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Personalized interventions improve BP medication adherence
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Automated, personalized text and voice message interventions were feasible ways to improve adherence to hypertension medications as an adjunct to primary care, according to findings recently published in BMJ Open.
A second study, appearing in PLoS One, found that patient-physician communication that involves interpersonal components had the potential to change medication overuse beliefs among older adults with hypertension.
Data suggest such interventions may be needed: the CDC indicates one in three Americans has high BP, and related costs are $48.6 billion each year. In addition, previous research has suggested 41% of these patients do not properly follow their medication regimen.
Technological approach
In the first article, researchers developed tailored 1-month long digital interventions based on a combination of the patient’s beliefs about medications, self-efficacy, social norms and his or her prescription plan. Each of the 17 participants — all older adults with high BP or comorbidities who said they took a mean of six medications daily — controlled the frequency of the messages or could opt out completely.
“Patients reported that the intervention content increased awareness about the necessity to take and maintain adherence to medication, reinforced social support and habit formation, and reminded them to take medication as prescribed,” Aikaterini Kassavou, PhD, of the public health and primary care department at the University of Cambridge in England and colleagues wrote.
The intervention is currently under evaluation in a randomized controlled trial, they added.
Verbal approach
In the second study, Song Hee Hong, PhD, MS, MA, of the College of Pharmacy at Seoul National University in Korea reviewed survey responses from 211 older adults with hypertension living in Korea relevant to the Primary Care Assessment Survey, which measured informative and interpersonal physician communication, and the Beliefs about Medicines Questionnaire, which measured medication harm and beliefs regarding medication overuse.
Hong found interpersonal patient-physician communication significantly explained the medication overuse beliefs (ß = –0.28, P = 0.05), but neither interpersonal nor informative communication significantly explained the medication harm beliefs.
“The finding that patient-physician communication has the potential to change patients’ medication beliefs could have important implications with respect to improving their drug-taking behaviors,” Hong wrote. “Patient-physician communication, when tailored to the needs of individual patients, helps them form favorable medication beliefs and show better medication-taking behaviors. – by Janel Miller
Reference: CDC.gov. “High blood pressure in the United States.” https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm. Accessed Feb. 20, 2019.
Disclosures: Healio Primary Care Today was unable to determine Hong’s relevant financial disclosures prior to publication. Kassavou and colleagues report no relevant financial disclosures.
Perspective
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Nancy Sobecks, MD
Effective treatment of any chronic illness like hypertension is dependent on medication adherence. Both articles highlight different methodologies that can improve that adherence — one through technology and one through communication.
The study in BMJ Open explored how leveraging technology can impact the behavior of patients via text and voice messages to remind patients to take their medication and found this method to be effective in this small sample of participants.
However, there were some limitations in that the investigators had trouble in recruiting nonadherent patients and limitations on the health care provider’s time to be able to explain the intervention. Time constraints are a common issue for busy primary care providers. The implementation of new interventions like the use of technology may be best if there is technology support behind the initiative, and physicians must be given enough time to effectively communicate the intervention to patients. The authors indicate that the intervention has been extended from 1 month to 3 months and will include an additional level of tailoring. The authors are evaluating the intervention in a randomized controlled trial, which includes looking at overall outcomes. I look forward to seeing those results.
The other study, which appeared in PLOS One, also focused on patients with hypertension, but this time looked at the effects of the physician-patient relationship on patients’ beliefs about medications. The study found that stronger physician-patient communication decreased the patient’s belief of medication overuse. In contrast, informative communication did not change a patient’s view about medication harms. This study highlights the importance of taking the time to listen to the patient and developing trust, getting to know patients’ concerns and engaging them to play an active role in their health care, thus empowering them to follow treatment recommendations. This study confirms the importance of the relationship over straight facts.
patient experience officer,
Cleveland Clinic
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