At least 25% of hypertension patients do not adhere to medication regimens. A survey of MCI patients showed that 56.5% had a medium or low level of medication adherence. Clinicians are inaccurate in predicting the medication adherence of their patients.

To meet the goal of having 70% of its’ patients with hypertension controlled to a level of 140/90 or less Mercy Clinics needs to assess medication adherence by screening patients who are not meeting treatment goals. MCI suggests the following recommendations:

1. Assess for medication compliance by directly asking the patient: “Many people forget to take their pills from time to time.Have you missed any pills in the last week?”
   • Any indication of missing 1 or more pills signals a problem with low adherence.
2. Elicit the patient’s barriers to taking medications.“What gets in the way of taking your medicines on some days?”
   • Common barriers are: cost, side effects, forgetting, regimen is too complex, not sure medicine is needed, doesn’t think medicine is working, poor health literacy, depression.
3. Elicit the patient’s ideas for increasing adherence. “Do you feel there is anything that will help you take your medicine?” or “what works on the days you do take your medicine?”
   • Methods for increasing adherence are: simplify regimens, written instructions, pill dispensers, reduce cost by using generics or referring to assistance programs, screen for and treat depression, support groups. 
4. Collaboratively agree on a plan and set goals to improve adherence.
   • Patient generated ideas are the most likely to be effective.
   • Document the goal in the medical record.
5. Advise on the importance of taking medications and provide written instructions about taking medicines. Handouts should be written at the eighth grade level or less.
6. Arrange for a follow-up visit and ideally contact between visits.
   • Call patient between visits and ask how the plan is going.
   • Call patients who miss the follow-up visit.