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Health Services Research & Development

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2005 HSR&D National Meeting Abstract

1048 — Understanding Adherence to BP-Lowering Regimens: A Qualitative Study of Facilitators and Barriers

Author List:
Voils CI (Durham VAMC)
Steinhauser KE (Durham VAMC)
McCant F (Durham VAMC)
Oddone EZ (Durham VAMC)
Bosworth HB (Durham VAMC)

To identify facilitators and barriers of adherence to blood pressure (BP)-lowering regimens and to examine differences in perspectives between patients, spouses, and providers.

We conducted 14 focus groups with hypertensive veteran patients, their spouses, and primary care providers. We asked participants to identify factors that make it easy or difficult for patients to follow their BP-lowering regimens.

Patients were 32 to 89 years old (M = 64.8, SD = 12.0), 93% male, 50% Black, 45% White, and 73% married. Spouses were 30 to 82 years old (M = 63.8, SD = 14.2), 100% female, 27% Black, and 67% White. Providers were 80% male, 20% Black, and 80% White. Six themes emerged. “Provider relationship” included trust and open communication with physicians. “Behavioral strategies” were detailed behavioral plans for various aspects of the treatment regimen (e.g., use pill box, salt substitute). “Social support” included instrumental support (e.g., cooking, reminding to take medication) and emotional support, which were provided mostly by spouses. “Cost-benefit negotiations” included weighing quantity against quality of life and weighing side effects and possible long-term organ damage against the benefit of reducing cardiovascular events. “Information processing” included confusion about medications, forgetting to take medication, attitudes, hypertension knowledge, and functional decline. Discussions around “meaning and purpose” indicated that the treatment regimen must not prevent patients from performing activities that are important to them (e.g., attend church, volunteer). Although it was possible that spouses and providers would have different perspectives, there was high agreement in factors identified by patients and spouses. Providers generally identified similar factors but did not discuss meaning and purpose.

Couples’ perspectives on adherence included meaning and purpose, whereas providers’ perspectives were more biomedical.

Given that less than a third of all hypertensive patients have their BP under control, additional areas amenable to intervention need to be identified. The consistency in identified barriers and facilitators among patients and spouses lends credence to including spouses in hypertension-lowering interventions. These findings also have implications for physician-patient communication regarding adherence: Discussions about treatment for high BP should take place in the larger context of patients’ values and what gives their lives meaning and purpose. Physicians should join with patients in negotiating strategies that promote lower BP while preserving quality of life.

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