In this blog, Dr Katerina Kassavou reports that more patients with high blood pressure took their medications as prescribed and experienced lower blood pressure after participating in a behavioural intervention in primary care called the Programme on Adherence to Medication, compared with patients who had normal care.
In the UK around a third of adults have been diagnosed with hypertension (HBP; High Blood Pressure). Adherence to prescribed medication can considerably reduce the risks associated with HBP, however a substantial proportion of patient are not adherent to prescribed treatment. Although practitioners have an important role in advising and supporting patients’ adherence, their time is limited and expensive.
Researchers at the Behavioural Science Group, led by Professor Stephen Sutton at the University of Cambridge, have developed and tested the feasibility of a behavioural intervention to support medication adherence to patients prescribed treatment for hypertension in primary care. The research is published in Scientific Reports today.
The intervention consists of a Very Brief Advice (VBI) by a practice nurse or a health care assistant, followed by ongoing digital support in the form of text messages or a smartphone app – the Programme on Adherence to Medication (PAM).
The randomised clinical controlled trial in primary care
This research tested the feasibility of the PAM intervention in nine primary care practices across East of England and London. Primary care practices identified non-adherent patients with HBP by searches at their practice records and invited them to the trial. The invitation had 15.5% expression of interest to participate within the first two weeks of invitation.
In total 101 patients were recruited (average age 65.8 years, 54% male), with most patients located in middle to high areas of deprivation. They had been prescribed on average 2.5 (min 1, max 6) daily doses of medication for hypertension. Patients attended usual care consultations at their GP practice, during which a practice nurse or health care assistant confirmed patient eligibility and completed medication reviews and blood pressure checks. Patients were then randomly allocated to the PAM intervention or to usual care only.
Three months later, patients (83%) attended follow up clinical consultations, where a practitioner completed the follow up blood pressure checks. Patients provided urine samples for biochemical analysis of adherence to antihypertensive medications.
Adjusted analysis suggested that biochemically validated medication adherence was improved by 20% (95%CI 3% to 36%) in the intervention than control, and systolic blood pressure was reduced by 9.16 mmHg (95%CI 5.69 to 12.64) in intervention than control. Improvements in medication adherence and reductions in blood pressure suggested potential intervention effectiveness.
The results of this feasibility RCT will inform the design of a larger clinical trial in primary care. The main trial will involve 50 practices across East of England, London, Yorkshire, and Thames and South Midlands to recruit 542 patients to evaluate the effectiveness and the cost effectiveness of the PAM intervention in primary care.
This research is funded by the NIHR National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0615-20013).
A Kassavou, V Mirzaei, S Shpendi, J Brimicombe, J Chauhan, D Bhattacharya, F Naughton, W Hardeman, H Eborall, M Van Emmenis, A De Simoni, A Takhar, P Gupta, P Patel, C Mascolo, AT Prevost, S Morris, S Griffin, R J. McManus, J Mant & S Sutton ‘The feasibility of PAM intervention to support treatment‑adherence in people with hypertension in primary care: a randomised clinical controlled trial‘ Scientific Reports 26 April 2021
Lucy Lloyd, Primary Care Unit communications