Abstract 17373: The Effect of a Multi-Level Nurse-Led and M-Health Intervention on Medication Adherence Among Adults with Uncontrolled Hypertension in the ADHINCRA Study

Abstract

Introduction: Poor adherence to antihypertensive therapy is a major contributor to poor cardiovascular outcomes for patients diagnosed with hypertension (HTN). However, multifaceted patient centered interventions may improve medication adherence and HTN control. Objective: To examine the impact of the nurse-led, multi-level, m-health intervention on medication adherence in adults with uncontrolled HTN in the ADHINCRA study in Ghana. Methods: Using a cluster randomized controlled pilot trial design, four hospitals were randomized to the intervention arm and enhanced usual care (EUC) arm; 120 participants in each. We estimated HTN medication adherence using the Hill-Bone Medication Adherence Scale (Range, 9-36), higher scores indicate better adherence. A logistic regression model was used to estimate dichotomized adherence score (low and high adherence) as a function of the treatment group over time. Results: Among 240 participants, mean (±SD) age was 53 (±9.7) years; 117 men (49%). Mean (SD) adherence scores for intervention and EUC arms at baseline were 33.7 (2.9) and 33.2 (3.1) respectively. At month 12, the mean adherence score was 34.8 (1.8) in the intervention group and 34.3 (2.5) in EUC arm. Comparing baseline to month 6, the intervention arm had higher odds of adherence (Odds Ratio, OR, 1.85; 95%CI, 1.14-4.45) compared to EUC arm (OR, 1.74; 95%CI, 0 .91-3.31), and similarly for month 12, the intervention arm had higher odds of adherence (OR, 3.25; 95%CI, 1.68-6.27) compared to EUC arm (OR, 2.32; 95%CI, 1.19-4.52) (Figure 1). Conclusions: The ADHINCRA Study intervention resulted in greater improvement in medication adherence in the intervention than the EUC arm. Multi-level interventions should be integrated into clinical practice in Ghana to improve medication adherence.