Intensive care to improve adherence to anti-hypertensives in primary care: a pragmatic clinical trial
METHODS: Design, Subjects and Setting: a pragmatic clinical trial with 396 subjects with hypertension (6 month or more) assisted in 10 family health care services of Brazilian Public Health System were interviewed and blood pressure measured in baseline. The Intervention Group (IG) received 6 medical visits in 9 month period and 9 community health care worker visits based on integrality of care and focused on “technical and practical success”. Control group (CG) received usual care. Main outcomes: adherence rate and proportion of adherent persons estimated by self-report questionnaires and pill count on baseline, 3, 6, 9 12 months as well as blood pressure. Analysis: Intention to treat analysis, inside and between groups.
RESULTS: 234 subjects participated (IG=128; CG=106) with 41% of lost or refusal. Both groups there are no differences of social, demographics and medical-assistance characteristics. There was no difference between groups at baseline considering proportion of adherence (IG=40,6 x CG=38,6; p=0,55), but it was greater in IG at the end (65,7 x 40,4; p=0,0005). Considering blood pressure, it was similar in both groups in the begining (mean systolic blood pressure IG=137 x CG=139; p=0,529 and mean diastolic blood pressure IG=84,3 x CG=84,8; p=0,799), but it was higher in CG at the end (mean systolic blood pressure IG=125 x CG=136; p=0,001 and mean diastolic blood pressure IG=76,8 x CG=83,6; p=0,007).
CONCLUSIONS: The results suggest that an approach based on dialogue, reflexion and partnership between health workers and patients could improve adherence and get better control of blood pressure in a primary care setting.