Improving medication use by patients with hypertension prevents adverse outcomes. When their blood pressure is carefully controlled, patients with uncomplicated hypertension are spared suffering complications such as myocardial infarction or stroke. Because hypertension is often asymptomatic and antihypertensive drugs have side effects, patients often feel better when they are not taking their medication. Innovative strategies are needed to educate patients and improve their adherence to an often-complex regimen. Doing so can reduce morbidity, mortality, and the costs of care. Minority and low-income patients often do not have access to the resources needed to assist them with their medications and as such they are especially vulnerable. Recent studies suggest that blood pressure control improves when pharmacists provide patients with education and monitoring. This study aims to develop and test, in a randomized controlled trial, a multileveled pharmacy-based program to improve adherence in minority and low-income patients. A study pharmacist will access a computer integrated into an electronic medical database called the Regenstrief Medical Record System. The conceptual framework is built upon two models: (1) a social-cognitive model for medication adherence, and (2) a behavioral model of healthcare utilization. We have designed patient education materials and medication packaging specifically formatted to promote comprehension in persons with low health literacy. Using these materials, a schema for instruction for use by a pharmacist, and an integrated computer system, we will conduct a randomized controlled trial. Patients with hypertension (N about488), stratified as uncomplicated (n about264) or complicated (n=224), will be randomly assigned to usual care or intervention within each stratum. The study duration will be 18 months: 12 months of active intervention and 6 months of post-intervention follow-up. Adherence will be assessed using electronic monitoring of all medications for hypertension. Endpoints will include medication adherence, blood pressure, health-related quality of life, symptoms, incident vascular complications such as myocardial infarction, and patient satisfaction. We hypothesize that patients receiving the intervention will have improved medication adherence, which will be accompanied by improved blood pressure control, improved health-related quality of life, fewer complications, greater satisfaction with care, and reduced health care costs. We further hypothesize that patients in the uncomplicated stratum will initially experience mild drug side effects from improved antihypertensive medication adherence whereas those in the complicated stratum will have fewer symptoms from improved control of blood pressure and the complications associated with poorly controlled hypertension. Finally, we will assess the cost-effectiveness of the intervention.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
1R01HL069399-01
Application #
6440366
Study Section
Special Emphasis Panel (ZRG1-RPHB-4 (02))
Program Officer
Czajkowski, Susan
Project Start
2001-09-30
Project End
2005-08-31
Budget Start
2001-09-30
Budget End
2002-08-31
Support Year
1
Fiscal Year
2001
Total Cost
$537,607
Indirect Cost
Name
Purdue University
Department
Other Health Professions
Type
Schools of Pharmacy
DUNS #
072051394
City
West Lafayette
State
IN
Country
United States
Zip Code
47907
Hansen, Richard A; Kim, Mimi M; Song, Liping et al. (2009) Comparison of methods to assess medication adherence and classify nonadherence. Ann Pharmacother 43:413-22
Murray, Michael D; Ritchey, Mary E; Wu, Jingwei et al. (2009) Effect of a pharmacist on adverse drug events and medication errors in outpatients with cardiovascular disease. Arch Intern Med 169:757-63
Levinthal, Brian R; Morrow, Daniel G; Tu, Wanzhu et al. (2008) Cognition and health literacy in patients with hypertension. J Gen Intern Med 23:1172-6
Murray, Michael D; Young, James; Hoke, Shawn et al. (2007) Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med 146:714-25
Morrow, Daniel G; Weiner, Michael; Steinley, Douglas et al. (2007) Patients'health literacy and experience with instructions: influence preferences for heart failure medication instructions. J Aging Health 19:575-93
Stroupe, Kevin T; Teal, Evgenia Y; Tu, Wanzhu et al. (2006) Association of refill adherence and health care use among adults with hypertension in an urban health care system. Pharmacotherapy 26:779-89
Morris, Andrew B; Li, Jingjin; Kroenke, Kurt et al. (2006) Factors associated with drug adherence and blood pressure control in patients with hypertension. Pharmacotherapy 26:483-92
Roswarski, Todd Eric; Murray, Michael D (2006) Supervision of students may protect academic physicians from cognitive bias: a study of decision making and multiple treatment alternatives in medicine. Med Decis Making 26:154-61
Morrow, Dan; Clark, Dan; Tu, Wanzhu et al. (2006) Correlates of health literacy in patients with chronic heart failure. Gerontologist 46:669-76
Tu, Wanzhu; Morris, Andrew B; Li, Jingjin et al. (2005) Association between adherence measurements of metoprolol and health care utilization in older patients with heart failure. Clin Pharmacol Ther 77:189-201

Showing the most recent 10 out of 17 publications