Hypertension Medication Adherence Research Articles

Effect of pharmacist‐led interventions on hypertension‐related knowledge, medication adherence, and blood pressure control: A multi‐center, randomized, controlled trial in Vietnam

AbstractIntroductionHypertension is the single most important leading cause of morbidity and mortality in the Vietnamese population and remains poorly controlled by the current conventional care model.ObjectivesTo evaluate whether pharmacist‐led interventions can improve hypertension knowledge, medication adherence, and blood pressure (BP) control in Vietnamese patients with hypertension.MethodsA multi‐center, randomized, controlled trial was conducted in three hospitals in Vietnam from October 2021 to May 2022. The educational interventions included direct counseling, printed material, and educational videos for smartphones. The primary outcome was hypertension knowledge assessed by the Hypertension Knowledge‐Level Scale (HK–LS). Secondary outcomes were medication adherence as assessed by the Morisky Green Levine Adherence Scale (MGL) and changes in systolic (SBP) and diastolic BP (DBP) at week 12.ResultsA total of 381 patients were included in the study, with 190 and 191 patients in the intervention and control groups, respectively. At week 12, patients in the intervention group had a significantly higher mean HK–LS than the control group (18.97 ± standard deviation [SD] 2.10 vs. 14.98 ± SD 3.55, respectively; p < 0.001). Significantly higher medication adherence was observed in the intervention group than in the control group (MGL score of 3.76 ± 0.52 vs. 3.20 ± 0.87, respectively; p < 0.001). Patients in the intervention group had a significant reduction in mean SBP/DBP (−6.15/−2.58 mmHg) compared with the control group (−0.98/−0.92 mmHg; p < 0.001).ConclusionPharmacist‐led interventions resulted in a significant improvement in disease knowledge, medication adherence, and BP control in the Vietnamese context of practice and health system.

Development and implementation of ambulatory care pharmacy services at an internal medicine clinic.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. This report describes the step-by-step process that led to expansion of ambulatory care pharmacy services at a newly established internal medicine clinic within a patient-centered medical home in North Carolina. Implementation of clinical pharmacist services at the clinic was led by a postgraduate year 2 (PGY2) pharmacy resident and guided by the 9 steps described in the book Building a Successful Ambulatory Care Practice: A Complete Guide for Pharmacists. After a needs assessment and review of the demographics and insurance status of the clinic's target population, it was determined that pharmacist services would focus on quality measures including diabetes nephropathy screening, diabetes eye examination, blood glucose control in diabetes, discharge medication reconciliation, annual wellness visits, and medication adherence in diabetes, hypercholesterolemia, and hypertension. Clinic appointments were conducted under 3 models: a pharmacist-physician covisit model, a "floor model" of pharmacist consultation on drug information or medication management issues during medical resident sign-out sessions with supervising physicians (medical residents could also see patients along with the pharmacist at a covisit appointment), and a covisit model of stacked physician and pharmacist appointments. The pharmacist's services were expanded from 2 half-day clinic sessions per week initially to 5 or 6 half-day clinic sessions by the end of the residency year. By the fourth quarter of the first PGY2 residency year in which ambulatory care pharmacy services were provided in the clinic, the clinical and financial impact of those services justified the addition of a second full-time pharmacist to the clinic team.

Predicting the Intention to Adhere to Hypertensive Medication among Seniors: A Cross-Sectional Survey

Non-adherence to hypertension treatment is a wide problem, especially among senior citizens. Several approaches are needed to improve adherence, including identifying and prioritizing problems related to adherence. A formative study employing Theory of Planned Behavior (TPB) has revealed some salient beliefs underlying the intention to adhere to hypertension medication among seniors. To be the priority in a medication adherence strategy, the correlation of these beliefs on adherence needs to be further investigated. This study aims to determine which beliefs correlate most to the intention to hypertension medication adherence among seniors. A cross-sectional survey was conducted to seniors with hypertension in Yogyakarta and its surroundings. A questionnaire based on TPB was developed and utilized in this study. The questionnaire was distributed conveniently through two senior communities (offline) as well as Google Form link to some WhatsApp group of seniors (online) during September-October 2023. The data were analyzed using multiple linear regressions. Thirty-seven seniors completed the offline questionnaire, and 60 seniors completed the online questionnaire. The age of participants was 64.70 ± 7.123 years. Subjective norms and perceived behavioral control accounted significantly (p<0.001) for 59,3% of the variance in the adherence intention, but not attitude. Perceived behavioral control had the strongest correlation on intention. Participants’ beliefs of knowing how high their blood pressure was had the highest correlation to perceived behavioral control. Understanding which belief correlates most with intention to adherence provides insight to develop strategy to improve adherence among seniors.

Association Between Self-Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of SPRINT (Systolic Blood Pressure Intervention Trial).

Therapeutic inertia (TI), failure to intensify antihypertensive medication when blood pressure (BP) is above goal, remains prevalent in hypertension management. The degree to which self-reported antihypertensive adherence is associated with TI with intensive BP goals remains unclear. Cross-sectional analysis was performed of the 12-month visit of participants in the intensive arm of SPRINT (Systolic Blood Pressure Intervention Trial), which randomized adults to intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic BP goals. TI was defined as no increase in antihypertensive regimen intensity score, which incorporates medication number and dose, when systolic BP is ≥120 mm Hg. Self-reported adherence was assessed using the 8-Item Morisky Medication Adherence Scale (MMAS-8) and categorized as low (MMAS-8 score <6), medium (MMAS-8 score 6 to <8), and high (MMAS-8 score 8). Poisson regressions estimated prevalence ratios (PRs) and 95% CIs for TI associated with MMAS-8. Among 1009 intensive arm participants with systolic BP >120 mm Hg at the 12-month visit (mean age, 69.6 years; 35.2% female, 28.8% non-Hispanic Black), TI occurred in 50.8% of participants. Participants with low adherence (versus high) were younger and more likely to be non-Hispanic Black or smokers. The prevalence of TI among patients with low, medium, and high adherence was 45.0%, 53.5%, and 50.4%, respectively. After adjustment, neither low nor medium adherence (versus high) were associated with TI (PR, 1.11 [95% CI, 0.87-1.42]; PR, 1.08 [95% CI, 0.84-1.38], respectively). Although clinician uncertainty about adherence is often cited as a reason for why antihypertensive intensification is withheld when above BP goals, we observed no evidence of an association between self-reported adherence and TI.

Impact of a Pharmacy Care Management Service on Medically Complex Medicare Advantage Members

Summary Medicare Advantage (MA) programs have grown rapidly, and a shift toward more medically complex beneficiaries has implications for health care utilization, costs, and quality in the MA program. Ensuring safe and effective medication use in this population has been identified as a priority, yet there is limited evidence to guide MA plans’ pharmacy care management (PCM) efforts. The goal of this study was to investigate the impact of an integrated PCM program for MA beneficiaries taking multiple chronic medications, including a subset with high predicted cost savings from improved medication adherence, assessed using the Value of Future Adherence (VFA) score. Using adjudicated administrative claims data from a regional Medicare Advantage and Part D (MAPD) plan, a retrospective matched cohort study was designed. A total of 724 members receiving PCM services were matched to 3,620 control members who received usual pharmacy care. From these two cohorts, 196 of 724 PCM participant members and 980 of 3,620 control group members were defined as having a high VFA score. PCM program enrollees underwent monthly medication reviews, reconciliation, and synchronization of refills, which were dispensed and delivered to the home in adherence packaging by a specially equipped pharmacy. Members were contacted monthly and received, as needed, education, referral to health care providers, consultation with prescribers on changes to medication regimens, and referral to social support or case management programs. Primary outcomes of interest were per enrollee per month (PEPM) costs, resource utilization, and medication adherence for three MAPD Star Ratings measures — Medication Adherence for Diabetes Medications, Medication Adherence for Hypertension (renin-angiotensin system antagonists [RASAs]), and Medication Adherence for Cholesterol (statins) — over 12 months for all members and for the subgroup with a high VFA score. The authors found that among all PCM program enrollees, there was a $50 (95% confidence interval [CI], $15 to $86; P = 0.005) PEPM increase in average pharmacy spending compared with control members and an offsetting $158 (95% CI, −$265 to −$51; P = 0.004) PEPM decrease in medical spending, resulting in PCM participants having $108 (95% CI, −$221 to $5; P = 0.062) lower PEPM total cost of care. Compared with the control group, PCM enrollees had 15% (P = 0.008) fewer inpatient stays and improvements in medication adherence of 7.3% among members taking oral antidiabetic agents, 9.4% among members taking statins, and 12.9% among members taking RASA antihypertensive agents (P < .001 for all three measures). These effects were driven by the patients in the subgroup with a high VFA score, for whom PEPM total cost of care was $406 (95% CI, −$645 to −$161; P < 0.001) lower than control members. These findings support the potential value of an integrated PCM program for MAPD beneficiaries on multiple medications, particularly when targeted to those members predicted to benefit most.

ASSESSING USABILITY OF A MEDICATION ADHERENCE SYSTEM FOR PERSONS WITH MILD COGNITIVE IMPAIRMENT

Abstract Persons with mild cognitive impairment (PwMCI) are at risk of medication nonadherence due to prospective memory deficits. Over time, they are likely to experience accelerated deterioration in cognitive functions and may develop dementia when comorbid treatable health conditions, such as hypertension, are not well managed. A digital therapeutic system called Medication Education, Decision Support, Reminding, and Monitoring (MEDSReM©) has been designed for cognitively normal older adults to support hypertension medication adherence and is currently being tested in a randomized controlled trial. MEDSReM has the potential to support PwMCI with hypertension medication adherence, but it must be optimized specifically for this population. We conducted a cognitive walkthrough to identify usability issues and inform the redesign and optimization of the system for PwMCI. This usability technique is used to evaluate a system from a user’s perspective and is typically conducted by subject matter experts. We had 12 individuals with interdisciplinary expertise in cognitive aging, cognitive impairment, hypertension management, nursing, human factors, and health technology participate in the cognitive walkthrough. Usability issues related to figure-ground contrast, text complexity, and flexibility related to decision making were identified. Overall, recommendations included (1) simplifying the user interface (e.g., color contrast/textual cues), (2) eliminating options related to medication taking actions (e.g., snooze, take later) to mitigate memory-related errors, and (3) providing more direct, prescriptive instructions to minimize decision-making demands. Based on these recommendations, MEDSReM is currently being redesigned for testing with PwMCI. Our approach can inform the design of other mobile health tools.

A cost-analysis of managing secondary and apparent treatment-resistant hypertension in a specialist multidisciplinary hypertension clinic.

A knowledge gap exists around the costs and budget impact of specialist hypertension clinics. This study reports on the cost of providing care in a multidisciplinary hypertension clinic staffed by nephrologist, endocrinologist and cardiologist, which manages patients with suspected secondary hypertension and/or apparent treatment-resistant hypertension. The aim of this study is to provide the evidence required to inform policy and planning care pathways for this patient group. A cost analysis from a healthcare provider perspective using micro-costing techniques was conducted to estimate the direct implementation costs of existing standard practice for the care pathway of patients attending the multidisciplinary hypertension clinic. Sixty-five patients originally recruited for a study of medication adherence in hypertension were included in the sample. The total care-pathway cost per patient, taking into account clinic visits, clinical reviews, investigations and MDT discussion, was estimated to be €3277, on average. For the patient subgroups, the average cost was €5644 for patients diagnosed with primary aldosteronism and €1446 for patients diagnosed with essential hypertension. There is significant cost associated with providing specialized hypertension care for patients with apparent treatment-resistant hypertension. Given the high rates of nonadherence in this population, it is likely that some of this cost could be avoided with better detection and management of medication adherence in this challenging population. Future studies should consider the cost-effectiveness of this or similar models of care by exploring the benefit to patients and the wider healthcare context of providing care of this type.

Abstract 13622: Association Between Self-Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)

Introduction: Therapeutic inertia (TI), the failure to intensify antihypertensive medication when blood pressure (BP) is above goal, remains highly prevalent in hypertension management. The degree to which self-reported antihypertensive adherence is associated with TI when targeting intensive BP goals remains unclear. Methods: Cross-sectional analysis of the 12-month visit of participants randomized to the intensive systolic BP (SBP) arm of the SBP Intervention Trial (SPRINT), which randomized adults at high cardiovascular disease risk to an intensive (&lt;120 mm Hg) vs. standard (&lt;140 mm Hg) SBP treatment group. TI was defined as no change in the antihypertensive medication regimen intensity score, which incorporates the medication number and dose, when the SBP &gt;120 mm Hg. Self-reported medication adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8) and categorized as low (&lt;6), medium (6 to &lt;8), and high (8). Poisson regression models with robust error variance estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for TI associated with MMAS-8 category. Results: Among 1,009 intensive arm participants with SBP &gt;120 mm Hg at the 12-month visit (mean age 69.6 years, 35.2% female, 28.8% non-Hispanic Black), TI occurred in 50.8% of participants. Participants with low self-reported adherence (vs. high) were younger and more likely to be non-Hispanic Black or current smokers. The prevalence of TI among low, medium, and high adherence was 45.0%, 53.5%, and 50.4%, respectively. After adjustment, neither low nor medium adherence (vs. high) were associated with TI (PR 1.11; 95% CI 0.87,1.42, PR 1.08; 95% CI 0.84,1.38, respectively). Conclusion: Although clinician uncertainty about medication adherence is often cited as a reason for why antihypertensive intensification is withheld when the BP is above goal, we observed no evidence of an association between self-reported adherence to antihypertensive medication and TI.

Systematic review of motivational interventions to improve adherence to medication in patients with hypertension and meta-analysis

IntroductionAntihypertensive medication non-adherence is an important cause of poor control in hypertension. The role of motivational interventions to increase antihypertensive medication adherence remains unclear. ObjectiveTo systematically review RCTs of motivational interventions for improving medication adherence in hypertension. MethodsEMBASE and Pubmed were searched from inception to February 2019 for RCTs of motivational interventions for improving medication adherence in hypertension vs. usual care. Inclusion criteria: RCTs with motivational intervention to improve medication adherence in adults with hypertension. A blinded review was conducted by 2 reviewers. Disagreements were resolved by consensus/a third reviewer.Data extraction and quality appraisal was performed using the risk of bias tool from cochrane collaboration. The meta-analyses of blood pressure control used random-effects models to report mean difference and 95% CIs. Primary outcome was medication adherence and second outcome was blood pressure control. ResultsThe search methodology yielded 10 studies comprising 1171 participants. Medication adherence improved significantly in 5 studies. We could not perform pool analysis for this outcome due to different measurements of medication adherence. Seven trials reported significant results regarding blood pressure control.On pooled analysis, motivational interventions were not significantly associated with a systolic blood pressure (mean difference, −0.06; 95% CI, −0.05 to 0.18; p=0.63; I2=0.0%) or diastolic blood pressure (mean difference, −0.11; 95% CI, −0.10 to 0.31; p=0.28; I2=23.8%) decrease or blood pressure control. ConclusionsMotivational interventions seem to significantly improve medication adherence but not significantly blood pressure control in hypertension, although evidence is still being based on few studies, with unclear risk of bias.

The Impact of COVID-19 on Hypertension and Hypertension Medication Adherence Among Underrepresented Racial and Ethnic Groups: A Scoping Review.

To conduct a scoping review of articles which examined the impact of COVID-19 on HTN and HTN medication adherence among underrepresented racial/ethnic minorities. Seven studies were included in this review and impact of COVID-19 was examined at 4 levels: patient, provider, health system and society. The results indicated that patient level factors, such as high unemployment and inequitable access to telemedicine due to society factors- lack of access to high-speed Internet and variation in the offering of telehealth by health systems, were most impactful on adherence. Additionally, provider level clinical inertia may have further impacted adherence to HTN medication. Our review showed that the COVID-19 pandemic did not introduce new barriers but exacerbated preexisting barriers. Ongoing efforts are needed to change policies at the state and local levels to dismantle inequities in underrepresented communities to ensure access to health care with telemedicine to promote health equity.

Leveraging Electronic Health Record Technology and Team Care to Address Medication Adherence: Protocol for a Cluster Randomized Controlled Trial.

Low medication adherence is a common cause of high blood pressure but is often unrecognized in clinical practice. Electronic data linkages between electronic health records (EHRs) and pharmacies offer the opportunity to identify low medication adherence, which can be used for interventions at the point of care. We developed a multicomponent intervention that uses linked EHR and pharmacy data to automatically identify patients with elevated blood pressure and low medication adherence. The intervention then combines team-based care with EHR-based workflows to address medication nonadherence. This study aims to describe the design of the Leveraging EHR Technology and Team Care to Address Medication Adherence (TEAMLET) trial, which tests the effectiveness of a multicomponent intervention that leverages EHR-based data and team-based care on medication adherence among patients with hypertension. TEAMLET is a pragmatic, cluster randomized controlled trial in which 10 primary care practices will be randomized 1:1 to the multicomponent intervention or usual care. We will include all patients with hypertension and low medication adherence who are seen at enrolled practices. The primary outcome is medication adherence, as measured by the proportion of days covered, and the secondary outcome is clinic systolic blood pressure. We will also assess intervention implementation, including adoption, acceptability, fidelity, cost, and sustainability. As of May 2023, we have randomized 10 primary care practices into the study, with 5 practices assigned to each arm of the trial. The enrollment for the study commenced on October 5, 2022, and the trial is currently ongoing. We anticipate patient recruitment to go through the fall of 2023 and the primary outcomes to be assessed in the fall of 2024. The TEAMLET trial will evaluate the effectiveness of a multicomponent intervention that leverages EHR-based data and team-based care on medication adherence. If successful, the intervention could offer a scalable approach to address inadequate blood pressure control among millions of patients with hypertension. ClinicalTrials.gov NCT05349422; https://clinicaltrials.gov/ct2/show/NCT05349422. DERR1-10.2196/47930.

Stakeholder’s perspectives on acceptable interventions for promoting hypertension medication adherence in Namibia: nominal group technique

ObjectiveTo determine the most acceptable hypertension intervention package to promote hypertension adherence based on stakeholders’ perspectives.DesignWe employed the nominal group technique method and purposively sampled and invited key stakeholders offering...

Hypertension care during the COVID-19 pandemic in an integrated health care system.

Retention in hypertension care, medication adherence, and blood pressure (BP) may have been affected by the COVID-19 pandemic. In a retrospective cohort study of 64766 individuals with treated hypertension from an integrated health care system, we compared hypertension care during the year pre-COVID-19 (March 2019-February 2020) and the first year of COVID-19 (March 2020-February 2021). Retention in hypertension care was defined as receiving clinical BP measurements during COVID-19. Medication adherence was measured using prescription refills. Clinical care was assessed by in-person and virtual visits and changes in systolic and diastolic BP. The cohort had a mean age of 67.8 (12.2) years, 51.2% were women, and 73.5% were White. In 60757 individuals with BP measurements pre-COVID-19, 16618 (27.4%) had no BP measurements during COVID-19. Medication adherence declined from 86.0% to 80.8% (p< .001). In-person primary care visits decreased from 2.7 (2.7) to 1.4 (1.9) per year, while virtual contacts increased from 9.5 (12.2) to 11.2 (14.2) per year (both p < .001). Among individuals with BP measurements, mean (SD) systolic BP was 126.5 mm Hg (11.8) pre-COVID-19 and 127.3 mm Hg (12.6) during COVID-19 (p= .14). Mean diastolic BP was 73.5 mm Hg (8.5) pre-COVID-19 and 73.5 mm Hg (8.7) during COVID-19 (p= .77). Even in this integrated health care system, many individuals did not receive clinical BP monitoring during COVID-19. Most individuals who remained in care maintained pre-COVID BP. Targeted outreach may be necessary to restore care continuity and hypertension control at the population level.

Prevalence and determinants of medication adherence among patients taking antihypertensive medications in Africa: A systematic review and meta-analysis 2010-2021.

This study synthesized the prevalence and determinants of hypertension medication adherence. Systematic review and meta-analysis through systematic search in PUBMED, EMBASE, CINAHL, Cochrane library and Google Scholar, from 2010 to 2021. Screening was conducted and reported according to PRISMA criteria, and ten studies identified according to predetermined criteria. The studies were evaluated using the Mixed Method Appraisal Tool. Analysis was done using the narrative synthesis method. Prevalence data were examined using random effects meta-analysis in Comprehensive Meta-Analysis version 3. The overall prevalence of medication adherence was 34.1%, and determinants of medication adherence were the ability to attain hypertension control; hypertension knowledge; and treatment-related factors including belief of the drug efficacy, having commodities, sociocultural and financial-related factors. It is imperative to develop, test and use a comprehensive hypertension medication adherence tool that is culturally congruent to Africa.

Family Support Increases the Hypertension Medication Adherence in the elderly at Public Health Center of Simpang Tiga Pekanbaru

The prevalence of hypertension globally affects 22% of the world's population, and 36% of the incidence rate in Southeast Asia as well as in Indonesia continues to increase. Elderly with hypertension require special care and attention, family support is needed to remind them of medication adherence. The purpose of the study was to determine the correlation of family support and hypertension medication adherence in the elderly at Public Health Center of Simpang Tiga Pekanbaru. Desain of this study is descriptive correlation using cross sectional approach. Sample of this study consists of 112 elderly people with hypertension taken by purposive sampling technique. The instruments in his study used a Morisky Medication Adherence Scale (MMAS) questionnaire and a family support questionnaire. The data analysis used is chi-square. The results of the study from good family support were 59 (52.7%) respondents, family support was sufficient as many as 26 (23.2%) respondents, and families were less as many as 27 (24.1%) respondents. Meanwhile, the results of compliance with hypertension drug consumption were 63 (56.3%) respondents and non-compliance with drug consumption as many as 49 (43.8%) respondents. The results of the Chi-Square statistical test obtained a p-value of 0.002 (p&lt;0.05) meaning that there was a significant relationship between the relationship of family support to adherence to hypertension drug consumption in the elderly at the Public Health Center of Simpang Tiga Pekanbaru. The recommendations of this study are expected by families to always provide motivation and accompany the elderly in their control and activities.

A TRANSDISCIPLINARY TEAM APPROACH TO TECHNOLOGY DEVELOPMENT TO SUPPORT HEALTH AND WELL-BEING

Abstract Diverse disciplinary and experiential knowledge is required to understand the challenges and develop workable solutions to support the health and wellbeing of a rapidly aging population. We are developing a theory-based, digital therapeutic for self-management of hypertension medication adherence for older adults; namely, the Medication Education, Decision Support, Reminding, and Monitoring (MEDSReM) system. This development process has necessitated a transdisciplinary approach with members co-learning and working collaboratively to advance the MEDSReM system. Our group includes complementary expertise in pharmacy, nursing, human factors, cognitive aging, gerontology, and technology development. We describe the challenges of transdisciplinary teamwork, our collaborative processes, and strategies that led to successful integration of expertise in advancing MEDSReM. Lastly, we discuss useful approaches to technology conceptualization, and digital therapeutic development and implementation, as well as lessons learned in effective communication and coordination among the diverse team members to ensure that the MEDSReM goals are achieved.

TECHNOLOGY TO SUPPORT OLDER ADULTS' HEALTH, SAFETY, AND WELLBEING

Abstract Technology has revolutionized the ability to deliver interventions to support older adults’ health, safety, and wellbeing, and technology-based solutions have become increasingly important in the delivery of remote care during the COVID-19 pandemic. However, these interventions and novel approaches require a careful understanding of older adults’ needs, preferences, and abilities, and need to undergo tests of feasibility, acceptability, and efficacy. This session will present a sampling of research examining the development, testing, and implementation of technology-based solutions to support older adults. R. Azevedo will present on the development of a novel digital therapeutic for the self-management of hypertension medication adherence among older adults. S. Kwon will present on the initial efficacy of an app-based mindfulness-meditation intervention to alleviate stress and depressive symptoms among bereaved older adults. Y. Du will discuss the use of a commercial fitness tracker to facilitate activity self-monitoring among overweight diabetic older adults with and without kidney disease. S. Dimmick will discuss the development of a novel augmented reality (AR) safety checklist to reduce fall risk among older adults. Finally, F. Jain will present on the development of a new mobile application platform to meet the needs of family dementia caregivers informed by focus groups and an inductive and deductive mixed method analytic approach. Themes of the necessity of a user-centered design approach in the development of technology-solutions will be emphasized.

Adherence to prescribed antihypertensive medication among patients with depression in the United States

BackgroundHypertensive patients with depression have a higher mortality rate and a worse prognosis compared with hypertensive only. Depression may reduce medication adherence in hypertension patients.MethodsThis study includes respondents in the National Health and Nutritional Examination Survey (NHANES) database from 2005 to 2018 who had previously been diagnosed with hypertension. Medication adherence was defined as taking medication as recommended by a physician. The depressive state was assessed using the patient health questionnaire (PHQ)-9.ResultsNine thousand one hundred eighty-six respondents were included in the analysis. Medication adherence was associated with depression (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.26 to1.75) and depression score (OR: 1.04 per each point increase, 1.03 to 1.05) in the unadjusted analyses. After adjusting for clinical and socioeconomic/demographic factors, there were significant statistical correlations between depression score and medication adherence (aOR: 1.02 per each point increase, 1.00 to 1.03, p < 0.05), but there was no significant statistical correlation between depression and medication adherence (p > 0.05). It was still statistically significant relationships between sex, age, body mass index (BMI), race, marital status, and health insurance with medication adherence after adjusted socioeconomic/demographic factors.ConclusionDepression was marginally associated with poor medication adherence in hypertensive patients, and the correlation increased with depression degree. Moreover, socioeconomic/demographic factors have an independent impact on medication adherence including sex, age, BMI, race, marital status, and health insurance.

Effect of Income Level on Stroke Incidence and Mediated Effects of Medication Adherence in Newly Diagnosed Hypertensive Patients: A Causal Mediation Analysis Using a Nationwide Cohort Study in South Korea

Objectives: This study aimed to determine the associations between income level and stroke incidence in hypertensive patients. We also tried to measure the mediating effect of poor antihypertensive medication adherence through causal mediation analysis. Methods: This study used the National Health Insurance Service National Sample Cohort Data from 2006 to 2015. The study population was newly diagnosed patients with hypertension aged 18 to 80. The associations between the independent-dependent variables, the mediator-dependent variables were confirmed with Cox proportional hazards regression models. In order to verify the mediating effect of poor hypertension medication adherence between income level and stroke occurrence, a weighting approach of causal mediation analysis method was used. Since age was the moderate variable, 18-49 years old and 50-80 years old were stratified. Results: Under 50 years of age, all the other income groups had a significantly higher risk of poor medication adherence than the highincome group. For the patients aged 50 and older, the low-income group and the Medical Aid beneficiaries had a higher risk of poor medication adherence compared to the high-income group. In the patient under 50 years of age, the risk for the stroke incidence of the low-income group and the Medical Aid beneficiaries were higher than those in the high-income group. In the patients aged 50 and older, all the other income groups had a significantly higher risk of incidence of stroke. Causal mediation analysis showed that the mediated effect of poor medication adherence in all groups was not significant. Conclusions: Low income significantly increased poor hypertension medication adherence and the incidence of stroke. The mediated effect of poor medication adherence was not significant.

A Study on Types of Medication Adherence in Hypertension among Older Patients and Influencing Factors.

Hypertension has the characteristic that the risk of complications can be reduced through appropriate medication in daily life. Hence, it is important to consider practical measures to increase medication adherence, particularly among older patients. This study used the Korea Health Panel 2020 data (Version 2.0.1), jointly conducted by Korea Institute for Health and Social Affairs and National Health Insurance. A total of 2300 patients with high blood pressure over 65 years of age were selected. In order to identify types of medication adherence in older hypertensive patients, and examine factors that influence the types, the Latent Profile Analysis (LPA) and logistic regression were performed. The types of adherence groups were classified into two groups: an 'adherence group' (87.1%) and a 'non-adherence group' (12.9%). Furthermore, age, living alone, and depressive symptoms were identified as determinants of medication adherence type among older hypertensive patients. The significant impact of sociodemographic status (age, living alone, and depressive symptoms) on medication adherence among older hypertensive patients indicates the need to establish more specific empirical interventions based on each type's characteristics. It is expected that this study will provide an in-depth understanding of factors associated with medication adherence among older patients with hypertension, which can support interventions tailored to the specific needs of those who are non-adherent.