Assessment of Medication Adherence Pattern for Patients with Chronic Diseases in South Indian Hospitals
Corresponding Author(s) : Karibasappa Mathad V
mathad_000@yahoo.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 9 No. 2 (2021): 2021 Volume - 9 Issue - 2
Abstract
There is a need for specialized medication education programs for rural patients because of the limited health care services and low literacy level. The objectives of the study are to evaluate the pattern of medication knowledge of hypertensive patients living in the rural area with they are consultation in various south Indian district and Primary Health Care hospitals and to assess the impact of pharmacist provided education sessions on their medication knowledge status. A total of 1500 rural hypertensive patients were randomized into control and intervention group. Intervention group patients were educated regarding their medications, whereas control group patients did not receive any education by the study pharmacist during initial stage, 150th, 300th and 450th 530th day. Medication knowledge was assessed by administering medication knowledge assessment questionnaire, which was administered to control and intervention groups during the follow-up visits and eighty days after the last follow-up (530th day). At starting point there was no statistically significant (p>0.05) variance in the medication knowledge scores of the intervention and control groups. After the pharmacist provided education sessions there was an improvement in the medication knowledge assessment scores of intervention group patients were observed with reference to recall of medication name, dose, indication, side effects, duration of treatment, usefulness, effectiveness and missed medicines (p<0.05). Demographic variables such as female gender, lower education and income were the determinants of lower medication knowledge. Pharmacist provided education sessions contributed in enhancing the medication knowledge of the intervention group patients. Our study findings warrant the necessity of educating the rural patients with chronic disease conditions to improve the knowledge regarding their medications.
Keywords
hypertension
medication knowledge
adherence
clinical pharmacist
1.
Karibasappa Mathad V, Dr. K. Sattanathan. Assessment of Medication Adherence Pattern for Patients with Chronic Diseases in South Indian Hospitals. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2021 Jul. 26 [cited 2025 Nov. 10];9(2):432-41. Available from: https://ijamscr.com/ijamscr/article/view/1037
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References
-
1. Eric E, Pasanen AL, Annis GL, Guyer KL, Wintersten GA. The influence of age on knowledge and medication usage by persons attending rural North Florida clinics. Fla Public Health Rev. 2006;3:8-15.
2. Ponnusankar S, Surulivelrajan M, Anandamoorthy N, Suresh B. Assessment of impact of medication counseling on patients’ medication knowledge and compliance in an outpatient clinic in South India. Patient Educ Couns. 2004;54(1):55-60. doi: 10.1016/S0738-3991(03)00193-9, PMID 15210260.
3. Papanikolaou PN, Ioannidis JP. Awareness of the side effects of possessed medications in a community setting. Eur J Clin Pharmacol. 2003;58(12):821-7. doi: 10.1007/s00228-003-0570-x, PMID 12698309.
4. Edward E, Pasanen A, Guyer L. Community Health Scholar Program Evaluation of knowledge and medication use in patients in rural clinics. PDF. Available from: http://www.flahec.org/NFAhec/chs/2003/edwards [accessed on Feb 7 2006].
5. Akici A, Kalaça S, U?urlu MU, Toklu HZ, Iskender E, Oktay S. Patient knowledge about drugs prescribed at primary health care facilities. Pharmacoepidemiol Drug Saf. 2004;13(12):871-6. doi: 10.1002/pds.1020, PMID 15455466.
6. Jaye C, Hope J, Martin IR. What do general practice patients know about their precripation medication. J New Zealand Medical Association. 2002;115:1162-7.
7. Mclane CG, Zyzanski SJ, Flocke SA. Factors associated with medication noncompliance in rural elderly hypertensive patients. Am J Hypertens. 1995;8(2):206-9. doi: 10.1016/0895-7061(94)00194-G, PMID 7755952.
8. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent pattern of medication use in ambulatory adult population of the United States. 2002;287:337-44.
9. Dolce JJ, Crisp C, Manzella B, Richards JM. Hardin and Baily WC. Medication adherence pattern in chronic obstructive pulmonary disease. Chest. 1999;5:837-41.
10. Shyamal Kumar D, Sanyal K, Arindam B. Study of urban community survey in India: growing trend of high prevalence of hypertension in a developing country. Int J Med Sci. 2005;2:70-8.
11. Eric E, Pasanen AL, Annis GL, Guyer KL, Wintersten GA. The influence of age on knowledge and medication usage by persons attending rural North Florida clinics. Fla Public Health Rev. 2006;3:8-15.
12. Patel RP, Taylor SD. Factors affecting medication adherence in hypertensive patients. Ann Pharmacother. 2002;36(1):40-5. doi: 10.1345/aph.1A046, PMID 11816255.
13. Michael J, Kenneth W, Schafermeyer. Measuring adherence and persistence in drug therapy. J Manag Care Pharm. 2002;8(3):4-8.
14. Mohan JC. Prevalence, awareness, treatment, control and risk factors of hypertension in India and its neighborhood: newer data and older perspective. Indian Heart J. 2006;58(1):7-9. PMID 18984923.
15. Cleary DJ, Matzke GR, Alexander AC, Joy MS. Medication knowledge and compliance among patients receiving long-term dialysis. Am J Health Syst Pharm. 1995;52(17):1895-900. doi: 10.1093/ajhp/52.17.1895, PMID 8528852.
16. Jani AA, Stewart A, Robin DN, Tavel L. Medication adherence and patient education. HIV/AIDS Primary care guide. Florida Aids Education and Training Center. university of Florida. 2002; 8: 83-91.
17. Papanikolaou PN, Ioannidis JP. Awareness of the side effects of possessed medications in a community setting. Eur J Clin Pharmacol. 2003;58(12):821-7. doi: 10.1007/s00228-003-0570-x. PMID 12698309.
18. Boonstra E, Lindbaek M, Ngome E, Tshukudu K, Fugelli P. Labelling and patient knowledge of dispensed drugs as quality indicators in primary care in Botswana. Qual Saf Health Care. 2003;12(3):168-75. doi: 10.1136/qhc.12.3.168, PMID 12792005.
19. Anonymous. V. Patient education [Suppl]. J Allergy Clin Immunol. 1991;88(3):460-72. doi: 10.1016/0091-6749(91)92141-M.
20. Seventh Report of the Joint National Committee on Prevention. Detection, evaluation, and treatment of high blood pressure (JNC 7). US Department of Health and Human Services. NIH Publ. May 2003:1-52.
21. Koda Kimble LY, Young WA, Kradjan BL, Alldredge RC, Corelli C. Hypertension. In: Guglielmo BK, Alldredge RC, editors. A textbook Applied Therapeutics. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 14-1 to 14-40.
22. Gans JA. Improving medication adherence: pharmacists should take the lead. J Am Pharm Assoc (2003). 2003;43(6):665. doi: 10.1331/154434503322642570, PMID 14717261.
23. Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertens. 2004;18(2):73-8. doi: 10.1038/sj.jhh.1001633.
24. Alldredge RC. Effects of alcohol reduction on blood pressure. A meta analysis of randomized controlled trials. 2000;35:838.
25. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331-42. doi: 10.1046/j.1365-2710.2001.00363.x, PMID 11679023.
26. Griffith S. A review of factors associated with patient compliance and the taking of prescribed medicines. Br J Gen Pract. 1990;40:14-6.
27. Possidente CJ, Kathryn K. Bucci and McClain WJ. Motivational interviewing: a tool to improve medication adherence? Am J Health Syst Pharm. 2003;26:120-80.
28. Mckenney JM, Slining JM, Henderson HR, Devins D, Barr M. The effect of clinical pharmacy services on patients with essential hypertension. Circulation. 1973;48(5):1104-11. doi: 10.1161/01.cir.48.5.1104, PMID 4201656.
29. Possidente CJ, Bucci KK, McClain WJ. Motivational interviewing: a tool to improve medication adherence?. Am J Health Syst Pharm. 2005;62(12):1311-4. doi: 10.1093/ajhp/62.12.1311. PMID 15947131.
30. Svarstad BL, Chewning BA, Sleath BL, Claesson C. The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999;37(2):113-24. doi: 10.1016/s0738-3991(98)00107-4. PMID 14528539.
31. Balkrishnan R. Predictors of Medication Adherence in the elderly. Clin Ther. 1998;20(4):764-71. doi: 10.1016/s0149-2918(98)80139-2, PMID 9737835.
32. Franks TJ, Bunton DL, Simpson MD. Evaluated patient’s knowledge of asthma therapy and adherence. Ann Pharmacother. 2000;20:76-9.
33. O’Connell MB, Johnson JF. Evaluation of medication knowledge in elderly patients. Ann Pharmacother. 1992;26(7-8):919-21. doi: 10.1177/106002809202600711, PMID 1504400.
34. Gray SL, Mahoney JE, Blough DK. Medication adherence in Elderly patients receiving Home Health Services Following Hospital discharge. Ann Pharmacother. 2001;35(5):539-45. doi: 10.1345/aph.10295, PMID 11346058.
35. Patient HS T. Education: A tool in the Outpatient Management of deep vein thrombosis. Pharmacotherapy. 1998;18:1585-645.
36. Haugbølle LS, Sørensen EW, Henriksen HH. Medication- and illness-related factual knowledge, perceptions and behaviour in angina pectoris patients. Patient Educ Couns. 2002;47(4):281-9. doi: 10.1016/s0738-3991(01)00229-4. PMID 12135819.
37. Shahansky SJ, Adrian R. Effect of number of medication on cardiovascular therapy adherence. Ann Pharmacother. 2002;36:1-8.
38. Grant RW, Nicole GD. Poly pharmacy and medication adherence in patients with 2 type diabetic patients. Diabet Care. 2003;36:1408-12.
39. Huang YM, Wang HP, Yang YH, Lin SJ, Lin HW, Chen CS, Wu FL. Effects of a national Health Education Program on the Medication Knowledge of the Public in Taiwan. Ann Pharmacother. 2006;40(1):102-8. doi: 10.1345/aph.1G312, PMID 16368924.
40. Taylor CT, Byrd DC, Krueger K. Improving Primary Care in Rural Alabama with a Pharmacy initiative. Am J Health Syst Pharm. 2003;60(11):1123-9. doi: 10.1093/ajhp/60.11.1123, PMID 12816022.
41. Farris KB, Kassam R, Cox CE, Cave A. Pharmaceutical care research and education project t: patient outcomes. J Am Pharm Assoc. 2001;41(3):411-20.
42. Bluml BM, McKenney JM, Cziraky MJ. Pharmaceutical care services and results in project impact: hyperlipidemia. J Am Pharm Assoc (Wash). 2000;40(2):157-65. doi: 10.1016/s1086-5802(16)31059-2, PMID 10730019.
43. Canadian Hypertension Education Program. Recommendations of the 2006 Canadian Hypertension Education Program: A brief overview. Can J Hosp Pharm. 2006;139(3):11-3.
44. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331-42. doi: 10.1046/j.1365-2710.2001.00363.x. PMID 11679023.
45. Kurian V. New ’rural area’ definition to benefit life insurance companies [cited 10/1/2006]. Available from: http://www.thehindubusinessline.com/2002/10/29/stories/2002102901831000.htm.
46. Saseen SJ, Carter LB. Hypertension. In: Dipiro TJ, Wells GB, Posey M, Talbert LR, Yee CG, Matzke RG, editors. Text book of pharmacotherapy. A pathophysiologic approach. 6th ed, New York, McGraw-Hills; 2005. p. 185-217.
47. Karnataka I, mathad publications. Mr. Karinbasappa M v. A text book of community pharmacy practice. 5th ed, Davanagere; 2021. p. 140-90.
48. Karnataka I, mathad publications. Mr. Karinbasappa M v. A pocket book of patient counseling. 1st ed, Davanagere; 2021. p. 35-90.
References
1. Eric E, Pasanen AL, Annis GL, Guyer KL, Wintersten GA. The influence of age on knowledge and medication usage by persons attending rural North Florida clinics. Fla Public Health Rev. 2006;3:8-15.
2. Ponnusankar S, Surulivelrajan M, Anandamoorthy N, Suresh B. Assessment of impact of medication counseling on patients’ medication knowledge and compliance in an outpatient clinic in South India. Patient Educ Couns. 2004;54(1):55-60. doi: 10.1016/S0738-3991(03)00193-9, PMID 15210260.
3. Papanikolaou PN, Ioannidis JP. Awareness of the side effects of possessed medications in a community setting. Eur J Clin Pharmacol. 2003;58(12):821-7. doi: 10.1007/s00228-003-0570-x, PMID 12698309.
4. Edward E, Pasanen A, Guyer L. Community Health Scholar Program Evaluation of knowledge and medication use in patients in rural clinics. PDF. Available from: http://www.flahec.org/NFAhec/chs/2003/edwards [accessed on Feb 7 2006].
5. Akici A, Kalaça S, U?urlu MU, Toklu HZ, Iskender E, Oktay S. Patient knowledge about drugs prescribed at primary health care facilities. Pharmacoepidemiol Drug Saf. 2004;13(12):871-6. doi: 10.1002/pds.1020, PMID 15455466.
6. Jaye C, Hope J, Martin IR. What do general practice patients know about their precripation medication. J New Zealand Medical Association. 2002;115:1162-7.
7. Mclane CG, Zyzanski SJ, Flocke SA. Factors associated with medication noncompliance in rural elderly hypertensive patients. Am J Hypertens. 1995;8(2):206-9. doi: 10.1016/0895-7061(94)00194-G, PMID 7755952.
8. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent pattern of medication use in ambulatory adult population of the United States. 2002;287:337-44.
9. Dolce JJ, Crisp C, Manzella B, Richards JM. Hardin and Baily WC. Medication adherence pattern in chronic obstructive pulmonary disease. Chest. 1999;5:837-41.
10. Shyamal Kumar D, Sanyal K, Arindam B. Study of urban community survey in India: growing trend of high prevalence of hypertension in a developing country. Int J Med Sci. 2005;2:70-8.
11. Eric E, Pasanen AL, Annis GL, Guyer KL, Wintersten GA. The influence of age on knowledge and medication usage by persons attending rural North Florida clinics. Fla Public Health Rev. 2006;3:8-15.
12. Patel RP, Taylor SD. Factors affecting medication adherence in hypertensive patients. Ann Pharmacother. 2002;36(1):40-5. doi: 10.1345/aph.1A046, PMID 11816255.
13. Michael J, Kenneth W, Schafermeyer. Measuring adherence and persistence in drug therapy. J Manag Care Pharm. 2002;8(3):4-8.
14. Mohan JC. Prevalence, awareness, treatment, control and risk factors of hypertension in India and its neighborhood: newer data and older perspective. Indian Heart J. 2006;58(1):7-9. PMID 18984923.
15. Cleary DJ, Matzke GR, Alexander AC, Joy MS. Medication knowledge and compliance among patients receiving long-term dialysis. Am J Health Syst Pharm. 1995;52(17):1895-900. doi: 10.1093/ajhp/52.17.1895, PMID 8528852.
16. Jani AA, Stewart A, Robin DN, Tavel L. Medication adherence and patient education. HIV/AIDS Primary care guide. Florida Aids Education and Training Center. university of Florida. 2002; 8: 83-91.
17. Papanikolaou PN, Ioannidis JP. Awareness of the side effects of possessed medications in a community setting. Eur J Clin Pharmacol. 2003;58(12):821-7. doi: 10.1007/s00228-003-0570-x. PMID 12698309.
18. Boonstra E, Lindbaek M, Ngome E, Tshukudu K, Fugelli P. Labelling and patient knowledge of dispensed drugs as quality indicators in primary care in Botswana. Qual Saf Health Care. 2003;12(3):168-75. doi: 10.1136/qhc.12.3.168, PMID 12792005.
19. Anonymous. V. Patient education [Suppl]. J Allergy Clin Immunol. 1991;88(3):460-72. doi: 10.1016/0091-6749(91)92141-M.
20. Seventh Report of the Joint National Committee on Prevention. Detection, evaluation, and treatment of high blood pressure (JNC 7). US Department of Health and Human Services. NIH Publ. May 2003:1-52.
21. Koda Kimble LY, Young WA, Kradjan BL, Alldredge RC, Corelli C. Hypertension. In: Guglielmo BK, Alldredge RC, editors. A textbook Applied Therapeutics. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 14-1 to 14-40.
22. Gans JA. Improving medication adherence: pharmacists should take the lead. J Am Pharm Assoc (2003). 2003;43(6):665. doi: 10.1331/154434503322642570, PMID 14717261.
23. Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertens. 2004;18(2):73-8. doi: 10.1038/sj.jhh.1001633.
24. Alldredge RC. Effects of alcohol reduction on blood pressure. A meta analysis of randomized controlled trials. 2000;35:838.
25. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331-42. doi: 10.1046/j.1365-2710.2001.00363.x, PMID 11679023.
26. Griffith S. A review of factors associated with patient compliance and the taking of prescribed medicines. Br J Gen Pract. 1990;40:14-6.
27. Possidente CJ, Kathryn K. Bucci and McClain WJ. Motivational interviewing: a tool to improve medication adherence? Am J Health Syst Pharm. 2003;26:120-80.
28. Mckenney JM, Slining JM, Henderson HR, Devins D, Barr M. The effect of clinical pharmacy services on patients with essential hypertension. Circulation. 1973;48(5):1104-11. doi: 10.1161/01.cir.48.5.1104, PMID 4201656.
29. Possidente CJ, Bucci KK, McClain WJ. Motivational interviewing: a tool to improve medication adherence?. Am J Health Syst Pharm. 2005;62(12):1311-4. doi: 10.1093/ajhp/62.12.1311. PMID 15947131.
30. Svarstad BL, Chewning BA, Sleath BL, Claesson C. The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999;37(2):113-24. doi: 10.1016/s0738-3991(98)00107-4. PMID 14528539.
31. Balkrishnan R. Predictors of Medication Adherence in the elderly. Clin Ther. 1998;20(4):764-71. doi: 10.1016/s0149-2918(98)80139-2, PMID 9737835.
32. Franks TJ, Bunton DL, Simpson MD. Evaluated patient’s knowledge of asthma therapy and adherence. Ann Pharmacother. 2000;20:76-9.
33. O’Connell MB, Johnson JF. Evaluation of medication knowledge in elderly patients. Ann Pharmacother. 1992;26(7-8):919-21. doi: 10.1177/106002809202600711, PMID 1504400.
34. Gray SL, Mahoney JE, Blough DK. Medication adherence in Elderly patients receiving Home Health Services Following Hospital discharge. Ann Pharmacother. 2001;35(5):539-45. doi: 10.1345/aph.10295, PMID 11346058.
35. Patient HS T. Education: A tool in the Outpatient Management of deep vein thrombosis. Pharmacotherapy. 1998;18:1585-645.
36. Haugbølle LS, Sørensen EW, Henriksen HH. Medication- and illness-related factual knowledge, perceptions and behaviour in angina pectoris patients. Patient Educ Couns. 2002;47(4):281-9. doi: 10.1016/s0738-3991(01)00229-4. PMID 12135819.
37. Shahansky SJ, Adrian R. Effect of number of medication on cardiovascular therapy adherence. Ann Pharmacother. 2002;36:1-8.
38. Grant RW, Nicole GD. Poly pharmacy and medication adherence in patients with 2 type diabetic patients. Diabet Care. 2003;36:1408-12.
39. Huang YM, Wang HP, Yang YH, Lin SJ, Lin HW, Chen CS, Wu FL. Effects of a national Health Education Program on the Medication Knowledge of the Public in Taiwan. Ann Pharmacother. 2006;40(1):102-8. doi: 10.1345/aph.1G312, PMID 16368924.
40. Taylor CT, Byrd DC, Krueger K. Improving Primary Care in Rural Alabama with a Pharmacy initiative. Am J Health Syst Pharm. 2003;60(11):1123-9. doi: 10.1093/ajhp/60.11.1123, PMID 12816022.
41. Farris KB, Kassam R, Cox CE, Cave A. Pharmaceutical care research and education project t: patient outcomes. J Am Pharm Assoc. 2001;41(3):411-20.
42. Bluml BM, McKenney JM, Cziraky MJ. Pharmaceutical care services and results in project impact: hyperlipidemia. J Am Pharm Assoc (Wash). 2000;40(2):157-65. doi: 10.1016/s1086-5802(16)31059-2, PMID 10730019.
43. Canadian Hypertension Education Program. Recommendations of the 2006 Canadian Hypertension Education Program: A brief overview. Can J Hosp Pharm. 2006;139(3):11-3.
44. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331-42. doi: 10.1046/j.1365-2710.2001.00363.x. PMID 11679023.
45. Kurian V. New ’rural area’ definition to benefit life insurance companies [cited 10/1/2006]. Available from: http://www.thehindubusinessline.com/2002/10/29/stories/2002102901831000.htm.
46. Saseen SJ, Carter LB. Hypertension. In: Dipiro TJ, Wells GB, Posey M, Talbert LR, Yee CG, Matzke RG, editors. Text book of pharmacotherapy. A pathophysiologic approach. 6th ed, New York, McGraw-Hills; 2005. p. 185-217.
47. Karnataka I, mathad publications. Mr. Karinbasappa M v. A text book of community pharmacy practice. 5th ed, Davanagere; 2021. p. 140-90.
48. Karnataka I, mathad publications. Mr. Karinbasappa M v. A pocket book of patient counseling. 1st ed, Davanagere; 2021. p. 35-90.
2. Ponnusankar S, Surulivelrajan M, Anandamoorthy N, Suresh B. Assessment of impact of medication counseling on patients’ medication knowledge and compliance in an outpatient clinic in South India. Patient Educ Couns. 2004;54(1):55-60. doi: 10.1016/S0738-3991(03)00193-9, PMID 15210260.
3. Papanikolaou PN, Ioannidis JP. Awareness of the side effects of possessed medications in a community setting. Eur J Clin Pharmacol. 2003;58(12):821-7. doi: 10.1007/s00228-003-0570-x, PMID 12698309.
4. Edward E, Pasanen A, Guyer L. Community Health Scholar Program Evaluation of knowledge and medication use in patients in rural clinics. PDF. Available from: http://www.flahec.org/NFAhec/chs/2003/edwards [accessed on Feb 7 2006].
5. Akici A, Kalaça S, U?urlu MU, Toklu HZ, Iskender E, Oktay S. Patient knowledge about drugs prescribed at primary health care facilities. Pharmacoepidemiol Drug Saf. 2004;13(12):871-6. doi: 10.1002/pds.1020, PMID 15455466.
6. Jaye C, Hope J, Martin IR. What do general practice patients know about their precripation medication. J New Zealand Medical Association. 2002;115:1162-7.
7. Mclane CG, Zyzanski SJ, Flocke SA. Factors associated with medication noncompliance in rural elderly hypertensive patients. Am J Hypertens. 1995;8(2):206-9. doi: 10.1016/0895-7061(94)00194-G, PMID 7755952.
8. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent pattern of medication use in ambulatory adult population of the United States. 2002;287:337-44.
9. Dolce JJ, Crisp C, Manzella B, Richards JM. Hardin and Baily WC. Medication adherence pattern in chronic obstructive pulmonary disease. Chest. 1999;5:837-41.
10. Shyamal Kumar D, Sanyal K, Arindam B. Study of urban community survey in India: growing trend of high prevalence of hypertension in a developing country. Int J Med Sci. 2005;2:70-8.
11. Eric E, Pasanen AL, Annis GL, Guyer KL, Wintersten GA. The influence of age on knowledge and medication usage by persons attending rural North Florida clinics. Fla Public Health Rev. 2006;3:8-15.
12. Patel RP, Taylor SD. Factors affecting medication adherence in hypertensive patients. Ann Pharmacother. 2002;36(1):40-5. doi: 10.1345/aph.1A046, PMID 11816255.
13. Michael J, Kenneth W, Schafermeyer. Measuring adherence and persistence in drug therapy. J Manag Care Pharm. 2002;8(3):4-8.
14. Mohan JC. Prevalence, awareness, treatment, control and risk factors of hypertension in India and its neighborhood: newer data and older perspective. Indian Heart J. 2006;58(1):7-9. PMID 18984923.
15. Cleary DJ, Matzke GR, Alexander AC, Joy MS. Medication knowledge and compliance among patients receiving long-term dialysis. Am J Health Syst Pharm. 1995;52(17):1895-900. doi: 10.1093/ajhp/52.17.1895, PMID 8528852.
16. Jani AA, Stewart A, Robin DN, Tavel L. Medication adherence and patient education. HIV/AIDS Primary care guide. Florida Aids Education and Training Center. university of Florida. 2002; 8: 83-91.
17. Papanikolaou PN, Ioannidis JP. Awareness of the side effects of possessed medications in a community setting. Eur J Clin Pharmacol. 2003;58(12):821-7. doi: 10.1007/s00228-003-0570-x. PMID 12698309.
18. Boonstra E, Lindbaek M, Ngome E, Tshukudu K, Fugelli P. Labelling and patient knowledge of dispensed drugs as quality indicators in primary care in Botswana. Qual Saf Health Care. 2003;12(3):168-75. doi: 10.1136/qhc.12.3.168, PMID 12792005.
19. Anonymous. V. Patient education [Suppl]. J Allergy Clin Immunol. 1991;88(3):460-72. doi: 10.1016/0091-6749(91)92141-M.
20. Seventh Report of the Joint National Committee on Prevention. Detection, evaluation, and treatment of high blood pressure (JNC 7). US Department of Health and Human Services. NIH Publ. May 2003:1-52.
21. Koda Kimble LY, Young WA, Kradjan BL, Alldredge RC, Corelli C. Hypertension. In: Guglielmo BK, Alldredge RC, editors. A textbook Applied Therapeutics. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 14-1 to 14-40.
22. Gans JA. Improving medication adherence: pharmacists should take the lead. J Am Pharm Assoc (2003). 2003;43(6):665. doi: 10.1331/154434503322642570, PMID 14717261.
23. Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertens. 2004;18(2):73-8. doi: 10.1038/sj.jhh.1001633.
24. Alldredge RC. Effects of alcohol reduction on blood pressure. A meta analysis of randomized controlled trials. 2000;35:838.
25. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331-42. doi: 10.1046/j.1365-2710.2001.00363.x, PMID 11679023.
26. Griffith S. A review of factors associated with patient compliance and the taking of prescribed medicines. Br J Gen Pract. 1990;40:14-6.
27. Possidente CJ, Kathryn K. Bucci and McClain WJ. Motivational interviewing: a tool to improve medication adherence? Am J Health Syst Pharm. 2003;26:120-80.
28. Mckenney JM, Slining JM, Henderson HR, Devins D, Barr M. The effect of clinical pharmacy services on patients with essential hypertension. Circulation. 1973;48(5):1104-11. doi: 10.1161/01.cir.48.5.1104, PMID 4201656.
29. Possidente CJ, Bucci KK, McClain WJ. Motivational interviewing: a tool to improve medication adherence?. Am J Health Syst Pharm. 2005;62(12):1311-4. doi: 10.1093/ajhp/62.12.1311. PMID 15947131.
30. Svarstad BL, Chewning BA, Sleath BL, Claesson C. The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999;37(2):113-24. doi: 10.1016/s0738-3991(98)00107-4. PMID 14528539.
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