Patient and Physician Adherence in Hypertension Management

Topic: Risk, prevention and care in population studies

The authors observed that “Our findings showed that nurses provided chronic disease management that was acceptable, feasible and sustainable.” Allen and colleagues46 reported results from a randomized, controlled trial evaluating the effectiveness of “a comprehensive program of cardiovascular disease risk reduction delivered by nurse practitioner/community health worker (NP/CHW) teams vs enhanced usual care (EUC)” to improve control of various parameters including BP. The NP/CHW intervention included “aggressive pharmacological management and tailored educational and behavioral counseling for lifestyle modification and problem-solving to address barriers to adherence and control.” Compared with EUC, patients in the NP/CHW group had significantly greater 12-month improvement in BP. The author noted that “A pilot study recruiting patients with diabetes or hypertension, diseases with clear and objective outcome measures, would be useful to examine true costs, savings, and health outcomes of such a reward program.” In contrast to the traditional principle that all services must cost the same for all patients, ie, all patients pay the same out-of-pocket costs for health care services whose benefits are nonetheless dependent on individual patient characteristics, value-based insurance design (VBID) “encourages the use of services when the clinical benefits exceed the cost and likewise discourages the use of services when the benefits do not justify the cost,” thus leading to a high-value health system.63 Farley and colleagues64 examined whether participation in a population-based VBID program was associated with improved medication adherence to various drugs for several indications including hypertension 2 years after implementation. VBID was associated with improved medication adherence, with changes being most notable among patients who were less adherent before VBID implementation. Using year 2006 US dollars, the author noted that the “overall prevalence of hypertension was estimated at 19.7%, with 36% of identified patients treated inappropriately. Overall, 95.0% of physicians felt that patients' systolic BP values needed to be higher than the guideline-recommended goal levels before taking immediate action: the respective figure for diastolic BP was 90.1%. The authors surmised that “Clinical hesitation in relation to reducing elevated BP to goal levels is putting patients at increased cardiovascular risk and contributing to the substantial health and econom

@article{turner2013-23815530,
  author  = {Turner, J. Rick},
  title   = {{Patient and Physician Adherence in Hypertension Management}},
  journal = {Journal of Clinical Hypertension},
  year    = {2013},
  doi     = {10.1111/jch.12105},
  pmid    = {23815530},
  url     = {https://doi.org/10.1111/jch.12105}
}

Key findings

• The authors observed that “Our findings showed that nurses provided chronic disease management that was acceptable, feasible and sustainable.” Allen and colleagues46 reported results from a randomized, controlled trial evaluating the effectiveness of “a comprehensive program of cardiovascular disease risk reduction delivered by nurse practitioner/community health worker (NP/CHW) teams vs enhanced usual care (EUC)” to improve control of various parameters including BP.
• The NP/CHW intervention included “aggressive pharmacological management and tailored educational and behavioral counseling for lifestyle modification and problem-solving to address barriers to adherence and control.” Compared with EUC, patients in the NP/CHW group had significantly greater 12-month improvement in BP.
• The author noted that “A pilot study recruiting patients with diabetes or hypertension, diseases with clear and objective outcome measures, would be useful to examine true costs, savings, and health outcomes of such a reward program.” In contrast to the traditional principle that all services must cost the same for all patients, ie, all patients pay the same out-of-pocket costs for health care services whose benefits are nonetheless dependent on individual patient characteristics, value-based insurance design (VBID) “encourages the use of services when the clinical benefits exceed the cost and likewise discourages the use of services when the benefits do not justify the cost,” thus leading to a high-value health system.63 Farley and colleagues64 examined whether participation in a population-based VBID program was associated with improved medication adherence to various drugs for several indications including hypertension 2 years after implementation.
• VBID was associated with improved medication adherence, with changes being most notable among patients who were less adherent before VBID implementation.
• Using year 2006 US dollars, the author noted that the “overall prevalence of hypertension was estimated at 19.7%, with 36% of identified patients treated inappropriately.

Why it matters

This article discusses patient and physician adherence in hypertension management, including nurse-led programs that improved blood pressure control. It does not address treating, curing, or preventing Alzheimer's disease.

Study details

• Study designrandomized controlled trial
• Effect size19.7%; 95.0%; 90.1%
• Evidence strengthHigh

Read the original

• DOI: 10.1111/jch.12105
• PubMed: 23815530
• Original source →
• Free full text: PubMed Central →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

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