Achieving patient buy-in and long term compliance with antihypertensive treatment

Noncompliance is a major problem in antihypertensive treatment, Up to 50% o f patients are noncompliant after 1 year and 85% after 5 years. Current app roaches for predicting compliance are based on patient demographics, medica tion characteristics and clinical factors, health beliefs and the quality o f patient-provider communication. All of these factors together predict com pliance only less than half the time, indicating that over half of the pati ents in disease management programmes may not buy-in to their treatment. A new approach views compliance as behaviour change that takes place over t ime. Patients move through 5 stages in their 'readiness to comply'. Our stu dy of over 700 patients with hypertension using brief self-report measures to assess their 'readiness to comply' found a highly significant relationsh ip between 'readiness to comply' and reported compliance. Clinicians can in crease patient buy-in and long term compliance by assessing their patients 'stage-of-change' using validated measures and then matching their interven tions to each patient's 'readiness to comply'. Physicians who treat patients with hypertension know that compliance with o utpatient drug therapy is a major problem in disease management. Over the l ast 35 years, many clinicians and clinical researchers have tried to solve this problem but their attempts to Set patients to consistently take their medication have been, at most, partially successful. Even those able to som ewhat increase compliance have turned out to be very costly in terms of bot h resources and pcrsonnel.([1]) This paper describes what has and has not worked to improve patient complia nce, and includes new ideas about compliance from research in behavioural m edicine. In addition, it makes some suggestions, based on research, of what can be done to increase patients' involvement with, and adherence to, trea tment. These interventions do not have to be costly in terms of time, perso nnel or resources but, for them to be effective, they have to be customised to the individual needs of each patient. To do so, a patient's 'readiness to comply' has to be assessed carefully.