvantage with this method is that the measure of adherence is not accurate as the patients may open the container and not take the medication, take the wrong amount of medication or take multiple doses out of the container at the same time ( or place multiple doses in another container). Conclusion.
What is the primary determinant of treatment success?
Adherence to therapies is a primary determinant of treatment success. Failure to adherence is a serious problem which not only affects the patient but also the health care system. Medication non adherence in patients leads to substantial worsening of disease, death and increased health care costs. A variety of factors are likely to affect adherence.
Can medication adherence be improved?
A single method cannot improve medication adherence, instead a combination of various adherence techniques should be implemented to improve patient’s adherence to their prescribed treatment. A systematic approach that could be instituted in improving medication adherence is as follows: 1) Level of prescribing:
Does nonadherence to medication varies between patients?
It has also been observed that patient non adherence varies between and within individuals, as well as across time, recommended behaviors and diseases.32Adherence to drug therapy varies with patient age group also. In children, adherence to drug therapy is affected due to their dependence on an adult care giver.
Does complexity affect medication adherence?
Complexity of drug regimen is found to negatively affect medication adherence. Modification will have to be made to medication regimens to reduce the frequency of administration, and/or reduce the number of different medications, and if applicable, to replace with combination products.
Can a nurse read blood pressure?
A. The nurse obtains a blood pressure reading from a patient who is being treated with lifestyle modifications and drug therapy for stage 1 hypertension.
Does furosemide lower blood pressure?
Furosemide increases the blood flow to the kidneys so the normal renin-angiotensin cycle is optimized and blood pressure is lowered. C. The nurse is caring for a patient who is receiving furosemide (Lasix) for treatment of hypertension.