Medication Adherence in Hypertension | Lark Health

Medication Adherence in Hypertension


Estimates vary from 20 to 80%, but what is clear is that many hypertensive patients are non-compliant. Consequences include a higher risk of stroke, coronary heart failure, dementia, reduced renal function, and blindness.

  • Hypertension is largely asymptomatic, so motivation to adhere can be lower because medications do not make patients feel better.

  • The biggest cause of uncontrolled hypertension is non-adherence.

  • Low understanding of hypertension and its risks may contribute to non-adherence.

  • Hypertension drugs can be complicated to take.

 

 How to Improve Medication Adherence in Hypertensive Patients


Improving medication adherence could potentially save lives, reduce healthcare costs, and improve healthcare outcomes. There are several strategies for improving medication adherence, and patients, healthcare providers, and manufacturers can all be involved.


Reducing Forgetfulness

Forgetting to take medications can be a barrier to adherence for patients who intend to take their medication as prescribed. These are some CDC medication adherence strategies that could be effective at improving medication adherence among patients who fill their prescriptions, but do not always remember to take the proper dose at the right time.

  • Pillboxes allow patients to set out their pills for the day or week ahead so they can see which ones they have taken and still need to take.

  • Blister packs make it easier for patients to see whether they have already taken their medication.

  • Electronic pill monitors can not only remind patients when to take their medication, but can also notify healthcare providers if the patient misses a dose.


Increasing Access to Medications

Cost is a significant barrier to medication adherence. Reducing or eliminating co-pays for prescription drugs, especially common ones with big payoffs such as statins, could potentially increase patient adherence. The move could pay for itself because of cost savings from fewer hospitalizations and adverse events. Offering generics is another way to limit costs.

Another way to increase access to medications is to implement delivery methods that are easier for patients. Free delivery of medications from the healthcare provider or pharmacy is one example. Pharmacists can also automatically prepare refills and notify patients via phone calls or text messages that they can pick up their prescriptions at any time. This eliminates barriers such as remembering to call in the refill order, and waiting for a long time at the pharmacy for the order to be filled.


Improving Motivation

Patients who can see the effects of their medications, such as when they have less pain as the result of taking prescription analgesics, may be more adherent than patients who do not feel immediate benefits. This can happen when managing chronic conditions, such as high blood pressure or cholesterol.

Frequent self-monitoring is one way to try to improve motivation. In conditions such as diabetes or hypertension, patients who regularly measure their blood sugar or blood pressure may not feel any symptoms of their condition. However, they may notice that their numbers are lower when they follow their drug regimen properly, and therefore be more motivated to be adherent.


Patient Education and Support

An article in the “Annals of Internal Medicine” explores potential solutions for medication non-adherence. Case management is an approach to patient support can increase medication adherence. It can include:

  • Identifying patients who at risk for non-adherence for reasons such as polypharmacy or lack of reaching treatment goals.

  • Assessing each medication for necessity and safety.

  • Working with the patient to identify and address each barrier to adherence.


There are more ways to support patients. Explanations from pharmacists and clear labels can make it easier for patients to understand how to take their medications properly once they get them. Prescribing fixed-dose medications, or two-in-one pills, when possible reduces the number of pills the patient needs to take. It can actually reduce patient non-compliance by almost one-quarter.

 

Medication Adherence Program for Hypertension


Medication adherence interventions can address many of the barriers to non-adherence. They can include care coordination between doctors and pharmacists to target and assist patients who have trouble following their regimens. They can assist patients in obtaining the lowest-possible cost medications. And all of this can be coordinated by Lark.

There are some limitations to traditional medication adherence programs.

  • They can be costly due to the live human interaction and cost of paying pharmacists and doctors or nurses for extra time.

  • Not all members of the patient support team can be available 24/7. What happens if the patient needs a nudge on the weekend or evenings?

  • The patient may feel some embarrassment at asking for help or admitting that a dose has been missed.

 

Apps & Tools for Medication Adherence


There are abundant medication adherence tools that can improve adherence rates among patients, but Lark stands out for it's effectiveness and "whole person" approach to care. Some other innovative strategies are:

  • Automatically sending pre-sorted pills to patients every week or two.

  • Automatically detecting a patient’s pill ingestion via an ingestible sensor.

  • Learning patients’ habits through digital interactions.

  • Using wearables that easily allow for patients to record when they take their medications.

  • Medication adherence apps show promise as low-cost, effective solutions that are easy for patients to use. Features can include:

  • Reminders to take medications and order refills.

  • Tracking dose history.

  • Notifications for caregivers or providers if users do not login to the app.

 

The Lark Hypertension health coach can assist with adherence to the medication regimen in a number of ways.


  • Connecting to claims data to monitor patients and segment them by risk;

  • Reminding patients to take their medications: when and how much.

  • Monitoring patients' at-home blood pressure cuff readings and activity automatically to watch for outliers and correlations.

  • Connecting patients to healthcare providers when needed.

  • Educating patients on the importance of medication adherence.

  • Tracking patient adherence so patients can see how well they have been following doctor’s orders.

In addition, Lark provides coaching to encourage healthy behaviors, including weight management, nutritious eating, getting active, and getting enough sleep. These behaviors can all support general well-being as well as increase patient self-efficacy in taking charge of health and staying adherent to medications to stay as healthy as possible.

 

Natalie Stein

Exercise, Fitness & Nutrition Expert | Assistant Professor of Public Health

Medication Adherence in Different Patient Groups

Medication Adherence in Various Patient Groups


While there are many common themes in medication adherence, there are some special considerations for different patient groups.


Medication Adherence in Diabetes

The goal of medication regimens in diabetes is to improve blood sugar control to prevent complications. Type 2 diabetes accounts for 9 out of 10 cases, and is the result of insulin resistance. Without proper management with lifestyle behaviors such as diet and exercise, the WHO asserts that most patients eventually need medications. Diet, exercise, monitoring, and medications are the cornerstones of management.

These are some facts related to diabetes self-management.

  • Only 1 in 4 patients follow a physical activity plan and only 1 or 2 in 3 are adherent to a diet plan.

  • As few as 1 in 3 patients regularly monitor blood glucose at home.

  • Adherence ranges from 15 to 80%, with non-adherence including taking extra doses and skipping doses.

  • A greater self-efficacy, better stress management, and better support are all linked to improved adherence.


Medication Adherence in Schizophrenia


Schizophrenia is a condition in which the patient has an altered perception of the world that can include untrue beliefs or hearing voices that are not there. Treatment usually includes psychotherapy and medications such as antidepressants, antipsychotics, and anti-anxiety drugs. As in other long-term conditions, such as diabetes and hypertension, patients are less adherent as their diagnosis is further in the past, and only about 1 in 4 continue to take medications properly.

  • There are no immediate consequences for skipping doses, so patients may not understand the significance.

  • Patients often skip up to half of doses due to forgetfulness.

  • Side effects can cause patients to stop taking their medications.

  • Family and social support can improve adherence.

 

HIV Medication Adherence


Medication adherence in patients with HIV/AIDS is particularly challenging. Adherence of at least 95% is required for best results, but the WHO reports that only 1 out of 3 patients take their medications properly, even when they understand the importance of highly active anti-retroviral therapy, or HAART, in preventing progression of HIV/AIDS. Even slight non-adherence can allow viral cell loads to increase, and infectiousness can also increase with non-adherence.

These are some challenges:

  • The drug regimen is complex, with multiple doses per day and possible food restrictions.

  • Side effects can be unpleasant and include nausea, diarrhea, and neuropathy.

  • Substance abuse is a predictor of non-adherence.

  • Social support and patient-provider trust can help in adherence.

 

Medication Adherence in Hypertension


Estimates vary from 20 to 80%, but what is clear is that many hypertensive patients are non-compliant. Consequences include a higher risk of stroke, coronary heart failure, dementia, reduced renal function, and blindness.

  • Hypertension is largely asymptomatic, so motivation to adhere can be lower because medications do not make patients feel better.

  • The biggest cause of uncontrolled hypertension is non-adherence.

  • Low understanding of hypertension and its risks may contribute to non-adherence.

  • Hypertension drugs can be complicated to take.

 

  Medication Adherence in COPD


Chronic obstructive pulmonary disease, or COPD, is a progressive chronic disease that makes breathing difficult and is the fourth most common cause of death in the U.S. Medication adherence issues in patients treated for COPD include periods of symptom remission and the long-term nature of the disease. In addition, side effects can be severe. Only about half of COPD patients are adherent to their prescribed regimen.

 

 Lark health coach can assist with adherence to the medication regimen in a number of ways.


  • Connecting patients devices, such as inhalers and blood pressure cuffs, to measure usage and trends.

  • Reminding patients to take their medications: when and how much.

  • Connecting patients to healthcare providers when needed.

  • Educating patients on the importance of medication adherence.

  • Tracking patient adherence so patients can see how well they have been following doctor’s orders.

In addition, Lark provides coaching to encourage healthy behaviors, including weight management, nutritious eating, getting active, and getting enough sleep. These behaviors can all support general well-being as well as increase patient self-efficacy in taking charge of health and staying adherent to medications to stay as healthy as possible.

 

Natalie Stein

Exercise, Fitness & Nutrition Expert | Assistant Professor of Public Health