Patients’ persistence with antihypertensive medication found directly related to clinical decision-making
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Better clinical decision-making and data collection skills, as well as early modifications in therapy, improved the persistence among those taking an antihypertensive medication, study results suggested.
The patients with hypertension (n=13,205) compiled for the study had started antihypertensive medication and entered a clinical practice in Quebec, between 1993 and 2007. Researchers used Medical Council of Canada licensing examination scores to determine medical management and communication ability, as well as population-based prescription and medical services databases to assess starting therapy, treatment changes, comorbidity and persistence with antihypertensive treatment.
Within 6 months, 2,926 patients (22.2%) had discontinued all antihypertensive medication. The risk of non-persistence decreased in patients treated with better medical management (OR=0.74; 95% CI, 0.63-0.87); improved communication ability (OR=0.88; 95% CI, 0.78-1.00); and with early therapy changes, more follow-up visits and non-diuretics as the initial choice of therapy (OR=0.45; 95% CI, 0.37-0.54). Furthermore, medical management ability, particularly clinical decision-making, accounted for 15.8% (95% CI, 7.5%-23.3%) of persistence in the first 6 months.
According to the researchers, the most fruitful way to support clinical decision-making and medication monitoring will be the development and evaluation of tools in the practice environment. “In particular, new information technologies that can be integrated with the electronic medical record may have the greatest promise for enhancing drug- and patient-specific follow-up of adverse effects and treatment effectiveness,” they concluded. “Technologies such as computerized decision support, community drug profiles from retail pharmacies, and follow-up monitoring tools such as interactive voice recording approaches have been shown to be effective in management of some chronic conditions, and their increased use in hypertension treatment should improve patient adherence and, ultimately, clinical outcome.” – by Brian Ellis
Tamblyn R. Arch Intern Med. 2010;170:1064-1072.
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