Adherence to Blood Pressure Drugs Among Low Income Patients Remains a Challenge

Collaborative communication may improve medication adherence among low-income patients with high blood pressure.

Ensuring that low-income patients are taking their blood pressure medications properly may be easily achieved through open communication, according to a study published by Circulation: Quality and Outcomes.

The new study found that when healthcare providers did not use a collaborative communication style or inquire about social issues, such as employment, housing, and relationships, patients were less likely to adhere to treatment regimens.

Non-adherence to blood pressure drugs results in continuously uncontrolled blood pressure, which can put patients at an increased risk of heart attacks and strokes.

Included in the study were taped interactions between 92 patients and 27 providers over 3 months. Provider practices were located in low-income areas in New York City.

The authors reported that a majority of patients were black, unemployed, and had some college education. A majority of the patients were women who had been seeing the provider for more than 1 year.

Medication adherence was assessed through electronic monitoring devices that tracked when patients opened the pill bottle.

The authors discovered that patients were 3 times less likely to adhere to treatment regimens if their providers did not use a collaborative communication style, which is characterized by asking open-ended questions and ensuring patient understanding of instructions, according to the study.

Notably, the authors also found that patients were 6 times less likely to be adherent to blood pressure drugs if their provider did not ask about social issues.

“When healthcare providers ask patients about life challenges or take the time to check their patient’s understanding of instructions, it signals that their healthcare provider genuinely cares about them and provides the motivation and confidence to manage their health issues on their own,” said lead author Antoinette Schoenthaler, EdD.

Additionally, the authors discovered significant differences in the adherence of black and white patients. Black patients were more likely to have poor adherence to blood pressure drugs compared with white patients.

Compared with all patients, black patients whose social issues were not discussed were 8 times less likely to adhere to blood pressure drugs compared with the general population, which was 6 times as likely, according to the study.

The authors suggest that providers should collaborate with community health workers, nurses, or medical assistants to identify resources that can help improve adherence to blood pressure medication.

“Healthcare providers should talk to patients about the things that get in the way of taking their medication, such as relationship status, employment and housing,” Dr Schoenthaler said. “Unemployment, for example, affects whether patients can afford medication, which is a primary risk factor for non-adherence. If these issues go undiscussed, healthcare providers may never figure out why patients are not taking their medications.”