title: Improving Medication Adherence in Patients with Hypertension: A Randomized Trial.
abstract: OBJECTIVE
  In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention.
  
  
  METHODS
  Patients (n = 532) were recruited from 3 hospital outpatient clinics and randomized to usual care or a 6-month pharmacist intervention comprising collaborative care, medication review, and tailored adherence counseling including motivational interviewing and telephone follow-ups. The primary outcome was composite medication possession ratio (MPR) to antihypertensive and lipid-lowering agents, at 1-year follow-up, assessed by analyzing pharmacy records. Secondary outcomes at 12 months included persistence to medications, blood pressure, hospital admission, and a combined clinical endpoint of cardiovascular death, stroke, or acute myocardial infarction.
  
  
  RESULTS
  At 12 months, 20.3% of the patients in the intervention group (n = 231) were nonadherent (MPR <0.80), compared with 30.2% in the control group (n = 285) (risk difference -9.8; 95% confidence interval [CI], -17.3, -2.4) and median MPR (interquartile range) was 0.93 (0.82-0.99) and 0.91 (0.76-0.98), respectively, P = .02. The combined clinical endpoint was reached by 1.3% in the intervention group and 3.1% in the control group (relative risk 0.41; 95% CI, 0.11-1.50). No significant differences were found for persistence, blood pressure, or hospital admission.
  
  
  CONCLUSIONS
  A multifaceted pharmacist intervention in a hospital setting led to a sustained improvement in medication adherence for patients with hypertension. The intervention had no significant impact on blood pressure and secondary clinical outcomes.
authors: Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark; Clinical Pharmacy Department, Hospital Pharmacy of Funen, Odense University Hospital, Odense, Denmark. Electronic address: uhedegaard@health.sdu.dk.
authors: Ulla
authors: U
authors: Hedegaard
authors: The Danish Research Unit for Hospital Pharmacy, Copenhagen, Denmark.
authors: Lene Juel
authors: LJ
authors: Kjeldsen
authors: Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark.
authors: Anton
authors: A
authors: Pottegård
authors: Department of Endocrinology, Odense University Hospital, Odense, Denmark.
authors: Jan Erik
authors: JE
authors: Henriksen
authors: Department of Internal Medicine, Odense University Hospital - Svendborg, Svendborg, Denmark.
authors: Jess
authors: J
authors: Lambrechtsen
authors: Department of Internal Medicine, Odense University Hospital - Svendborg, Svendborg, Denmark.
authors: Jørgen
authors: J
authors: Hangaard
authors: Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark.
authors: Jesper
authors: J
authors: Hallas
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods; D010595:Pharmacists; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents
keywords: Hospital; Hospital outpatient clinic; Hypertension; Medication adherence; Motivational interviewing; Pharmacy services