Interventions
Each participant had a minimum of one physician assessment
and six consultations with the NCMin addition to their routine
SPC visits over the six-month study period. At the first study
visit, a specialist in internal medicine with an interest in hypertension
management and stroke counselled participants on the
need for medication adherence. Included was an assessment of
the need for 1) adjustments to current blood pressure medications
(altering dosages or simplification of dosing schedules), 2)
additional medications, and 3) utilization of combination therapy
(for example, a vasodilator medication combined in the
same pill as a diuretic). At this visit, the NCM reviewed with
participants the purpose of their medications and discussed
individual lifestyle changes to assist in blood pressure reduction.
Lifestyle changes discussed included reduction in dietary
salt, increased activity, weight loss, smoking cessation, reduced
alcohol consumption, and improved adherence tomedications.
Motivational interviewing techniques and a self-managed care
approach were integrated into all discussions with participants
to support behaviour change. Group training in motivational
interviewing and self-managed care had been previously provided
by the regional stroke program. At their first study visit
with the NCM, participants were provided with a memory cue
in the formof a weeklymedication dosette if they were not previously
using one. Additional individualized memory cues were
collaboratively identified by the NCM, participants and family
members/supportive others that would assist in takingmedications
at the prescribed times, for example, at meal times or at
time of brushing teeth in the morning. Participants were also
instructed in how to self-monitor blood pressure using either
personal machines or equipment available at their local pharmacy.
Where other resources were not available, automatic
blood pressure machines were loaned to participants for the
duration of the study