Determinants of adherence to anti-hypertensive medications among adult hypertensive patients on follow-up in Hawassa Referral Hospital: A case–control study

Abstract

Introduction: Hypertension is a global challenge which accounts for high morbidity and mortality rates in the world. The availability of effective anti-hypertensive medications does not result in a good outcome in controlling blood pressure which points towards poor adherence. Thus, this study was conducted to assess the determinants of adherence to anti-hypertensive medication among hypertensive patients on follow-up in Hawassa Referral Hospital. Methods: Institution-based case-control study was conducted on a sample of 289 clients from February to May 2018. Census was conducted on 1600 clients to select cases and controls. Then, systematic random sampling was used to select study subjects, and adherence was measured by Morisky medication adherence scale. The associations of variables were analyzed using bivariable followed by multivariable logistic regression analyses. Results: The respondent's adherence to medication was found to be 67% as measured by Morisky medication adherence scale. The multivariate logistic regression analysis showed that medication adherence was found to be better in younger age (<45) (AOR ¼ 3.8), clients living in urban areas (AOR ¼ 6.84), those clients who had good knowledge (AOR ¼ 3.13), those with no co-morbidities (AOR ¼ 3.14) and patients who controlled their blood pressure (<140/90) (AOR ¼ 2.35). Conclusions: The rate of medication adherence was found to be low, and hence educational interventions focusing on factors promoting adherence and patients' health support should be implemented.

Adherence to antihypertensive medications and associated factors among hypertensive patients in Ethiopia: Systematic review and meta-analysis

“…The full-text papers of 31 articles were retrieved and reviewed for inclusion which resulted in a total of 18 studies eligible for the methodological quality assessment. After excluding four studies with reasons mainly a weak quality score, 14 studies were included in the final SR (qualitative synthesis) [19][20][21][22][23][24][25][26][27][28][29][30][31][32] and 12 of them were also included in MA ( Figure 1).…”

“…Regarding the geographical part of the country, one study was conducted in the north, 19 four studies were in the northwest, 20,27,30,31 one study was in the northeast, 24 three studies were in the central, 26,29,32 two studies were in the western, 22,23 one study was in the southern, 28 and two studies were in the southwest. 21,25 Except for the study in Hawassa 28 which was an unmatched case-control study, all other studies were hospital-based cross-sectional quantitative in type. Except for the study in Adama, 29 the source population were adult hypertensive patients on antihypertensive medication for at least 1 month.…”

“…The sample size of studies was ranged from 100 24 to 1600 28 subjects, and the total sample sizes included for this review were 4938. Systematic random sampling was the main sampling technique which was used by six studies, 20,26,[28][29][30]32 , while six studies were included all adult hypertensive patients visiting the chronic follow-up clinic during data collection. 19,21,22,24,25,27 Face-to-face interviews with chart review were the main data collection technique used by eight studies 19 -21,23,25,26,28,30 while five studies 22,24,29,31,32 used interview (non-specific) technique and only one study 27 used self-administered questionnaires to assess adherence.…”

“…Methods of assessing adherence. The aim of eight studies was to assess the magnitude of adherence to antihypertensive medication and associated factors among hypertensive patie nts, 20,21,25,26,[29][30][31][32] while three studies were aimed to assess the proportion of non-adherence to antihypertensive medication and associated factors among hypertensive patients, 19,23,24 one study 22 was aimed to assess the patient compliance and associated factors of antihypertensive treatments, another study 28 was designed to assess the determinants of adherence to antihypertensive medication, and the remaining study 27 was intended to measure the contribution of adverse effects on antihypertensive medications adherence.…”

“…Five studies indicated that the presence of comorbidities affected the extent of antihypertensive medication adherence. 20,21,[28][29][30] This finding was, however, non-conclusive. Hypertensive patients with comorbid conditions were 50% less likely (AOR = 0.50, 95% CI: 0.290-0.893) to be adherent compared to patients without comorbidity in Adama.…”