Healthcare Adherence Research Articles

Borderline personality symptomatology and compliance with general health care among internal medicine outpatients

Objectives. The extant literature on borderline personality disorder (BPD) and compliance with mental health treatment contains conflicting findings. However, among those individuals with this type of personality dysfunction, reduced compliance with mental health treatment appears to be the predominant theme. To our knowledge, the relationship between BPD and compliance with general health care has not been studied. In addition, there is no prior study in this area examining a primary care population. Methods. Using a cross-sectional survey methodology among a sample of internal medicine outpatients (N = 261), we assessed borderline personality symptoms with two self-report measures and general health care compliance or adherence with four self-report measures. Results. With the exception of on-time arrival for doctor appointments, the remaining compliance variables demonstrated statistically significant relationships at the p < 0.01–0.001 levels, with borderline personality symptoms predicting reduced compliance (i.e., conscientiousness with medical treatment, regular dental check-ups, timely completion of laboratory work, following doctor's exercise and nutrition instructions, remembering to take medications, and Medical Outcomes Study General Adherence Score). Conclusions. Compared with participants without borderline personality symptoms, those participants with such symptoms in this study evidenced lower general health care compliance.

A cross-sectional survey of childhood trauma and compliance with general health care among adult primary care outpatients.

Beyond the examination of medication compliance among individuals with substance abuse or human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), few studies have examined relationships between childhood trauma and health care compliance in adulthood-the focus of the present study. Using a cross-sectional approach and a self-report survey methodology, we examined 5 types of childhood trauma (ie, witnessing violence, physical neglect, emotional abuse, physical abuse, sexual abuse) in relationship to 4 measures of general health care compliance (ie, self-rated general conscientiousness with medical treatment; 5 items pertaining to general health care compliance such as scheduling regular dental checkups, timely arrival for doctor's appointments, and timely completion of laboratory work; 2 medication compliance items; and the Medical Outcomes Study general adherence score) among a sample of adult primary care outpatients (N = 272). Data were collected in March 2014. According to findings, some health care adherence variables demonstrated relationships with the summed childhood trauma score, whereas others did not. It could be interpreted that the more subjective health care compliance variables (eg, self-rated conscientiousness with regard to medical treatment) demonstrated no relationship with a summed childhood trauma score, whereas the more objective health care compliance variables (eg, frequency of regular dental checkups, ability to remember to take all medications, Medical Outcomes Study general adherence score) did demonstrate statistically significant relationships with a summed childhood trauma score (most at P < .01). Patients with histories of childhood trauma demonstrate some deficits with health care compliance in comparison to those without childhood trauma. One interpretation is that the mistreated appear to believe that they are fairly compliant with health care treatment, but objective variables appear to suggest otherwise.

Health Care Adherence and Personalized Medicine

Non-adherence in health care results when a patient does not initiate or continue care that a provider has recommended. Previous research identifies non-adherence as a major source of waste in US health care, totaling approximately 2.3% of GDP, and has proposed a plethora of interventions to raise adherence. However, health economics provides little explicit analyses of the important dynamic demand behavior that drives non-adherence, and it is often casually attributed to uninformed patients. We argue that whereas providers may be more informed about the population-wide effects of treatments, patients are more informed about the individual-specific value of treatment. We interpret a patient’s decision to adhere to a treatment regime as an optimal stopping problem in which patients learn the value of a treatment through treatment experience. We derive strong positive and normative implications resulting from interpreting non-adherence as an optimal stopping problem. Our positive analysis derives an “adherence survival function,” depicting the share of patients still on treatment as a function of time, and predicts how various observable factors alter adherence. Our normative analysis derives the efficiency effects of non-adherence and the conditions under which adherence is too high or low. We consider the efficiency implications of this analysis for common adherence interventions. We argue that personalized medicine is intimately linked to adherence issues. It replaces the learning through treatment experience with a diagnostic test, and thereby speeds up the learning process and cuts over-adherence and raises under-adherence. We assess the quantitative implications of our analysis by calibrating the degree of over- and under-adherence for one of the largest US drug categories: cholesterol-reducing drugs. Contrary to frequent normative claims of under-adherence, our estimates suggest the efficiency loss from over-adherence is over 80% larger than from under-adherence, even though only 43% of patients fully adhere.

Intensive multidisciplinary care programme for frail patients

Rationale and Objectives: Patients with chronic diseases re-admitted for acute events are associated with a high use of hospital resources and represent a challenge for healthcare systems. In such cases, follow-up interventions at discharge can be effective. The widespread adoption of follow-up procedures not involving telemonitoring may greatly decrease re-admissions rates without the costs associated with telemedicine. To assess the impact of a structured follow-up programme on patient-perceived healthcare quality, treatment adherence, re-admissions and Emergency Department attendances.Methods: This was a before and after study of 242 patients at risk of re-admission for chronic obstructive pulmonary disease (COPD) or heart failure (HF), recruited between 1st July 2009 and 30th June 2010 at Donostia Tertiary University Hospital (Gipuzkoa, Spain). The follow-up ended on 30th December 2010. The intervention involved identifying independent re-admitted patients, providing personalised information and a direct number to call in the event of clinical worsening, assigning specialists and liaison nurses, structured follow-up by telephone and appointments and contact with general practitioners. Patient perceived quality of care estimated was analyzed using a focus group technique. To assess the number of re-admissions and the Emergency Department attendances we estimated the relative risk reduction as a percentage and corresponding 95% confidence intervals.Results: In terms of perceived quality of care, the most valued elements were related to having an assigned doctor/nurse and easy access in the event of worsening. Overall, 97.9% of patients reported full adherence to treatment (95% CI: 95.4-98.83).Hospital bed days and Emergency Department attendances decreased by 60.7% (95% CI: 58.7-62.7) and 77% (95% CI: 73.2-80.3), respectively.Conclusions: The intensive multidisciplinary care programme can reduce Emergency Department attendances and improve perceived quality of care in patients with HF and COPD.

A socio-cognitive approach to customer adherence in health care

Purpose – Adherence is a critical factor for success, for both the health of the customer and the financial outcomes of the firm. Central to the success of adherence behavior is the co-productive role of the customer which is determined by service perceptions as well as individual attributes. Based on social cognition theory, the aim of this paper is to examine the factors that influence past adherence behavior, and whether past adherence behavior predicts future intentions. Design/methodology/approach – The model was tested using structured equation modeling on a sample of 771 weight-loss customers. Findings – The authors show how service quality influences role clarity, which leads to increases in self-efficacy. The study also demonstrates the role of emotional intelligence (EI) in increasing efficacious beliefs. Past adherence behavior was found to predict future intentions. Research limitations/implications – This study was undertaken with a single service industry, and based on data which was collected at a single point in time. Limitations associated with common method bias inherent in cross-sectional designs, as well as limitations related to the use of self-report measures are acknowledged. Practical implications – The findings suggest that interventions to promote health outcomes should target customer skills in service consumption. By providing quality interactions, providers can increase customer role clarity which produces efficacious beliefs. Interventions should also address EI training in customers given its role in influencing self-efficacy. Originality/value – The simultaneous examination of traditional service factors and socio-cognitive factors contributes to theory by considering the individual health and organizational outcomes of these factors. The finding of a direct path between past adherence behavior and future intentions provides a unique insight into the prediction and control of behavior in a number of domains.

The Sistah Powah Structured Writing Intervention: A Feasibility Study for Aging, Low-Income, HIV-Positive Black Women

The purpose of this study was to test the feasibility and assess outcomes of health care adherence based on whether participants engage in particular risky behaviors relevant to general health or living with human immunodeficiency virus (HIV) infection and the frequency of these adherent behaviors. Health adherent behaviors include both self-advocacy and decreased stigma as underlying key components. A randomized control trial comparing peer-led attention control support and intervention groups. Community-based women's drop-in center in an urban, black neighborhood of Boston, Massachusetts. Aging, low-income, black women living with HIV infection. Peer-led, small-group, structured writing using film clips from Women's Voices Women's Lives as a writing prompt. Demographic and outcome data that included adherence, self-advocacy, and stigma; collected at baseline, 6 weeks, and 6 months. Repeated-measures analysis of variance scores were examined between groups and waves. Paired-sample t-tests were used to examine mean differences across time. Sample included 110 women (intervention, n = 56; comparison, n = 54). Retention was 85.5%. Repeated-measures analysis indicated intervention group condom use (n = 69, F = 8.02, df = 1, p < .01) and safe sex (n = 71, F = 13.02, df = 1, p < .01) was higher than that of comparison group. A time effect was also found in the Silencing the Self Scale (n = 91, Pillai's trace = 7.21, df = 2, p < .01). This study demonstrates the feasibility of a tailored, peer-led, and culturally relevant interventions and tentative efficacy in populations affected by health disparities. Key limitations include no comparison intervention format with women who can't write and the need to test generalizability.

Assessing medication adherence: options to consider

Adherence to chronic therapy is a key determinant of patient health outcomes in chronic disease. However, only about 50 % of patients adhere to chronic therapy. One of the challenges in promoting adherence is having an accurate understanding of adherence rates and the factors that contribute to non-adherence. There are many measures available to assess patient medication adherence. This review aims to present the commonly used indirect methods available for measuring medication adherence in routine healthcare and research studies. A literature review on medication adherence measures in patient populations with chronic conditions taking chronic medications was conducted through Medline (2003-2013). A complementary manual search of references cited in the retrieved studies was performed in order to identify any additional studies. Of the 238 initial Medline search results, 57 full texts were retrieved. Forty-seven articles were included as a result of the manual search. Adherence measures identified were: self-report (reported in 50 publications), electronic measures (33), pharmacy refills and claims data (26) and pill counts (25). Patient self-report, electronic measures, pharmacy refill and claims data were the most commonly used measures of adherence in research, routine practice, epidemiological and intervention studies. These methods, and their strengths and limitations have been described in this paper. A multitude of indirect measures of adherence exist in the literature, however, there is no "gold" standard for measuring adherence to medications. Triangulation of methods increases the validity and reliability of the adherence data collected. To strengthen the adherence data collected and allow for comparison of data, future research and practice interventions should use an internationally accepted, operational standardized definition of medication adherence and clearly describe the medication adherence methods used.

PIN114 - Health Care Resource Utilization and Adherence to Antiretroviral Treatment (ART) by HIV Patients: An Analysis with the Quebec (Canada) Public Drug Plan Database

PIN114 - Health Care Resource Utilization and Adherence to Antiretroviral Treatment (ART) by HIV Patients: An Analysis with the Quebec (Canada) Public Drug Plan Database

The Application of Intelligent Keywords to Patient Adherence Management System

Health behavior change is the key challenge for healthcare intervention adherence management. For each treatment planning, patient adherence can be managed, audited, and improved by the Patient Adherence Management System applying Intelligent Keyword (PAMSIK) featuring the use of intelligent keywords, which has been design to navigate users to the target in-time knowledge and also leverage the collective power – peer learning to encourage patients. Three major components of PAMSIK are: an autonomous, intelligent, friendly User Behavior Collector to identify patient's personal adherence problems, a Patient Similarity Analyzer to dynamically cluster peers, and a Cure Service Dispatcher to recommend suitable cures and thus deliver prompt services and in-time contents to users.

O091: Healthcare associated infections: an overview (videoclip)

HAI prevention and control is an essential component of patient safety. Healthcare workers awareness, knowledge and adherence are crucial in order to obtain the best results.

Motivational Measurements Predict No Show Rates for Titration Studies and Use of Alternative Therapies

Motivational Measurements Predict No Show Rates for Titration Studies and Use of Alternative Therapies Background: Overall adherence in health care is suboptimal, including adherence to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA). One of the leading strategies to improve patient acceptance and adherence to change is motivational interviewing (MI). We hypothesize that motivational measurements will predict patients’ show rate for CPAP titration studies and use of alternative therapies. Methods: Adult patients rated their perceived importance of CPAP therapy and their confidence of success with therapy on a 1-10 Likert-type scale prior to their diagnostic polysomnogram (PSG). Demographic data, referral clinic, body mass index (BMI), Epworth Sleepiness Scale (ESS), treatment, and apnea hypopnea index (AHI) were collected. We classified patients into either Group 1, defined by those who reported both high importance of CPAP and high confidence of success with therapy (scores of 8 or higher for both), or Group 2 as those that rated lower importance or confidence (score <8 on at least one measure). Statistical analysis utilized unpaired t-tests and Fisher’s exact tests with a significant p value of 0.05.

Evaluation of a psychosocial intervention in caring for adherence to treatment for HIV/AIDS: A case study

Patient adherence to medication is a central dimension for AIDS programs worldwide. The role of health professionals in adherence, especially with chronic diseases, has been emphasized by studies, including the committee of experts from the WHO, that recommends support to patients and not blame. We conducted a case study using the evaluation approach, analysing a set of four individual assistance sessions of a patient who had problems with adherence to antiretroviral therapy. An “Evaluative Framework” guided the analysis of one database case - audio recordings and transcripts of an overall protocol composed of 44 people cared for by three trained professionals in a specialized service, in the context of a clinical trial that evaluated the effectiveness of a novel modality of psychosocial intervention on adherence health care. Its theoretical and methodological bases are the ‘Vulnerability and Human Rights Framework’; the references of Care and Psychosocial Attention in the setting of AIDS, inspired by social constructionism. The notions of convenience and practical success were stressed to suggest a change in focus towards the patient’s perspective, democratizing the relation of care; in the dialogues centered on everyday scenes of the medications taken, seeking to enlarge the mutual recognition of the vulnerability to illness due to treatment failures. The results refer to the instrumentality of the “Evaluative Framework” and the content of the evaluations that focused on the intersubjective dynamics of interactions and dialogues related to the everyday experiences with ART in search of a better way of living with the treatment.

A systematic review of the effectiveness of therapeutic education for children diagnosed with cancer and their families on behavioural and health-related outcomes

Background Children with cancer may experience considerable psychological and physiological complications. The aim of patient therapeutic education is to improve quality of life, through developing knowledge and management skills, for both the child and the parents. Objectives To determine the best available evidence related to the use of patient therapeutic education, in which at least one nurse has been involved in the intervention, for children with cancer and their families. Inclusion criteria Types of participants Children diagnosed with cancer aged 0 to 21 years and their families, parents (or guardian) and siblings. Types of intervention The review focused on various forms of therapeutic educational intervention that included one or more of the following dimensions: 1.Cognitive 2.Perceptive 3.Infra-cognitive 4.Meta-cognitive and 5.Emotional/affective. Types of studies Randomised controlled trials and quasi-randomised controlled trials. Types of outcomes Self-efficacy, coping and psychological assessment, health-related quality of life, health care utilisation, symptom management, adverse effects, adherence, biological markers, and family functioning in children diagnosed with cancer and their families. Search strategy A systematic search was conducted across 13 databases to identify published and unpublished studies in English and French between the years 1980-2010. Methodological quality Critical appraisal was undertaken by two independent reviewers using the Joanna Briggs Institute critical appraisal checklist. Data collection/extraction Data were extracted using standardised data extraction forms provided by the Joanna Briggs Institute. Data synthesis Meta-analysis was performed with two studies. Regarding all other studies, pooling of the results was not possible due to the diversity of interventions and outcomes. Hence, the study findings are reported in narrative form. Results Six studies were included in the final review, providing a total of 244 patients. Five out of the six studies were randomised controlled trials and one was a pseudo-randomised controlled trial. The effectiveness of therapeutic education using an interactive CD-ROM on health locus of control was not statistically significant (overall effect size = 0.37, [95% CI -0.04-0.78]). The effectiveness of therapeutic education on quality of life, coping style, cancer knowledge and task-specific self-efficacy was not statistically significant. Therapeutic education reduced pain intensity (-0.65, p < .001) and oral mucositis (-1.85, p<.001) in patients, who were instructed on protocolised mouth wash utilisation. One study assessed the effectiveness of two behavioural interventions, matched with two coping styles during invasive procedures. The results showed a significant difference in anticipatory heart rate when not divided by coping style for the information group. One study reporting results of an educational intervention designated to facilitate self-care coping demonstrated no effect on hopefulness, self-esteem, general self-efficacy and treatment toxicity. No experimental or quasi-experimental studies involving therapeutic education targeted to both the child and one of their parents were found. Although the review aimed to investigate the effectiveness of patient therapeutic education on both children and parents, no studies with parent-related outcomes could be included. Conclusions This review identified six studies that tested therapeutic education on health locus of control, quality of life, coping, cancer knowledge, task-specific self-efficacy, pain, and rate of mucositis. It revealed that therapeutic education has a positive effect on the reduction of pain and mucositis, only. This review also highlighted the paucity of high level evidence research in patient therapeutic education in the nursing field. Implication for practice Teaching self-care is crucial for appropriate symptom management of cancer and cancer treatment. It is recommended that the role of nurses delivering patient therapeutic education is clarified to inform nursing practice and education. Implication for research Further research is warranted before it is possible to show the effect of patient therapeutic education as a nursing intervention. There is a need to define the core measures to test the effect of patient therapeutic education in children and parents.

P140: Interventions aiming to raise healthcare workers adherence to hand hygiene: integrative review

Hand hygiene is the most important measure to prevent healthcare associated infections. Although, compliance rates of healthcare workers to such act remain low, making the promotion of hand hygiene through several campaigns necessary.

The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review.

BackgroundNonadherence to mental health treatment incurs clinical and economic burdens. The clinician-patient alliance, negotiated through clinical interaction, presents a critical intervention point. Recent medical reviews of communication and adherence behaviour exclude studies with psychiatric samples. The following examines the impact of clinician-patient alliance and communication on adherence in mental health, identifying the specific mechanisms that mobilise patient engagement.MethodsIn December 2010, a systematic search was conducted in Pubmed, PsychInfo, Web of Science, Cochrane Library, Embase and Cinahl and yielded 6672 titles. A secondary hand search was performed in relevant journals, grey literature and reference.Results23 studies met the inclusion criteria for the review. The methodological quality overall was moderate. 17 studies reported positive associations with adherence, only four of which employed intervention designs. 10 studies examined the association between clinician-patient alliance and adherence. Subjective ratings of clinical communication styles and messages were assessed in 12 studies. 1 study examined the association between objectively rated communication and adherence. Meta-analysis was not possible due to heterogeneity of methods. Findings were presented as a narrative synthesis.ConclusionsClinician-patient alliance and communication are associated with more favourable patient adherence. Further research of observer rated communication would better facilitate the application of findings in clinical practice. Establishing agreement on the tasks of treatment, utilising collaborative styles of communication and discussion of treatment specifics may be important for clinicians in promoting cooperation with regimens. These findings align with those in health communication. However, the benefits of shared decision making for adherence in mental health are less conclusive than in general medicine.

Oral Health Knowledge, Past Oral Health Behaviors, and Barriers to Preventive Oral Care of Head Start Parents

Tooth decay remains the most common chronic disease of childhood. The CincySmiles Foundation (CSF) developed an instrument to evaluate Head Start parents’ knowledge of oral health care practices and to identify barriers Head Start parents face when seeking dental treatment for their children. Data from Head Start parents (n = 675) across 3 southwest counties in Ohio were collected by CSF and analyzed by a team of university researchers. The instrument elicited information about oral health care knowledge and practices from the participants. Findings from the parental oral health knowledge scale indicated oral health education programs would benefit the Head Start population. Results suggest oral health practitioners should primarily focus educational efforts on dietary behaviors, bottle feeding, and oral hygiene. Barriers to oral health care adherence of the target population were identified with lack of dental insurance emerging as the primary barrier. An analysis of variance test revealed that participa...

Single-pill vs free-equivalent combination therapies for hypertension: a meta-analysis of health care costs and adherence.

This meta-analysis compares health care resource use costs, adherence, and persistence between groups of patients taking antihypertensives as single-pill combinations (SPCs) vs free-equivalent components (FEC) based on a structured review of published studies. The search yielded 12 retrospective database studies included in analyses. The mean difference in combined total annual all-cause and hypertension-related health care costs was $1357 (95% confidence interval [CI], $778-$1935) lower in favor of SPC than FEC groups. Adherence, measured as the mean difference in medication possession ratio, was estimated to be 8% higher for patients naive to prior antihypertensives and 14% higher for nonnaive SPC patients compared with corresponding FEC patients. Persistence in the SPC groups was twice as likely as the FEC groups (pooled risk ratio, 2.1; 95% CI, 1.1-4.1). Improved adherence and persistence may have contributed to the lower costs in the SPC groups via improved clinical outcomes.

Early discontinuation and suboptimal dosing of duloxetine treatment in patients with major depressive disorder: analysis from a US third-party payer perspective

Objective:Little is known about early discontinuation of duloxetine therapy or the effect that initial dose has on discontinuation in patients with major depressive disorder (MDD).Methods:Data from a private payer insurance claim database included 6132 patients with MDD who started duloxetine between 7/1/2005 and 6/30/2006, had no prescription for duloxetine in the previous 3 months, and were enrolled for 12 months before and after initiation. Chi-square tests, t-tests, and logistic regression were used to compare demographic, clinical, and healthcare cost data stratified by length of continuation. Early discontinuation was defined as continuation ≤30 days. Healthcare costs, persistence, and adherence were compared between patients with suboptimal initial dose (<40 mg/day) and those with recommended initial dose (40–60 mg/day).Results:Discontinuation rates were 16.8% at ≤30 days, 16.7% at 31–90 days, 14.9% at 91–180 days, and 51.6% at >180 days. Suboptimal initial dose, younger age, male gender, prior benzodiazepine use, insomnia, psychiatric disorders, infectious diseases, digestive disorders, genitourinary disorders, and injury/poisoning increased the likelihood of early discontinuation (Odds ratios [ORs]: 1.18–2.16), while recent use of SSRIs or venlafaxine XR decreased the likelihood (ORs: 0.67–0.68). Compared with patients who persisted with therapy for >180 days, patients who discontinued early had more hospital admissions, longer hospital stays, and more ER visits during the 1-year follow-up (all p-values <0.01). Patients with an initial dose <40 mg/day had shorter persistence (p < 0.001) and lower rates of adherence (p < 0.001) compared with patients with an initial dose of 40–60 mg/day.Limitations:Limitations of this study were those of all analyses based on data from insurance claim databases.Conclusions:Early discontinuation was associated with increased healthcare utilization. Demographic and clinical predictors of early discontinuation were identified that may help target care for at-risk patients. Beginning therapy within the recommended dose range may improve persistence.

Participant satisfaction with group and individual components of Adolescent Impact: a secondary prevention intervention for HIV-positive youth

Adolescent Impact, a developmentally targeted behavioral intervention aimed at decreasing risk behaviors and promoting health care adherence, was delivered to 83 HIV-infected youth, aged 13–21 years, receiving care in five urban HIV centers. Participants completed a patient satisfaction survey following the 12 part intervention consisting of seven groups and five individual sessions. A feedback questionnaire was also completed during each group session to gain more insight on participant experiences. Several indicators suggested high levels of satisfaction. First, overall attendance was relatively high. Second, participants rated their subjective experience and group content favorably. No differences in satisfaction ratings emerged between perinatally infected adolescents and those who acquired HIV through risk behaviors. However, differences emerged regarding perceived intervention utility and content-specific preferences. Findings suggest that Adolescent Impact participants were satisfied with the intervention and that a heterogeneous group of HIV-infected youth could be advantageously integrated into the same secondary prevention program.

Outpatient antihypertensive drug utilization in Canton Sarajevo during five years period (2004-2008) and adherence to treatment guidelines assessment

Hypertension is chronic disease with high prevalence, which can successfully be treated with antihypertensive drugs. Previous researches have shown that existing hypertension treatment guidelines are not fully implemented in practice. We have analysed antihypertensive drug utilization in Canton Sarajevo during five-year period (2004-2008). Research findings are discussed in relation to expected drug utilization according to Canton Sarajevo treatment guidelines. Objective of this research is to examine prescription patterns of antihypertensive drugs in primary health care in Canton Sarajevo during five-year period. Based on study findings we did an estimation of adherence to local treatment guidelines, which are similar to those published globally. Drug utilization data were collected from the largest pharmacy (retail) chain, representing more than 80% of pharmacies in Canton Sarajevo. Following drug groups have been analyzed: diuretics, beta-blockers, calcium-channel-blockers, ACE-Inhibitors (plain and combinations), Angiotensin-II-antagonists and alpha-blockers. Drug utilization is expressed in number of defined daily dose (DDDs), defined daily dose per thousand inhabitants per day (DDD/TID), drug utilization 90% (DU90%) and value in euros. ACE-Inhibitors are most prescribed drug class; combination of ACE-Inhibitors and diuretics account 46% of total antihypertensive budget spending. ACEIs are followed by calcium-channel-blockers. Diuretics utilization is decreasing from 2006 and being replaced with beta-blockers. Diuretics, recommended as first line therapy, are ranked as third in total antihypertensive drug utilization. It is necessary to introduce follow-up and enforce adherence to developed treatment guideline. Drug utilization studies can be used as tool for assessment of treatment guidelines adherence in primary health care.