Patient-level factors influencing hypertension control in adults in Accra, Ghana

Okai, Darlene Esinam; Manu, Adom; Amoah, Emefa Modey; Laar, Amos; Akamah, Joseph; Torpey, Kwasi

doi:10.1186/s12872-020-01370-y

Cited by 26 publications

(35 citation statements)

References 36 publications

(48 reference statements)

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“… 13 Silent clinical picture and higher prevalence of hypertension, low people awareness (43%), poor adherence to antihypertensive medication, bad dietary habits, and high costs of drugs contribute to poor BP control. 5 , 14 – 16 Moreover, in developing countries, government priority is given to acute disorders, child and maternal health care, and control of communicable diseases, giving very little emphasis on chronic non-communicable diseases. 4 …”

Section: Introductionmentioning

confidence: 99%

Rate of blood pressure control and its determinants among adult hypertensive patients at Jimma University Medical Center, Ethiopia: Prospective cohort study

2021

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Introduction: Despite the fact that the goals for the management of hypertension are well-defined and effective therapies are available, control of hypertension remains poor in countries with low resources including Ethiopia. This study aimed to determine blood pressure control rate and its determinants among ambulatory adult hypertensive patients at Jimma University Medical Center. Methods: A general prospective cohort study was conducted among adult hypertensive patients who had regular follow-up at Jimma University Cardiac Clinic from 20 March to 20 June 2018. Hypertensive patients who fulfilled the inclusion criteria were selected in the first month of the data collection period. Then, only those patients who visited the clinic at the first month were consequently followed-up for the next 3 months. The Eighth Joint National Committee guideline was used to categorize controlled and uncontrolled blood pressures. Patients’ specific data were collected using a structured data collection tool. Data were analyzed using the statistical software package SPSS version 21.0. Bivariate and multivariable logistic regression analysis was used to identify independent variables influencing blood pressure control. p-values of less than 0.05 were considered statistically significant. Results: From a total of 416 patients, 237 (57.0%) were male with a mean age of 56.50 ± 11.96 years. Two hundred and fifty eight (62.0%) participants had comorbid conditions and 275 (66.1%) were on combination therapy. The rate of blood pressure control was 42.8%. Age ⩾60 years was negatively associated with uncontrolled blood pressure (adjusted odd ratio = 0.52, confidence interval = 0.31–0.88, p = 0.015). Medication non-adherence (adjusted odd ratio = 1.64, confidence interval = 1.04–2.58, p = 0.034) and non-adherence to international guidelines (adjusted odd ratio = 2.33, confidence interval = 1.49–3.64, p < 0001) were positively associated with uncontrolled blood pressure. Conclusion: The rate of blood pressure control among hypertensive patients was suboptimal. Age, clinicians’ non-adherence to international guidelines, and patients’ non-adherence to medications were independent predictors of blood pressure control. Physicians and clinical pharmacists should adhere to guidelines for better treatment and care of hypertensive patients.

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Section: Introductionmentioning

confidence: 99%

Rate of blood pressure control and its determinants among adult hypertensive patients at Jimma University Medical Center, Ethiopia: Prospective cohort study

2021

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“…Stopping medication when symptoms disappear, fear of addiction and side effects have been reported in other studies [ 11 , 43 ]. Our study also showed that physicians felt that fear of side effects from long term medication use contributed to patient non-adherence to antihypertensive medications.…”

Section: Discussionmentioning

confidence: 67%

“…Counseling alone or counseling combined with patient training improved BP control in another study [ 42 ]. A systematic review of qualitative studies from 16 countries, including Tanzania [ 11 , 43 ], showed that many patients intentionally reduced or stopped treatment without consulting their physicians. Patient-centric care and engaging patients in shared decision making have both been identified as important facilitators in addressing barriers to medication adherence [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

“…Patient forgetfulness has been documented as a key contributor to non-adherence [ 2 , 3 ], and provides both systems level and individual level interventions. A study from Ghana on patient-level factors reported that forgetfulness, along with medication side-effects and a high pill burden, were major factors for non-adherence to anti-HT medication [ 43 ]. Forgetfulness was also reported in our study, especially for older adults.…”

Section: Discussionmentioning

confidence: 99%

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Patient and healthcare provider perspectives on adherence with antihypertensive medications: an exploratory qualitative study in Tanzania

Edward

Campbell

Manase³

et al. 2021

BMC Health Serv Res

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Background Poor medication adherence is an extraordinarily common problem worldwide that contributes to inadequate control of many chronic diseases, including Hypertension (HT). Globally, less than 14% of the estimated 1.4 billion patients with HT achieve optimal control. A myriad of barriers, across patient, healthcare provider, and system levels, contributes to poor medication adherence. Few studies have explored the reasons for poor medication adherence in Tanzania and other African countries. Methods A qualitative study applying grounded theory principles was conducted in the catchment area of two semi-urban clinics in Dar es Salaam, Tanzania, to determine the perceived barriers to HT medication adherence. Ten key informant interviews were conducted with healthcare providers who manage HT patients. Patients diagnosed with HT (SBP ≥ 140 and DBP ≥ 90), were randomly selected from patient registers, and nine focus group discussions were conducted with a total 34 patients. Inductive codes were developed separately for the two groups, prior to analyzing key thematic ideas with smaller sub-categories. Results Affordability of antihypertensive medication and access to care emerged as the most important barriers. Fee subsidies for treatment and medication, along with health insurance, were mentioned as potential solutions to enhance access and adherence. Patient education and quality of physician counseling were mentioned by both providers and patients as major barriers to medication adherence, as most patients were unaware of their HT and often took medications only when symptomatic. Use of local herbal medicines was mentioned as an alternative to medications, as they were inexpensive, available, and culturally acceptable. Patient recommendations for improving adherence included community-based distribution of refills, SMS text reminders, and family support. Reliance on religious leaders over healthcare providers emerged as a potential means to promote adherence in some discussions. Conclusions Effective management of hypertensive patients for medication adherence will require several context-specific measures. These include policy measures addressing financial access, with medication subsidies for the poor and accessible distribution systems for medication refill; physician measures to improve health provider counseling for patient centric care; and patient-level strategies with reminders for medication adherence in low resource settings.

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“…There are some essential parameters which are used for the evaluation of patient's knowledge, which includes the name, the dose, the dosing frequency, the duration of therapy and one common side effect of the medicine (Saqib et al, 2019) . In Ghana, though there have been studies on patients knowledge on NCDs (Agyei-Baffour et al, 2018;Boima et al, 2015;Marfo and Owusu-Daaku, 2017;Okai et al, 2020) there appears to be paucity of data on co-morbid hypertension and diabetes patients regarding their knowledge about medication and therapy in hospital settings. This study therefore seeks to assess the knowledge of patients with hypertension and type-2diabetes mellitus at a municipal hospital in Ghana about their medications and therapy.…”

Section: Introductionmentioning

confidence: 99%

Knowledge of hypertension and diabetes comorbid patients about their medication in a municipal hospital in Ghana

Kwakye¹,

Buabeng²,

Opare-Addo³

et al. 2021

Afr. J. Pharm. Pharmacol.

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Patients with hypertension and diabetes co-morbidity may have medication knowledge and therapy challenges that could impact on patients' outcomes. The study examines knowledge of medication and therapy among hypertension and Type-2-diabetes mellitus co-morbid patients at a Municipal hospital in Ghana. This study was conducted at the medical outpatient department (OPD) of the Municipal Hospital in Tema (a Harbour City), in the Greater Accra Region of Ghana. This was a prospective study involving 389 patients, who had co-morbid hypertension and Type-2-diabetes mellitus visiting an OPD of the hospital, of which 338 patients consented to be part of the study. The patients were interviewed with a semi-structured questionnaire, on the name, purpose, number of medications taken, dose, duration of therapy, mode of administration, and side effects of the medication therapy. Bloom's cut off was used to assess the overall patients' knowledge, and chi-square analysis used to test the association between knowledge and other variables. From the study, 29% of the study subjects (n=98) had five medicines prescribed (the highest) and three patients (0.9%) were prescribed nine medicines (the least). Patients had knowledge of the names of medication (n=158, 46.8%), duration of therapy (n=322, 95.3%), route of administration (n=324, 95.9%), purpose of anti-hypertensive (n=254, 75.1%), anti-diabetic therapy (n=251, 74.9%) and common side effects (n=50, 14.8%). Overall, more than half had inadequate knowledge of their medication and therapy (n=187, 55.3%). The hypertensive and diabetic patients did not have adequate knowledge about their medications and therapy. This provides justification for the integration of effective pharmaceutical care interventions to improve patients' outcomes.

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Patient-level factors influencing hypertension control in adults in Accra, Ghana

Cited by 26 publications

References 36 publications

Rate of blood pressure control and its determinants among adult hypertensive patients at Jimma University Medical Center, Ethiopia: Prospective cohort study

Rate of blood pressure control and its determinants among adult hypertensive patients at Jimma University Medical Center, Ethiopia: Prospective cohort study

Patient and healthcare provider perspectives on adherence with antihypertensive medications: an exploratory qualitative study in Tanzania

Knowledge of hypertension and diabetes comorbid patients about their medication in a municipal hospital in Ghana

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