Enhancement of compliance among patients with hypertension.

Studies of patient compliance with medical advice consistently demonstrate a high level of noncompliance. Not following recommendations can have serious negative consequences in the management of disease. This study was an assessment of the effect on compliance of a longitudinal, individualized educational program for patients with hypertension in a managed care setting. A before-and-after self-paired design was used to assess the behavior of 107 patients with hypertension. Trained nurses using an interactive interview format reinforced prescribed treatment and provided appropriate printed material to participants. Brief telephone follow-up interviews at prescribed intervals were used to elicit problems, provide additional education, and reinforce compliance behaviors. Most of the patients who participated showed a statistically significant (P < 0.01) decrease in both systolic and diastolic blood pressure. There was also an effect on various recommended behaviors, including compliance with medication taking, ideal body weight, salt restriction, stress, and exercise. A statistically significant relation existed between improved compliance with individual behavior changes and decreased blood pressure (P < 0.01). Elderly persons were particularly likely to show statistically significant reductions in blood pressure (75.4% versus 50.0%). A chi 2 test indicated that those differences were significant at the 0.01 level. A relatively inexpensive, office-based educational protocol can have a statistically significant effect on treatment compliance among patients with hypertension. The intervention has particular implications for geriatric patients, whose high blood pressure is disproportionately represented.