A 47-year-old man comes to the office for follow-up of recently diagnosed hypertension. He was prescribed a generic formulation of lisinopril a month ago. Inspection of the patient's pill bottle shows 15 tablets remaining of an original 30-tablet supply. Medical history is otherwise unremarkable, and he is taking no other medications. Blood pressure measurement shows no significant improvement from his blood pressure a month ago. Serum chemistry panel, including potassium and creatinine, is also unchanged from prior results. The patient reports no adverse effects from the medication but often forgets to take it. Which of the following would be most helpful in improving this patient's medication adherence?

Question

A 47-year-old man comes to the office for follow-up of recently diagnosed hypertension.  He was prescribed a generic formulation of lisinopril a month ago.  Inspection of the patient's pill bottle shows 15 tablets remaining of an original 30-tablet supply.  Medical history is otherwise unremarkable, and he is taking no other medications.  Blood pressure measurement shows no significant improvement from his blood pressure a month ago.  Serum chemistry panel, including potassium and creatinine, is also unchanged from prior results.  The patient reports no adverse effects from the medication but often forgets to take it.  Which of the following would be most helpful in improving this patient's medication adherence?

Quizplus · Accepted Answer

11ec160b_3693_312a_9249_851b4cf63e27_MD0001_00 This patient with hypertension has been prescribed an appropriate antihypertensive medication but has had poor medication adherence. Nonadherence is common in patients with hypertension because the condition is generally asymptomatic, whereas medication has cost, inconvenience, and often symptomatic adverse effects (eg, headache, lightheadedness). Clinical features suggesting medication nonadherence include: The most effective interventions to improve adherence are likely to be those that can easily be integrated into the patient's schedule or can be linked to an established habit. For example, the patient could use a pill organizer or dispenser that can be placed in a prominent location that he will clearly see in his daily routine (eg, bathroom counter). (Choice A) Asking the patient's wife to give him daily reminders can sometimes be effective in reducing nonadherence but adds to the family care burden and can potentially increase interpersonal conflict. In addition, this strategy relies on the wife to remember the medication. (Choice B) Dosing medication more than once daily is associated with decreased adherence and would likely lead to even greater undertreatment. (Choice C) Well-known medications with prominent advertising campaigns are frequently associated with greater patient willingness to discuss the underlying medical condition (eg, phosphodiesterase inhibitors for erectile dysfunction) with the physician. However, adherence is generally higher for low-cost options due to the lesser financial burden. (Choice D) Discussing the risks of untreated hypertension is important to include in the initial patient education and counseling. However, there is no reason to think the patient is nonadherent because he does not understand the risks, and this approach may be viewed as negative or threatening. Educational objective: Nonadherence is common in patients with hypertension because the condition is generally asymptomatic, whereas medication has cost, inconvenience, and symptomatic adverse effects. The most effective interventions to improve adherence are those that can easily be integrated into the patient's schedule or linked to an established habit.

A 47-Year-Old Man Comes to the Office for Follow-Up of Recently