Table 16Hypertension: summary of findings

Type of InterventionStudies, N RandomizedAdherence:
Measure, Followup Period
Overall Result (+/=/−) and Timing
Additional Outcomes:
Outcome
Overall Result (+/=/−) and Timing
Blister packagingSchneider et al., 2008100
N=93
+

Percentage of patients refilling medications on time over 12 months

+

Medication possession ratio over 12 months

Morbidity
=

Systolic blood pressure change at 6 months and 12 months

=

Diastolic blood pressure change at 6 and 12 months

=

Proportion of patients with reduced systolic blood pressure at 6 and 12 months

=

Proportion of patients with reduced diastolic blood pressure at 6 months

+

Proportion of patients with reduced diastolic blood pressure at 12 months

=

Occurrence of angina at 6 and 12 months

=

Occurrence of MI at 6 and 12 months

=

Occurrence of stroke at 6 and 12 months

Health care utilization
=

ED visits and hospitalizations at 6 and 12 months

Case managementBogner et al., 2007101
N=64
+

Adherence for taking ≥80% hypertensive medications over 6 weeks

Morbidity
+

Systolic blood pressure (mean) at 6 weeks

+

Diastolic blood pressure (mean) at 6 weeks

Rudd et al., 2004102
N=150
+

Adherence for number of days medications taken correctly over 6 months

Morbidity
+

Systolic blood pressure (change), from baseline to 6 months

+

Diastolic blood pressure (change), from baseline to 6 months

Wakefield et al., 2011103
N=302
=

Morisky scale scores at 6 months

NA
Collaborative careCarter et al., 2009104
N=402
=

Morisky scale, percentage of patients reporting low medication adherence at 6 months

=

Morisky scale, within-group change in percentage of patients reporting low adherence from baseline to 6 months

NA
Hunt et al., 2008105
N=463
=

Morisky scale, percentage of patients reporting high medication adherence at 12 months

=

Morisky scale, change in report of high medication adherence, from baseline to 12 months

NA
Lin et al., 200689
N=329
=

Percentage of days nonadherent to hypertension medication over 12 months

=

Adjusted difference in percentage of days nonadherent comparing G1 and G2 over 12 months

NA
Education and behavioral support (telephone, mail, and/or video)Bosworth et al., 2008106,107
N=636
=

Morisky scale, percentage reporting high adherence at 6 months

=

Morisky scale, change in percentage reporting adherence from baseline to 6 months

NA
Bosworth et al., 2005108
N=588
=

Morisky scale, change in proportion reporting adherence from baseline to 6 months

NA
Friedman et al., 1996109
N=299
=

Unadjusted adherence to hypertensive medication by pill count, change from baseline to 6 months

+

Adjusted adherence to hypertensive medication by pill count, change from baseline to 6 months

Morbidity
=

Systolic blood pressure change from baseline to 6 months

=

Diastolic blood pressure change from baseline to 6 months

Johnson et al., 2006110
N=1227
=

Behavioral measure of nonadherence at 6 months

+

Behavioral measure of nonadherence at 12 months and 18 months

NR
Powell et al., 199597
N=4246
=

Medication possession ratio over 9 months, overall and for antihypertensive medications, over 9 months

=

Percentage of participants with ≥80% medication possession ratio, over 9 months, overall and for antihypertensive medications

NA
Education (face-to-face with pharmacist)Lee et al., 200678
N=159
+

Proportion of pills taken over 6-month RCT

+

Percentage of participants with ≥80% adherence to medications over 6-month RCT

Among patients with hypertension:
Morbidity
+

Systolic blood pressure (mean) at 14 months (2-month run-in + 6-month cohort + 6-month RCT)

+

Systolic blood pressure difference between 2 months and 14 months (2-month run-in + 6-month cohort + 6-month RCT outcome)

=

Diastolic blood pressure at 14 months (6-month cohort + 6-month RCT outcome)

=

Diastolic blood pressure difference between 2 months and 14 months (2-month run-in + 6-month cohort + 6-month RCT outcome)

Solomon et al., 1998111,112
N=133 (Hypertension)
Among patients with hypertension:
+

Morisky scale score, reporting compliance at 4- to 6-month visit

+

Morisky scale score, difference in proportion reporting compliance between baseline and 4- to 6- month visit; improved in G1 not G2

Among patients with hypertension:
Morbidity
+

Systolic blood pressure (mean) at 4- to 6-month visit

+

Systolic blood pressure difference from baseline to 4- to 6-month visit within intervention group

=

Diastolic blood pressure (mean) at 4 to 6 months

=

Diastolic blood pressure difference from baseline to 4- to 6-month visit within intervention group

Quality of life
=

Sexual dysfunction, dizziness and headaches at 4 to 6 months

Patient satisfaction
+

Four medication-related questions at 4 to 6 months

=

One medication-related question at 4 to 6 months

Health care utilization
=

Emergency department visits over 4 weeks prior, at 4 to 6 months

+

Hospitalizations over 4 weeks prior, at 4 to 6 months (one-tailed p<0.05)

+

Contacts with other health care providers (MD, NP, PA or RN) over 4 weeks prior, at 4 to 6 months (one-tailed p<0.05)

Vivian et al., 2002113
N=56
=

Compliance survey questions at 6 months

=

Proportion of patients that received refills within 2 weeks of next scheduled refill date over 6 months

NA
Education with social supportPearce et al., 200591
N=199
=

Morisky, proportion with high, medium, or low adherence at 12 months

NA
Risk communicationPowers et al., 2011114
N=89
=

Morisky, proportion with high adherence at 3 months

NA

Abbreviations: (+) = statistically significant difference favoring intervention arm(s); (=) = no statistically significant difference; (−) = statistically significant difference favoring comparison arm; ED = emergency department; G = group; MD = physician; MI = myocardial infarction; N = number; NA = not applicable; NP = nurse practitioner; NR = not reported; PA = physician assistant; RCT = randomized controlled trial; RN = registered nurse.

From: Results

Cover of Closing the Quality Gap: Revisiting the State of the Science (Vol. 4: Medication Adherence Interventions: Comparative Effectiveness)
Closing the Quality Gap: Revisiting the State of the Science (Vol. 4: Medication Adherence Interventions: Comparative Effectiveness).
Evidence Reports/Technology Assessments, No. 208.4.
Viswanathan M, Golin CE, Jones CD, et al.

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