Why we have not solved the nonadherence to antihypertensives problem yet

Hypertension is one of three most common chronic conditions with the highest avoidable cost. At least half of all strokes and heart attacks are associated with high blood pressure. In the UK, high blood pressure costs the NHS roughly £2.1 billion a year and is responsible for up to 75,000 deaths a year.[i] Although hypertension is one of the most preventable and treatable health conditions it is under-recognised and under-treated. When treated, between 50 and 80% of people with high blood pressure do not take their medicine as prescribed.[ii]

So why is the uptake of care and medication so low?

The OECD published a Health Working Paper on adherence in chronic conditions with hypertension being one of the highlighted conditions.[iii] There are many reasons why non-adherence is not effectively addressed, and the authors focus on three key issues:

1. Adherence is often overestimated by people working in healthcare and policy makers. It is therefore not a priority on the health policy agenda. This creates systematic barriers in providing interventions to address adherence and a lack of monitoring of the issue.

2. When there is an awareness of non-adherence, interventions tend to focus on patient-driven issues and are generally organised locally and temporarily - leading to little or temporary changes. The emphasis is often on giving information, rather than assessing the personal issues a patient is experiencing – such as side-effects or stigma.
   
   
3. When adherence is addressed in routine consultation, there is often a lack of shared decision-making. Healthcare providers may take a disease-focused approach - telling patients what to do but not including them in choices around their own health. This can leave patients feeling excluded; like the care offered does not represent their best interests.

How do we move away from this vicious cycle?

The OECD offers four targets to aid the adherence problem:

1. Acknowledge the impact of non-adherence on health outcomes and healthcare costs
2. Systematically monitor adherence
3. Make changes to financial incentives around better adherence
4. Better communication between prescriber/ dispenser/ patient through guidelines, training and systems

Research suggests that adopting a person-centred approach, rather than a disease-centred approach – incorporating patient believes, barriers and concerns – will lead to much better health outcomes. But the lack of training provided for healthcare professionals in assessing and tackling adherence issues, prevents effective interventions from being adapted. To improve medicine uptake amongst patients, healthcare professionals must understand the patients’ point of view. This is done through building trust and understanding individual needs.

CARE’s aims align with the OECD report targets. Through research and training, CARE aspires to inform the health community of the seriousness and scale of non-adherence amongst patients. The CARE training, in turn, provides healthcare professionals with the tools to address non-adherence from a patient-focused perspective, and the skills to change patient behaviour through individualised, shared decision-making strategies.

[i] Fenton, K., 2017. Health Matters: Combating high blood pressure. [Online]
Available at: https://ukhsa.blog.gov.uk/2017/01/24/health-matters-combating-high-blood-pressure/
[Accessed 12 May 2022].

[ii] Public Health England, Health matters: combating high blood pressure, January 2017

[iii] OECD (2018) Health Working Paper No. 105 INVESTING IN MEDICATION ADHERENCE IMPROVES HEALTH OUTCOMES AND HEALTH SYSTEM EFFICIENCY Adherence to medicines for diabetes, hypertension, and hyperlipidaemia.