A patient education program that included self-affirmation and positive affect in the form of occasional gifts significantly increased medication adherence among African Americans with high blood pressure, according to research presented at the American Heart Association's Scientific Sessions 2008.
The randomized, controlled trial found that calling patients occasionally with positive messages, coupled with standard information about hypertension encouraged them to take their medication more often than patients who received usual care.
"This is good news." said Olugbenga Ogedegbe, M.D., lead author of the study and an associate professor of medicine at the New York University School of Medicine. "We have a very cheap intervention that helps patients improve adherence. The key question here is 'How do we integrate this into daily practice?' "
Adherence — taking medication consistently and correctly — is a major issue in all patient populations and especially African Americans.
"African Americans have been shown in some studies to be nearly twice as likely to not take their medicines when compared to Caucasians," Ogedegbe said.
For this study, researchers measured adherence, with electronic monitors installed on the caps of the blood pressure pill bottles. The monitors recorded each time the pill bottles were opened. Researchers consider this method far more reliable than patient self-report.
The study of 252 African Americans with hypertension found that those who received unexpected quarterly gifts by mail plus bi-monthly calls reminding them of positive life experiences took their medication 43 percent of the time over 12 months. Patients who just received a workbook on their disease with no additional intervention (control group) took their medicines 36 percent of the time during the year-long study.
"The adherence level is still woefully low," Ogedegbe said.
Of the study patients, 80 percent were women, average age 58. All were prescribed at least one anti-hypertension medication.
Although, most of the study participants were women, Ogedegbe expects the results to also apply to African-American men.
Each patient in the study in the intervention group and in the control group received a 10-chapter hypertension education workbook that detailed ways to combat hypertension. Those in the intervention group also were called every two months with homework from the workbook along with reminders to think about proud moments in their lives, their goals and the values they hold dear. The calls were not costly, Ogedegbe said, because they came from research assistants with college degrees rather than medical professionals.
The intervention group also received up to six small gifts unexpectedly throughout the 12-month study duration, which included an umbrella and a duffle bag. The items were adorned with positive messages such as, "It's a beautiful day."
"The whole idea is to reduce the amount of negativity patients have in terms of their health," Ogedegbe said. "If you are depressed, you are much less likely to take your medicine. This study attacked it from two ways by reducing the rate of depressed feelings and helping patients affirm their own positive feelings. When people receive unexpected good news or gifts it tends to induce positive feelings and it is shown to carry over into other areas of life."
Co-authors are: Carla Boutin-Foster, M.D; Martin T. Wells, Ph.D.; John P. Allegrante, Ph.D.; Jared B. Jobe, Ph.D.; and Mary E. Charlson, M.D.
Individual author disclosures can be found on the abstract.
The National Heart Lung and Blood Institute funded the study.
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