_.png)
_.png)
_.png)
PUBLICATION ETHICS
FOCUS & SCOPE
AUTHOR(S) GUIDELINES
PLAGIARISM SCREENING
SUBMISSIONS
MMAS-8-Guided Nurse-Pharmacist Collaborative Education to Improve Medication Adherence and Blood Pressure Control in Patients with Hypertension: A Case Study
Abstract
Introduction: Poor adherence to antihypertensive medication remains a major challenge in hypertension management and may contribute to uncontrolled blood pressure and preventable complications. Structured education guided by medication adherence assessment may help patients understand their treatment and improve medication-taking behavior. Objective: This case study aimed to describe the implementation of MMAS-8-guided nurse-pharmacist collaborative education to improve medication adherence and blood pressure control in patients with hypertension. Methods: This study used a descriptive case study design involving five patients with hypertension in the working area of Cimandala Primary Health Center, Bogor, Indonesia. The intervention consisted of structured education delivered collaboratively by nurses and pharmacists over 14 days. Medication adherence was assessed using the Morisky Medication Adherence Scale-8 (MMAS-8), while blood pressure was measured before and after the intervention. Results: Before the intervention, four patients had medium medication adherence and one patient had low adherence. After the intervention, all patients achieved high adherence with MMAS-8 scores of 8. Mean systolic blood pressure decreased from 153 mmHg to 139 mmHg, and mean diastolic blood pressure decreased from 95 mmHg to 88 mmHg. Patients also reported improved understanding of hypertension management, increased motivation to take medication regularly, and stronger family support. Conclusion: MMAS-8-guided nurse-pharmacist collaborative education was associated with improved medication adherence and better blood pressure control among patients with hypertension. This approach may be considered a practical, patient-centered strategy to support hypertension management in primary healthcare settings.
Keywords
References
Burnier, M. (2025). The benefits of a team-based care approach to improve drug adherence in hypertension. Exploration of Medicine, 6, 1001285. https://doi.org/10.37349/emed.2025.1001285
Choudhry, N. K., Kronish, I. M., Vongpatanasin, W., Ferdinand, K. C., Pavlik, V. N., Egan, B. M., Schoenthaler, A., Houston Miller, N., Hyman, D. J., & American Heart Association Council on Hypertension. (2022). Medication adherence and blood pressure control: A scientific statement from the American Heart Association. Hypertension, 79(1), e1-e14. https://doi.org/10.1161/HYP.0000000000000203
Gastens, V., Tancredi, S., Kiszio, B., Del Giovane, C., Tsuyuki, R. T., Paradis, G., Chiolero, A., & Santschi, V. (2025). Pharmacists delivering hypertension care services: A systematic review and meta-analysis of randomized controlled trials. Frontiers in Cardiovascular Medicine, 12, 1477729. https://doi.org/10.3389/fcvm.2025.1477729
Guo, A., Jin, H., Mao, J., Zhu, W., Zhou, Y., Ge, X., & Yu, D. (2023). Impact of health literacy and social support on medication adherence in patients with hypertension: A cross-sectional community-based study. BMC Cardiovascular Disorders, 23, 93. https://doi.org/10.1186/s12872-023-03117-x
Kementerian Kesehatan Republik Indonesia. (2023). Hasil survei kesehatan Indonesia (SKI) 2023: Prevalensi hipertensi meningkat. Kementerian Kesehatan Republik Indonesia.
Mancia, G., Kreutz, R., Brunström, M., Burnier, M., Grassi, G., Januszewicz, A., Muiesan, M. L., Tsioufis, K., Agabiti-Rosei, E., Algharably, E. A. E., Azizi, M., Benetos, A., Borghi, C., Cifkova, R., Coca, A., Cornelissen, V., Cruickshank, J. K., Cunha, P. G., Danser, A. H. J., ... Kjeldsen, S. E. (2023). 2023 ESH guidelines for the management of arterial hypertension. Journal of Hypertension, 41(12), 1874-2071. https://doi.org/10.1097/HJH.0000000000003480
McEvoy, J. W., McCarthy, C. P., Bruno, R. M., Brouwers, S., Canavan, M. D., Ceconi, C., Christodorescu, R. M., Daskalopoulou, S. S., Ferro, C. J., Gerdts, E., Hanssen, H., Harris, J., Lauder, L., McManus, R. J., Molloy, G. J., Rahimi, K., Regitz-Zagrosek, V., Rossi, G. P., Sandset, E. C., ... ESC Scientific Document Group. (2024). 2024 ESC guidelines for the management of elevated blood pressure and hypertension. European Heart Journal, 45(38), 3912-4018. https://doi.org/10.1093/eurheartj/ehae178
Miao, Y., Luo, Y., Zhao, Y., Liu, M., Wang, H., & Wu, Y. (2024). Effectiveness of eHealth interventions in improving medication adherence among patients with cardiovascular disease: Systematic review and meta-analysis. Journal of Medical Internet Research, 26, e58013. https://doi.org/10.2196/58013
Morisky, D. E., Ang, A., Krousel-Wood, M., & Ward, H. J. (2008). Predictive validity of a medication adherence measure in an outpatient setting. Journal of Clinical Hypertension, 10(5), 348-354. https://doi.org/10.1111/j.1751-7176.2008.07572.x
Mustara, M., Hartono, H., & Pamungkasari, E. P. (2025). Key contents of health education and their impact on improving medication adherence among hypertensive patients: A systematic review and meta-analysis. Narra J, 5(2), e2080. https://doi.org/10.52225/narra.v5i2.2080
Reeves, L., Robinson, K., McClelland, T., Adedoyin, C. A., & Broeseker, A. (2021). Pharmacist interventions in the management of blood pressure control and adherence to antihypertensive medications: A systematic review of randomized controlled trials. Journal of Pharmacy Practice, 34(3), 480-492. https://doi.org/10.1177/0897190020903573
Ruksakulpiwat, S., Schiltz, N. K., Irani, E., Josephson, R. A., Adams, J., & Still, C. H. (2024). Medication adherence of older adults with hypertension: A systematic review. Patient Preference and Adherence, 18, 957-975. https://doi.org/10.2147/PPA.S459678
Setyoningsih, N., & Zaini, M. (2020). The effect of structured education on adherence to antihypertensive therapy. Jurnal Keperawatan Indonesia, 23(2), 101-109.
Stephen, C., Halcomb, E., Fernandez, R., McInnes, S., Batterham, M., & Zwar, N. (2022). Nurse-led interventions to manage hypertension in general practice: A systematic review and meta-analysis. Journal of Advanced Nursing, 78(5), 1281-1293. https://doi.org/10.1111/jan.15159
Susanto, T., Wuryaningsih, E. W., & Rahmawati, I. (2018). Factors influencing adherence to antihypertensive medication among patients in primary healthcare. Indonesian Journal of Public Health, 13(2), 159-169.
Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., Wainford, R. D., Williams, B., & Schutte, A. E. (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension, 75(6), 1334-1357. https://doi.org/10.1161/HYPERTENSIONAHA.120.15026
World Health Organization. (2020). HEARTS: Technical package for cardiovascular disease management in primary health care. World Health Organization.
World Health Organization. (2023a). Global report on hypertension: The race against a silent killer. World Health Organization.
World Health Organization. (2023b). Hypertension fact sheet. World Health Organization.
Wulandari, R., & Sari, D. (2022). Patient education and adherence in hypertension management. Indonesian Journal of Nursing and Midwifery, 10(3), 152-160.
Yulianti, T., Widayanti, A. W., Kristina, S. A., & Yasin, N. M. (2025). Theory-based interventions to improve medication adherence among patients with hypertension in primary healthcare and the community: A systematic review. Journal of Preventive Medicine and Public Health, 58(4), 348-359. https://doi.org/10.3961/jpmph.24.651
Zhou, X., Zhang, X., Gu, N., Cai, W., & Feng, J. (2024). Barriers and facilitators of medication adherence in hypertension patients: A meta-integration of qualitative research. Journal of Patient Experience, 11, 23743735241241176. https://doi.org/10.1177/23743735241241176
DOI: https://doi.org/10.17509/jpki.v12i1.90173
Refbacks
- There are currently no refbacks.
Jurnal Pendidikan Keperawatan Indonesia(JPKI) published by Indonesia University of Education. JPKI is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Office :
Nursing Department. FPOK UPI.
229, Dr. Setiabudhi Street. Bandung 40154
West Java , Indonesia
E-mail : [email protected]