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Improving Adherence

Adherence to treatment is a major barrier to managing hypertension.

There is evidence that around half of the patients prescribed an antihypertensive drug stopping taking it within 1 year[2]. Low adherence is the most common cause of apparent resistant hypertension [3].  

A systematic review and meta-analysis  [5] of interventions to improve medication adherence in hypertensive patients found the largest effect sizes for interventions that:

  • Linked patient habits with medication taking.
  • Employed motivational interviewing.
  • Provided medication in special packaging or pill boxes.
  • Encouraged self monitoring.
  • Were repeated over several visits, rather than once off. 

NICE has produced guidelines to help improve adherence which are available here. They recommend assessing non-adherence by asking the patient if they have missed any doses of medicine recently and making it easier for them to report non˗adherence by:

  1. Asking the question in a way that does not apportion blame
  2. Explaining why you are asking the question
  3. Mentioning a specific time period such as 'in the past week'
  4. Asking about medicine-taking behaviours such as reducing the dose, stopping and starting medicines.

Tools for addressing adherence include:

  1. Pointers for discussions on adherence 
  2. New Medicine Service (NMS)

The NMS is a nationally commissioned NHS contractual service aimed at providing support for patients within the first month of starting a new medication.  It covers four areas: hypertension, type 2 diabetes, asthma and chronic obstructive pulmonary disease (COPD), and anticoagulation and antiplatelet therapy. The NMS aims to improve patient adherence to long-term medications by encouraging engagement with their new medication. 

  • The NMS Medicines List Factsheet is available here

A RCT found that after 20 weeks adherence was ten percentage points higher in the intervention (NMS) group (70.7%) than in the control (usual care) group (60.5%) [4]

How to use the NMS:

  • Write on the paper prescription "NMS".
  • Or put "NMS" in the free text box of the electronic prescription.
  • Remind the patient to ask the pharmacist for a NMS when they give in their prescription.

Training available:

Addenbrookes hypertension clinic provides update training sessions for practices in hypertension. These can be found here.