January 18, 2024
By: Leah Fitzgerald, PharmD, BCACP
In 2024, CHPA will focus on three metrics that align across all populations served by member CHC’s: 1) A1c control for patients with diabetes, 2) blood pressure control for patients with hypertension, and 3) depression screening. According to the American Heart Association (AHA), hypertension is the number one diagnosis for office visits to primary care providers (1). Uncontrolled hypertension increases a patient’s risk of heart disease, stroke, and kidney disease. Drug therapy and lifestyle changes related to nutrition and physical activity are the recommended approaches to controlling hypertension. More than 55 million patients (about twice the population of Texas) are currently treated with anti-hypertensive medications (2) and studies have shown that adherence to antihypertensive medication therapy is the main predictor of treatment success and an effective step in controlling BP and preventing complications (3).
The AHA has identified four evidence-based categories that improve adherence to anti-hypertensive medications.
- Patient education and counseling should be provided to increase patient awareness of their condition and promote self-motivation and improve self-management skills. Education can be provided in the office or with pharmacist consultation. Incorporating a member of the behavioral health team has also shown to be effective in increasing adherence using motivational interviewing techniques.
- Medication regimen management can include simplifying regimens, using fixed-dose combination pills and offering 100-day supply of chronic medications to reduce refill burden. Because adherence data is often claims-based, don’t forget to send updated prescriptions to the pharmacy and let them know to cancel old prescriptions. If a patient is instructed to take a half tablet instead of one whole tablet and the pharmacy isn’t notified, a patient may be following the provider’s directions but will appear to be non-adherent based on old instructions and day supply calculations. Canceling old prescriptions will prevent automatic refills and also prevents patients from being included in a measure for a medication they are no longer taking.
- Reminders, monitoring, and feedback to assist patients with managing medication regimens improve adherence rates. Patient reminders to get refills through text, email and phone calls are all strategies that improve adherence rates. Self-monitoring of blood pressure and using smartphone apps to track measurements and remind patients to take medications are also effective.
- Incentives for patients can include eliminating copays and reducing out-of-pocket costs for obtaining anti-hypertensive medications. Providers can assist by paying attention to formulary compliance and being aware of preferred pharmacies that benefits the patient.
CHPA is dedicated to helping our members improve medication adherence rates and increase blood pressure control among patients with hypertension. Please contact me, CHPA’s clinical pharmacist, Leah Fitzgerald (lfitzgerald@chpanetwork.com) with questions about how we can support your CHC.
- American Heart Association. Medication Adherence and Blood Pressure Control: A Scientific Statement from the American Heart Association. Accessed January 20, 2024. https://www.ahajournals.org/doi/10.1161/HYP.0000000000000203
- Centers for Disease Control and Prevention. Facts about hypertension. Accessed November 9, 2020. https://www.cdc.gov/bloodpressure/facts.
- Mazzaglia G, Ambrosioni E, Alacqua M, Filippi A, Sessa E, Immordino V, et al. Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation. 2009;120:1598–1605. doi: 10.1161/CIRCULATIONAHA.108.830299. [PubMed] [CrossRef] [Google Scholar]
