PATIENT
EDUCATION

PATIENT EDUCATION General Considerations

· Treatment of hypertension is life long, thus patient cooperation and involvement are fundamental.

· It is an essential element in long term management of hypertension and is necessary in all patients.

· It is needed to improve patient’s compliance and should be individualized according to age, race, gender and other sociocultural and economic factors.

· It should be designed to influence patient’s behavior through changes in:

a. Patient’s knowledge, attitudes and beliefs.

b. Support and feedback from family and health care personnel.

· Behavior changes can only occur when the patient is actively committed in his treatment plan.

· Main goal of patient education is to improve patient’s compliance. Adherence both to nonpharmacologic and pharmacologic therapy.

Non-Compliance

Patient does not take his antihypertensive drugs as prescribed or he discontinues his medications completely.

Magnitude of the Problem

· 27% of diagnosed hypertensives, previously under therapy, have stopped taking their medications.

· 62% of causes of non compliance are secondary to

Patient Education

misunderstanding.

Causes of Patient’s Non-Compliance**

A. Lack of Confidence in Treatment

1. Too many tablets.

2. Doubts about drug interaction.

3. Fear of side effects.

4. Poorly written instructions.

5. Incorrect labelling.

6. Unavailability of drugs.

7. Lack of knowledge about medicines.

8. Expensive drugs: Cost of treatment.

9. Side effects.

10. Long duration of treatment.

11. Absence of immediate or subjective benefits.

12. Need for regular re-examinations.

13. Hypertension is a symptom free disorder.

B. Doctors Unable to Cope

1. Overcrowding at clinic.

2. Doctor intimidated and illtreats patients.

3. Time constraints of doctors.

4. Doctor is misinformed or inexperienced.

C. Established Beliefs Stronger Than Health Message

1. Traditional home remedies.

2. Belief in herbal and folkloric medicine.

Patient Education

D. Lack of Education Causing Poor Communication

1. Inability to read.

2. Instructions forgotten.

3. Poor communication between patient and doctor which leads to confusion and misunderstanding.

- The three main reasons of non-compliance and discontinuation of drugs in hypertensive patients are:

1. Doctor’s advice.

2. Patient no longer has high blood pressure.

3. No need to take medications.

Cost and side effects account for only 3% and 7% respectively.

Factors to Improve Patient’s Compliance

1. Patient-Practitioner Interaction:

· Allow patient to express problems and concerns.

· Sharing information such as patient’s blood pressure readings.

· Explain to the patient what is expected.

2. Social Support:

· Encourage involvement of family members.

· Provide family members current information about patients’ condition, management plans, nutritional advice.

3. Simple Therapy:

· Few pills.

· Once or twice daily dosage.

4. Identification and Correction of Wrong Health Beliefs:

· The asymptomatic nature of high blood pressure.

· The only way to be sure blood pressure is high is to have blood pressure checked.

· Not equating high blood pressure with nervous tension. Calm and easy going persons can have high blood pressure.

· No cure from high blood pressure, control of blood pressure by medications does not mean cure.

Patient Education

· High blood pressure is life long and hypertensives need to follow their treatment plan everyday.

· Diagnosis and treatment of hypertension does not interfere with quality of life, employment or daily activities.

5. Attention to socioeconomic factors.

Elements of Patients Education

A. Information about Hypertension in General

1. What is the meaning of blood pressure and what is the definition of hypertension?

2. Hypertension is not nervousness.

3. Blood pressure level is variable; it changes with emotions, meals, time of the day, salt intake, exercise and drugs.

4. Role of heredity.

5. Asymptomatic nature of hypertension.

6. Serious complications if pressure is not controlled.

7. Hypertension cannot be cured in 99% of patients, but high blood pressure can be controlled.

8. Life long nature of hypertension.

B. Lifestyle Modification

Importance: Can limit the need and dosage of pharmacologic therapy.

1. Weight reduction, salt limitation, exercise, alcohol moderation, control of modifiable risk factors.

2. Diet counselling.

Patient Education

C. Medications

1. What do they do?

2. Why they are needed?

3. Importance of adherence to therapy and risks of non-compliance.

4. Medications to avoid.

D. Appointments and Regular Clinic Visits

1. Follow up is necessary.

2. Frequent doctor’s visits at start of treatment.

3. Frequency of visits depends upon severity of hypertension, degree of control, target organ damage, cardiovascular risk factors and laboratory abnormalities.

4. Need and frequency of laboratory evaluation.

E. Provide Patient with Information About his Condition

1. Level of blood pressure.

2. Response of blood pressure to treatment.

3. Presence and significance of target organ damage.

4. Presence and significance of other cardiovascular risk factors.

5. Presence and significance of any laboratory abnormalities.

* World Health Forum – Pereira 1995