Abstract
ABSTRACTObjective:To examine whether the use of a monthly electronic medication organizer device equipped with an alarm clock, called Electronic System for Personal and Controlled Use of Medications (Supermed), improves medication adherence of older adults with hypertension.Methods:This is a quali-quantitative, prospective, before-and-after study performed with 32 older adult patients with diagnosis of hypertension, who were recruited at a Primary Care Unit in Brazil.Results:The main outcome measures were improvement of medication adherence and blood pressure control after intervention with Supermed. Regarding medication adherence, 81.2% of patients were “less adherent” in the pre-intervention period, and 96.9% were “more adherent” in the post-intervention period. This means that 78.1% of patients changed from “less adherent” to “more adherent” after the intervention with Supermed (p<0.001). The mean systolic and diastolic blood pressure differences between intervention day and post-intervention were 18.5mmHg (p<0.0001) and 4.3mmHg (p<0.007), respectively, and the differences between mean systolic and diastolic blood pressure between pre-intervention and post-intervention were 21.6mmHg (p<0.001) and 4.7mmHg (p<0.001) respectively.Conclusion:The use of Supermed significantly improved self-reported medication adherence and blood pressure control in a hypertensive older adult population.
Highlights
Hypertension is a major modifiable risk factor for cardiovascular events and mortality in older people.[1]
The systolic blood pressure (SBP) values were defined according to the Brazilian Hypertension Guidelines.[11]. The exclusion criteria were older adult diagnosed with mental disorders or cognitive impairment
The patients had been diagnosed with hypertension for an average of 19.4 years before study enrolment, and had been taking long-term medicines since to treat hypertension, and their comorbidities such as diabetes mellitus (75%), dyslipidaemia (75%), and obesity (59.4%)
Summary
Hypertension is a major modifiable risk factor for cardiovascular events and mortality in older people.[1]. Adherence to drug therapy is a complex and individual psychobehavioral phenomenon It is an increasing problem among older adults influenced by factors associated with the physician, specific treatment, healthcare system, comorbidities, patient’s understanding of their medical condition, and patient’s satisfaction with treatment.[4,5] This variety of factors can lead to intentional or unintentional patient nonadherence.[4] Intentional non-adherence is determined by the patients’ active decision of not taking their medication as prescribed. The strategies that clinical pharmacists may adopt to improve medication adherence include providing instructions to patients about their disease, treatment, and lifestyle; monitoring and recording blood pressure; providing medication reminders, including phone calls; and furnishing dispensing systems, such as electronic monitoring, blisters or pillboxes to organize daily doses.[7,8,9] In Brazil, there are some daily and weekly medicine box organizers, equipped with alarm clocks, but not an electronic monthly organizer device. The hypothesis tested in the study was that the use of Supermed may increase patient adherence to medication treatment
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