Clinic management combined with home visits did not differ from clinic management alone for medication adherence, with ~77% of completers taking >98% of prescribed pills at 6 months.
RCT (n=544)
randomized
Yes
Does adding home visits to clinic management improve medication adherence in patients with previously untreated hypertension?
A community-based, nurse-led hypertension treatment program achieved high medication adherence and blood pressure control in Nigeria, with no additional adherence benefit observed from adding home visits.
BACKGROUND: Research in industrialized countries has demonstrated that a key factor limiting the control of hypertension is poor patient adherence and that the most successful interventions for long-term adherence employ multiple strategies. Very little data exist on this question in low-income countries, wherein medication-taking behavior may be less well developed. METHOD: We conducted a treatment adherence trial of 544 patients mean age ∼63 years, mean blood pressure (BP) ∼168/92 mmHg with previously untreated hypertension in urban and rural Nigeria. Eligible participants were randomized to one of two arms: clinic management only, or clinic management and home visits. Both interventions included three elements: a community based, nurse-led treatment program with physician backup; facilitation of clinic visits and health education; and the use of diuretics and a β blocker as needed. After initial diagnosis, the management protocol was implemented by a nurse with physician backup. Participants were evaluated monthly for 6 months. RESULTS: Medication adherence was assessed with pill count and urine testing. Drop-out rates, by treatment group, ranged from 12 to 28%. Among participants who completed the 6-month trial, overall adherence was high (∼77% of participants took >98% of prescribed pills). Adherence did not differ by treatment arm, but was better at the rural than the urban site and among those with higher baseline BP. Hypertension control (BP <140/90 mmHg) was achieved in approximately 66% of participants at 6 months. CONCLUSION: This community-based intervention confirms relatively modest default rates compared with industrialized societies, and suggests that medication adherence can be high in developing world settings in clinic attenders.
Adeyemo et al. (Thu,) conducted a rct in previously untreated hypertension (n=544). Clinic management and home visits vs. Clinic management only was evaluated on Medication adherence. Clinic management combined with home visits did not differ from clinic management alone for medication adherence, with ~77% of completers taking >98% of prescribed pills at 6 months.