Patient Compliance with Antihypertensive Medication

Modern medical advancements have significantly decreased the prevalence and severity of infectious disease as well as the treatment of acute, traumatic conditions. Pharmacological research has also gained insight into the management of chronic disease. Still, there is an epidemic of chronic, treatable diseases like stroke, heart disease, and kidney disease. Hypertension proves to be the underlying factor associated with these diseases. Hypertension is often referred to as the silent killer because of its indication in deadly disease, and the importance of monitoring ones blood pressure is vital. Lifestyle, diet, and genetic predisposition are all factors of high blood pressure. Chronic high blood pressure above safe levels, known as hypertension, puts elevated physical stress on the renal and cardiovascular systems. By controlling this factor in patients, healthcare providers can decrease cardiovascular events, improve health outcomes, and decrease overall mortality. Patient education is often overlooked in its role in the control and prevention of high blood pressure. This paper analyzes the causes and physiology behind high blood pressure as they relate to the current nursing interventions. The role of nurses is discussed in relation to patient education regarding high blood pressure, and educational approaches are analyzed.

* The U.S. High Blood Pressure Education Program is a public-private cooperative effort formed to help reduce death and disability related to hypertension, which is at the root of 50% of those suffering heart attacks and two-thirds of those suffering strokes. Using a campaign that integrates social marketing to first build awareness of the “silent killer,” and then encourage action, awareness of the problem more than tripled to over 90% and those seeking treatment more than doubled within a single decade.

Patient Adherence: There is no known cure for chronic disease, the progressive nature of chronic disease the patient and family must adjust to continual treatment changes, and the chronic disease continues throughout the patient’s lifetime developmental and lifestyle changes often influence or pose additional challenges to the person with a chronic

The concern on whether anti-hypertensive’s should be withheld in patients who are hypertensive has been debatable in the recent past. Generally, the treatment of hypertension among hospitalized patients is basically an opportunity to enhance the recognition and treatment of blood pressure (Axon, Nietert & Egan, 2011, p.246). This is mainly because hypertension is a basic risk factor for heart diseases, stroke, and death whose impact is widespread to nearly 70 million adults in America. There have been numerous educational initiatives and publication of treatment processes to address this condition in the past few decades. Despite these measures, nearly 39 million Americans are at risk of hypertension because they have not reached their desired or optimal blood pressure.

Ross, S., Walker, A., & MacLeod, M. J. (2004). Patient compliance in hypertension: Role of illness perceptions and treatment beliefs. Journal of Human Hypertension, 18(9), 607-613. Retrieved from http://dx.doi.org/10.1038/sj.jhh.1001721

Hypertension (HTN) is a chronic illness that serves as a main risk factor for cardiovascular disease (Hanus, Simoes, Amboni, Ceretta, & Tuon, 2015). Although medication can manage HTN appropriately, lifestyle modifications make a substantial difference as well. However, many patients go through behavior stages in which he or she contemplate on making the necessary changes to improve their health. One solution to the problem is the development of an educational Hypertension Intervention and Follow-Up program (HIFP). Studies have shown that active educational interventions that incorporate small groups are more effective than passive delivery of educational materials (Pimenta, Caldiera, & Mamede,

I have chosen the research topic of medication non-compliance, specifically regarding high blood pressure medication. I see patients very often at my job who do not take their medication because they say they feel fine or they forgot. I do teach my patients that they need to take their medication every day and suggest to take it at the same time as something they already do daily such as eating breakfast but my words seem to fall on deaf ears. Some patients don’t like the way the medication makes them feel so they just stop taking it instead of going back to their doctor. I believe that more visual aids in teaching such as videos that show what is happening inside your body when your pressure is high in addition to meeting stroke patients

Some of the factors that patients do not adhere to when their healthcare provider tells them too is due to patients being too busy. Often times life is very busy as we all know this but forgetting to take of yourself can have detrimental effects to your health. Some people think they can get better on their own without the help of a doctor so they feel like they will be fine or able to handle any health complication on their own. Another reason is that often people do not understand or they forget what the doctor is telling them about their prescribed treatment regimens and other patients decide to simply not follow it. As stated in the article by Sklar, Min Sen Oh & & Chuen Li, 2008 “Poor communication with healthcare providers was also likely to cause a negative effect on patient’s compliance (Bartlett et al 1984; Apter et al 1998)”. Miscommunication between a doctor and patient is at the root of most adherence problems. Often times patients leave their doctors office not knowing or having the slightest clue to what they should be doing. Instead of asking for help or clarity they just leave. Communication needs to be clear and effective for both the patient and the doctor. Non-adherence is wide spread when it comes to patients not adhering to what professionals tell them. Many patients will have significant risks because they forget,

According to JNC 8 guidelines, close monitoring is essential when patients start on new hypertensive medication. Therefore, Mr. Hightower will require frequent visits to the clinic to ensure improvement in his health condition. His blood pressure will be monitored at each visit and blood work will be done to monitor his kidney and liver functions and to determine his adherence to treatment. In case of noncompliance, a third category of antihypertensive must be added to improve hypertension outcomes and prevent cardiovascular disease.

Counselor met with Pt. for an individual session. Counselor and Pt. discussed her progress in treatment and description of her medication compliance. Pt. reported wanting a higher dosage of methadone to side effects (cold). Pt. mentioned that she would like to switch to Vivitrol medication because she is going to move with her mother house in Lewes, DE and she cant come to the clinic everyday. Pt. requested, discussed and completed an AMS Modality Switch form. Counselor encouraged Pt. to talk about her current triggers and possible solutions she can plan ahead of time. Pt. stated, "I have no triggers." Counselor elicited the client’s perceptions on her several positive urine analysis. Pt. indicated that she use crack cocaine when she is depressed.

Another topic that is underlined throughout the book was Andie’s non-adherence to her insulin shot and other medications. Throughout the book, Andie has demonstrated many incidences of non-adherence. Andie does not use her needles properly and has intentionally miss insulin shots to lose weight. The reason behind her behavior can be explained by the “Health Belief Model” in the Adherence and Behavior section of PHRM 826 Patient Centered Care. For patients to take action, they need to have high perceived threat from not taking the action. Threat is influenced by severity of non-adherence and susceptibility of those severities. For Andie, she definitely has high perceived severity from knowledge of possible complications of diabetes from

Non-compliance to prescribed antidiabetic drug treatment has health consequences on both an individual population as well on the general

Multimodal interventions focusing on multiple barriers of medication adherence have mostly shown improvements in medication adherence and reduced health care utilization. For instance, the Ashville projects that combined expanded medication therapy management (MTM) and disease management services, showed improved clinical outcomes and reduced overall costs in studies targeting commercially insured patients with diabetes, hypertension/dyslipidemia, or asthma.40-42 Similarly, Pringle and colleagues evaluated the impact of a large-scale, pharmacy-based intervention on five chronic medication classes and found that, compared to the control group, the intervention group had improved adherence for all medication classes.43 Zillich and colleagues

The provision of written medication information given to the patient helps significantly in cases of medication non compliance (McGraw & Drennan 2004). This is because it aids in memory retention and presents patients with access to a reliable source of concise medication information, particularly if the patient needs to be reminded of certain aspects (Gorgos 2006). These written medication information sheets need to be provided in the patients primary, dominant language because it reduces the difficulty and limits barriers to patient understanding (Gorgos 2006).This is important because this intervention aims to increase a patient’s understanding of their medications, and when a patient feels more competent with the use of their medications, reduced

First goal: Patient will verbalize understanding of the importance of follow her heart medication regime as doctor prescribed it and describe the possible consequence of a non-compliance with her treatment by the end of her today’s appointment.