Magazine article Drug Topics

Effect of Health Education on the Utilization of Antihypertensive Therapy: A Prospective Trial among HMO Enrollees

Magazine article Drug Topics

Effect of Health Education on the Utilization of Antihypertensive Therapy: A Prospective Trial among HMO Enrollees

Article excerpt

Patient noncompliance with prescription regimens remains a major health care concern, especially for those persons prescribed life-long therapy.(1-3) The medical literature documents a rapid and alarming decline in prescription refill requests among patient groups recording no significant change in health status.(4,5) Moreover, patient noncompliance has been associated with an increase in hospital admissions, length of stay, and resulting health care expenditures.(6-9)

Systemic hypertension represents a significant risk factor for the development of atherosclerotic coronary artery disease and is a principal cause of myocardial infarctions, cerebral vascular accidents, and congestive heart failure.(10-12) An estimated 58 million Americans have elevated blood pressure (BP; systolic BP >140 mm Hg, and/or diastolic BP >90 mm Hg) requiring nonpharmacologic and/or pharmacologic treatment.(13-15) The expressed goal of life-style change and/or antihypertensive therapy is the achievement and long-term maintenance of a reduced BP (<140/90 mm Hg) with minimal, if any, adverse effects. (16-19) However, an estimated 30% to 50% of hypertensive patients withdraw from their prescribed regimen within 1 year of diagnosis; of the remainder, nearly 33% administer insufficient medication to reduce BP adequately.(20,21)

Recent evidence suggests that a multifactorial strategy incorporating written and verbal materials with sequential follow-up and reinforcement may enhance compliance with long-term therapeutic regimens.(22-26) In the present study, we attempted to determine the effectiveness of a multifaceted health education program to promote prescription-refill compliance among hypertensive patients enrolled in health maintenance organizations (HMOs).


The study population comprised 985 outpatient, staff model HMO enrollees from California, Delaware, Georgia, Massachusetts, Ohio, Texas, and Wisconsin. Patients were diagnosed with mild to moderate hypertension and prescribed a once-daily regimen of atenolol (Tenormin, ICI Pharmaceuticals, Inc) as monotherapy. The initial date of the 360-day study period was used to classify patients as having either new or existing (previously treated) hypertension. Patients with existing hypertension were required to have been prescribed atenolol for at least 3 months, but no more than 1 year, before entering the study. Patients in both categories were randomly assigned to an experimental or control group. Each patient was prescribed atenolol in a 30-day supply throughout the 360-day study period.

Patients assigned to the experimental groups received an enrollment kit when filling their initial prescription (new hypertension patients) or requesting their next sequential refill (existing-hypertension patients) during the study period. Each kit contained a 30-day supply of atenolol, an explanation of the intent and content of the educational program (Wellspring Service, ICI Pharmaceuticals, Inc), a newsletter discussing the importance of compliance with antihypertensive therapy, and information regarding nutrition and life-style change.

One week before the date of a patient's next sequential atenolol refill, a telephone conversation was initiated to ascertain whether the patient required information concerning the administration schedule and to remind the patient as to the date on which the next refill request was to be exercised. For 5 months thereafter, an enclosed medication refill reminder was mailed to the patient 10 days before the next scheduled prescription refill date. In addition, patients received an educational newsletter, with each issue devoted to a specific aspect of hypertension and life-style modification, along with samples and coupons for health related items.

The Medication Possession Patio (MPR) was defined as the number of days supply of medication obtained by a patient during the 360-day study period. Thus, the optimal outcome would result in a ratio of 1:1 (eg, 360 days supply obtained for 360 days); a less desirable outcome would be a ratio of <1:1 . …

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