Herrera, T. R. C. (2016). Team-based approach to improve antihypertensive medication adherence in San Jose, Province of Dinagat Islands (Unpublished master's thesis). Graduate School of Public and Development Management, Development Academy of the Philippines.

Graduate School of Public and Development Management Health Systems and Development Batch 6 Thesis (MPM-HSD)--Development Academy of the Philippines.

One in every five adult person today suffers from hypertension worldwide. It is the leading cause of death and disability globally. Approximately ten prevent of the worlds overall health care expenditures are spent on hypertension and its complications. Despite decades of advances in the understanding of the pathophysiology of hypertension and pharmacology of antihypertensive medication, the disease burden of hypertension has prevailed. This health and economic crisis disproportionately affects developing countries because of poor health care systems. Although numerous initiatives have been created to address hypertension disease burden, there has been clinical and policy inertia for several years now. Most of the preventive, curative and rehabilitative efforts were fragmented and outcome focused, overlooking that between treatment initiatives and target outcomes lies patient adherence to therapy. Poor adherence is the primary reason for suboptimal clinical benefit. In hypertension, antihypertensive medication adherence is a key determinant of blood pressure control to goal 140 90 mmHg. Adherence has been extensively researched and documented in literature. But existing strategies to improve adherence has been patient factor focused and one dimensionally motivated, forget=ting that adherence is multifactorial. In the Philippines, full national and local epidemiologic and economic studies on hypertension have been limited and almost non existent regarding studies on medication adherence. This action and plan project was designed to adopt locally a multi dimensionally designed adherence enhancing strategy to examine its validity in a low resource setting where hypertension has been a substantial issue. The idea was to adopt a combination of several well proven adherence enhancing methods such as simplifying treatment regimens, imparting knowledge, modifying beliefs and behaviours, providing communication, leaving biases and evaluating adherence, grouped into one strategy with the mnemonic SIMPLE. A mixed methods design was used where a correlational, observational, descriptive method was used for strategy implementation while non experimental, cross sectional method was employed to evaluate adherence. One hundred twenty hypertensive respondents were selected using inclusion criteria and were observe monthly to participate in hypertension club, refill maintenance medication and have consults to monitor blood pressure control. They also had specialized prescriptions, blood pressure monitoring sheets and treatment partners. Before after survey was used to obtain antihypertensive medication adherence scores and subsequently ranked using a vernacularly translated Morisky Medication Adherence Scale 4. Matched paired T test at 95% confidence level was used to determine whether antihypertensive medication improvement after project run was significant. This action plan and project found that using the SIMPLE ,method has increased the antihypertensive medications adherence of 120 respondents patients in San Jose, Province of Dinagat Islands and that this improved adherence to medication has been associated with decreased hypertension related morbidities among them. Adherence to antihypertensive medications among these patients was found out to be statistically noteworthy at t 119 8.67, p a 0.05. An improvement in the number of hypertension related morbidities were observed following SIMPLE method implementation providing evidence that a multifactorial approach targeting more than one factor with more than one intervention is a better way of addressing hypertension treatment and outcome goals and good medication adherence hypertension treatment and outcome goals and good medication adherence increases optimum clinical benefit. Indeed, understanding adherence locally, where health systems are weak, and increasing the effectiveness of adherence interventions could represent a vital contribution to knowledge gaps and an important potential source of health and economic improvement.