title: A multifaceted pharmacist intervention to improve antihypertensive adherence: a cluster-randomized, controlled trial (HAPPy trial).
abstract: OBJECTIVE
  About half of all patients taking antihypertensives discontinue treatment by 12 months. There is potential for substantial health gains at both individual and population levels through improved treatment adherence. The objective was to evaluate a community pharmacist intervention to improve adherence with antihypertensive medicines with a view to improving blood pressure (BP) control.
  
  
  METHODS
  
  
  
  METHODS
  prospective, non-blinded, cluster-randomized, controlled trial.
  
  
  METHODS
  adults with primary hypertension who obtained antihypertensives in the previous 6 months. Patients with poor refill adherence were preferentially identified with the help of a purpose-built software application.
  
  
  METHODS
  package comprising BP monitor; training on BP self-monitoring; motivational interviewing; medication use review; prescription refill reminders.
  
  
  RESULTS
  six months.
  
  
  METHODS
  change in proportion self-reporting medication adherence. Secondary outcome: BP changes.
  
  
  RESULTS
  Participants (n = 395; intervention - 207; control - 188) had a mean age of 66.7 years; 51.1% were males. The proportion of adherent participants increased in both groups but was not significantly different between groups [57·2% to 63·6% (control) vs. 60·0% to 73·5% (intervention), P = 0·23]. The mean reduction in systolic BP was significantly greater in the intervention group (10·0 mmHg vs. 4·6 mmHg; P = 0·05). The proportion of patients who were non-adherent at baseline and adherent at 6 months was 22·6% (95%CI 5·1-40·0%) higher in the intervention group (61·8% vs. 39·2%, P = 0·007). Among participants with baseline BP above target, reduction of systolic BP was significantly greater in the intervention group [by 7·2 mmHg (95%CI 1·6-12·8 mmHg); (P = 0·01)]. Among participants non-adherent at baseline and above target BP, the proportion reporting adherence at 6 months was significantly greater in the intervention group [56·8% vs. 35·9%, P = 0·039).
  
  
  CONCLUSIONS
  This community pharmacist intervention resulted in improved adherence to antihypertensive medication and reduced systolic BP.
authors.affiliation: Centre for Medicine Use and Safety, Monash University, Melbourne, Vic., Australia.
authors.forename: K
authors.initials: K
authors.lastname: Stewart
authors.forename: J
authors.initials: J
authors.lastname: George
authors.forename: K P
authors.initials: KP
authors.lastname: Mc Namara
authors.forename: S L
authors.initials: SL
authors.lastname: Jackson
authors.forename: G M
authors.initials: GM
authors.lastname: Peterson
authors.forename: L R
authors.initials: LR
authors.lastname: Bereznicki
authors.forename: P R
authors.initials: PR
authors.lastname: Gee
authors.forename: J D
authors.initials: JD
authors.lastname: Hughes
authors.forename: M J
authors.initials: MJ
authors.lastname: Bailey
authors.forename: Ys A
authors.initials: YA
authors.lastname: Hsueh
authors.forename: J M
authors.initials: JM
authors.lastname: McDowell
authors.forename: D A
authors.initials: DA
authors.lastname: Bortoletto
authors.forename: R
authors.initials: R
authors.lastname: Lau
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D018660:Blood Pressure Monitoring, Ambulatory; D003157:Community Pharmacy Services; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D010595:Pharmacists; D016896:Treatment Outcome; D014739:Victoria
chemical_list: D000959:Antihypertensive Agents
keywords: adherence; blood pressure; cardiovascular disease; community pharmacy; randomized controlled trial