Effect of general practitioner education on adherence to antihypertensive drugs: cluster randomised controlled trial

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Abstract
Objective To determine the impact of a simple educational package for general practitioners on adherence to antihypertensive drugs.Design Cluster randomised controlled trial.Setting Six randomly selected communities in Karachi, Pakistan.Participants 200 patients with hypertension taking antihypertensive drugs; 78 general practitioners.Intervention Care by general practitioners specially trained in management of hypertension compared with usual care.Main outcome measure Correct dosing, defined as percentage of prescribed doses taken, measured with electronic medication event monitoring system (MEMS) bottle.Results 200 patients were enrolled, and 178 (89%) successfully completed six weeks of follow-up. Adherence was significantly greater in the special care group than in the usual care group (unadjusted mean percentage days with correct dose 48.1%, 95% confidence interval 35.8% to 60.4%, versus 32.4%, 22.6% to 42.3%; P=0.048). Adherence was also higher among patients who had higher levels of education (P<0.001), were encouraged by family members (P<0.001), believed in the effect of drugs (P<0.001), and had the purpose of the drugs explained to them (P<0.001).Conclusions Special training of general practitioners in management of hypertension, emphasising good communication between doctors and patients, is more effective than usual care provided in the communities in Karachi. Such simple interventions should be adopted by other developing countries that are now facing an increasing burden of hypertension.Trial registration Clinical trials NCT00330408.