Running head: IMPROVING ADHERENCE TO ANTIHYPERTENSIVE REGIMEN 1 Improving Adherence to Antihypertensive Regimen Using the SIMPLE Method A Pilot Study

Societal and personal burden associated with nonadherence to provider prescribed antihypertensive regimen challenges both patient and providers to explore methods to improve adherence. Nonadherence to antihypertensive therapy severely underscores the efficacy of treatment making it a serious issue in population health both from the quality of life and from health economics standpoint. In this quasi-experimental study, the effect of 10 minutes of structured education on improving adherence to antihypertensive therapy among adults with primary uncontrolled hypertension at a rural primary care clinic in Missouri was studied. Education was delivered using the SIMPLE method and the study occurred over 6 month period. The SIMPLE mnemonic stands for simplifying the treatment regimen, impartation of knowledge through education, modification of patients’ beliefs, provision of open communication, leaving biases behind, and evaluating adherence using a valid adherence measurement tools. Level of adherence to antihypertensive regimen was measured using the Hill Bone Compliance to High Blood Pressure Therapy Scale (HCHTS). Six participants, three Caucasian males and females participated in the evidence based project. Pre and post intervention blood pressure values were collected and analyzed using paired t test, Wilcoxon signed rank test, and percentages. Thirty three percent of the participants experienced a reduction in their Blood Pressure (BP) values and met their target BP ranges at 3 and 6 months post intervention. Participants received structured education on the importance of adherence and the trajectory of hypertension which will assist them in the lifelong self-management of their disease. Keyword: antihypertensive, nonadherence, hill bone compliance scale, health belief model IMPROVING ADHERENCE TO ANTIHYPERTENSIVE REGIMEN 3 Evidence Based Project Proposal The diagnosis of hypertension (HTN) requires that patients make life style modifications in food, exercise, and adherence to prescribed medications; however, some patients' adherence to anti-hypertensive regimen does not meet their provider’s recommendation (Solomon et al., 2015). Adherence is the degree to which a patient’s behavior such as taking medications, following a recommended diet, and modifying lifestyle parallels with the provider’s prescription (Rimando, 2013). Patients’ poor adherence to antihypertensive regimen presents challenges to successful treatment of hypertension and increases the susceptibility to development of preventable complications (Solomon et al., 2015). Nonadherence to medications for management of HTN severely underscores the effectiveness of treatment and may contribute to HTN as serious population health issue affecting the patients’ quality of life and imposing a national economic burden (World Health Organization [WHO], 2003). Therefore, interventions directed at improving adherence to hypertension medication would provide a substantial benefit by preventing development of complications which include renal failure, blindness, stroke, cardiac disease, and death (WHO, 2003). Significance and Economic Policy Nonadherence to medication is a worldwide health problem averaging about 50% among those with chronic illnesses (WHO, 2003). In the United States, nonadherence to medication costs $284 to $634 per year per adult depending on the geographic area and disease condition (Nasseh, 2012). In 2010, the direct cost of nonadherence to HTN, diabetes and hyperlipidemia medications was $105.8 billion (Nasseh, 2012). In the United States about 59% of patients with hypertension are not adherent to treatment regimen (United States Department of Health and Human Services [USDHHS], 2015). IMPROVING ADHERENCE TO ANTIHYPERTENSIVE REGIMEN 4