Effects of a Case-Based Medication Adherence Promotion Program among Uncontrolled Hypertensive Patients at a Private Hospital in Bangkok

Abstract

This quasi-experimental study with a two-group pretest–posttest design aimed to: 1) compare medication adherence scores and blood pressure levels among patients with uncontrolled hypertension before and after participation in a case management medication adherence promotion program; 2) compare medication adherence scores and blood pressure control outcomes between the experimental and control groups after the intervention; 3) compare adaptation scores based on Roy’s Adaptation Theory between the experimental and control groups after the intervention; and 4) examine patient satisfaction with the program. The sample consisted of 60 patients with uncontrolled hypertension and low medication adherence scores, divided equally into an experimental group and a control group (30 participants each) using matching and random assignment. The experimental group received a case management medication adherence promotion program developed based on Roy’s Adaptation Theory integrated with the World Health Organization’s five-dimensional adherence framework for a period of 6 weeks, with continuous support through the Line application throughout the study. The control group received standard care. Research instruments included the 8-item Morisky Medication Adherence Scale (MMAS-8), the Roy Adaptation Assessment Questionnaire, and a satisfaction questionnaire. Data were analyzed using independent and paired t-tests.

The findings revealed that, after completion of the program, the experimental group demonstrated a statistically significant increase in medication adherence scores from 3.80 to 6.40 points (p-value < 0.001), which was significantly higher than that of the control group (p-value < 0.001). The experimental group also achieved a mean reduction in systolic blood pressure of 19.70 mmHg, and 70% of participants achieved the treatment target of <130/80 mmHg compared with 30% in the control group (p-value = 0.001; RR = 2.33; NNT = 2.50). In addition, the experimental group had significantly higher adaptation scores across all four modes of Roy’s Adaptation Theory compared with the control group (p-value < 0.001). Participants also reported a very high level of satisfaction with the program (Mean = 4.60, S.D. = 0.40). Therefore, the case management medication adherence promotion program based on Roy’s Adaptation Theory combined with digital support through the Line application was effective in improving medication adherence, reducing blood pressure, and enhancing holistic adaptation among patients with uncontrolled hypertension. The program should be applied in primary healthcare services and extended to the management of other chronic diseases.