The feasibility of the PAM intervention to support treatment-adherence in people with hypertension in primary care: a randomised clinical controlled trial

• Published in: Scientific reports Vol. 11; no. 1; pp. 8897 - 11
• Main Authors: Kassavou, Aikaterini, Mirzaei, Venus, Shpendi, Sonia, Brimicombe, James, Chauhan, Jagmohan, Bhattacharya, Debi, Naughton, Felix, Hardeman, Wendy, Eborall, Helen, Van Emmenis, Miranda, De Simoni, Anna, Takhar, Amrit, Gupta, Pankaj, Patel, Prashanth, Mascolo, Cecilia, Prevost, Andrew Toby, Morris, Stephen, Griffin, Simon, McManus, Richard J., Mant, Jonathan, Sutton, Stephen
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 26.04.2021; Nature Publishing Group; Nature Portfolio
• Subjects: 631/477; 692/1537; 692/308; 692/4019; 692/700; Aged; Antihypertensives; Blood pressure; Cholesterol; Female; Glycated Hemoglobin - metabolism; Hemoglobin; Humanities and Social Sciences; Humans; Hypertension; Hypertension - blood; Hypertension - drug therapy; Hypertension - physiopathology; Hypertension - psychology; Intervention; ISRCTN; ISRCTN74504989; Male; Medication Adherence; Middle Aged; multidisciplinary; Patient compliance; Patients; Primary Health Care; Science; Science (multidisciplinary); United Kingdom; United Kingdom
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-88170-2

The PAM intervention is a behavioural intervention to support adherence to anti-hypertensive medications and therefore to lower blood pressure. This feasibility trial recruited 101 nonadherent patients (54% male, mean age 65.8 years) with hypertension and high blood pressure from nine general practices in the UK. The trial had 15.5% uptake and 7.9% attrition rate. Patients were randomly allocated to two groups: the intervention group (n = 61) received the PAM intervention as an adjunct to usual care; the control group (n = 40) received usual care only. At 3 months, biochemically validated medication adherence was improved by 20% (95% CI 3–36%) in the intervention than control, and systolic blood pressure was reduced by 9.16 mmHg (95% CI 5.69–12.64) in intervention than control. Improvements in medication adherence and reductions in blood pressure suggested potential intervention effectiveness. For a subsample of patients, improvements in medication adherence and reductions in full lipid profile (cholesterol 1.39 mmol/mol 95% CI 0.64–1.40) and in glycated haemoglobin (3.08 mmol/mol, 95% CI 0.42–5.73) favoured the intervention. A larger trial will obtain rigorous evidence about the potential clinical effectiveness and cost-effectiveness of the intervention. Trial registration Trial date of first registration 28/01/2019. ISRCTN74504989. https://doi.org/10.1186/ISRCTN74504989 .