16 Strategies to Improve Adherence Multiple factors on multiple levels contribute to poor adherence. No single solution is likely to be effective, but a sustained approach using several supporting strategies can make a significant difference in adherence. Strategies should address the barriers as well as the importance and advantages of adhering to treatment. 7-Table 5, 7-Clinical Management/Mitigation of Suboptimal Adherence 1x Convenience and simplicity are key for treatment adherence. Polypharmacy may be unavoidable, but fewer pills are better than more pills. Mounting evidence supports improved adherence and improved clinical outcomes using once daily dosing over multiple daily doses as well as fixed-dose combination agents over multiple pills.3-Conclusion, 7-Clinical Management/Mitigation of Suboptimal Adherence Whenever possible, recommend that multiple medications be taken at the same time of day, consolidate refills for multiple medications and use 90-day prescriptions to reduce pharmacy visits. Easing treatment burden can improve adherence.6-Screening Methods, 7-Table 5, 8-Practice Pointers Treatment cost is also frequently a concern. Low-cost and generic agents are almost always preferred, even if not mandated by insurance coverage or other factors. Hypertension is a silent disease with no obvious signs and symptoms and taking hypertension medications brings little or no immediately obvious improvement for patients. However, hypertension education is crucial for patients, their families and caregivers — from the potentially dire consequences of hypertension to the potentially adverse effects of hypertension medications. Better informed patients are more engaged and involved in the decisionmaking process and more adherent. Telehealth and/or digital solutions including SMS, electronic monitoring and smartphone apps can help maintain contact and engagement between visits.9-Patient Factors Individual patient education and training on tools such as home BP monitoring can also boost engagement and adherence. Monitoring BP at home gives patients insight into their health and improves their sense of involvement in managing their own care and health.5-Multisystem Intervention to Improve Adherence Patient-centered motivational counseling can identify barriers to adherence and better include patients in treatment decisions. Successfu motivational approaches l include: • Daily reminder charts • Training in self-determination • Simplified treatment regimens • Combination of multiple medications that are meant to be taken together • Social and family support • Reminder texts and calls • Electronic aids • Virtual counseling7-Table 5, 8-Evidence-Based Answer, Practice Pointers Clinicians may also benefit from training to enhance their communication skills, boost their cultural competence and improve their interactions with patients. And all health care professionals can improve the care they provide if allowed more time with patients.5, Assessment of Adherence, Multisystem Intervention to Improve Adherence Patients may not have the health literacy skills needed to successfully navigate and manage the complex health care system. The Health Literacy Universal Precautions Toolkit recommends assuming that patients may have difficulty understanding. Create a supportive environment where all patients receive both written and oral communications in plain, non-medical terms in their preferred language to support empowerment and self-management. Key elements include visual, interactive education, a medication list and/or a pictorial medication schedule. The familiar teach-back method offers clinicians a nonthreatening way to confirm that patients understand what has been explained to them.5-Multisystem Intervention to Improve Adherence
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