title: A substudy evaluating treatment intensification on medication adherence among hypertensive patients receiving home blood pressure telemonitoring and pharmacist management.
abstract: OBJECTIVE
  Hypertension is a leading cause of death and major contributor to heart attacks, strokes, heart and kidney failure. Antihypertensive (HTN medication) non-adherence contributes to uncontrolled hypertension. Effective initiatives to improve uncontrolled hypertension include a team-based approach with home blood pressure (BP) monitoring. Our study objective was to evaluate whether objectively measured medication adherence was influenced by home BP telemonitoring and pharmacist management.
  
  
  METHODS
  We analysed HTN medication adherence in 240 patients who received home BP telemonitoring and pharmacist intervention (TI). Adherence was measured based on prescription fills and the proportion of days covered (PDC). HTN medications continued pre- to post-baseline were similar for telemonitoring intervention (TI) and usual care (UC) patients (rate ratio = 1·00, P = 0·90).
  
  
  CONCLUSIONS
  More HTN medications were discontinued pre- to post-baseline in TI patients (rate ratio = 1·38, P = 0·04). Similarly, more HTN medications were added in TI patients (rate ratio = 2·46, P < 0·001). The proportion with a mean PDC ≥ 0·8 for HTN medications added after baseline and overall adherence did not differ between groups.
  
  
  CONCLUSIONS
  Medication adherence was high in both groups; however, medication adherence was not significantly altered by the intervention. There were more medication modifications and greater medication intensification among TI patients.
authors.affiliation: HealthPartners Institute, Minneapolis, MN, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Pawloski
authors.affiliation: HealthPartners Institute, Minneapolis, MN, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Asche
authors.affiliation: HealthPartners Institute, Minneapolis, MN, USA.
authors.forename: N K
authors.initials: NK
authors.lastname: Trower
authors.affiliation: HealthPartners Institute, Minneapolis, MN, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Bergdall
authors.affiliation: HealthPartners Institute, Minneapolis, MN, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Dehmer
authors.affiliation: HealthPartners Institute, Minneapolis, MN, USA.
authors.forename: M V
authors.initials: MV
authors.lastname: Maciosek
authors.affiliation: HealthPartners Institute, Minneapolis, MN, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Nyboer
authors.affiliation: HealthPartners Institute, Minneapolis, MN, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: O'Connor
authors.affiliation: HealthPartners Institute, Minneapolis, MN, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Sperl-Hillen
authors.affiliation: Group Health Research Institute, Seattle, WA, USA.
authors.forename: B B
authors.initials: BB
authors.lastname: Green
authors.affiliation: HealthPartners Institute, Minneapolis, MN, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Margolis
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010595:Pharmacists; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents
keywords: adherence; antihypertensive; clinical pharmacy; disease management; hypertension