Physicians' approach to the management of hypertension in a developing community

Olubodun, J.

doi:10.1016/0167-5273(95)02409-p

Cited by 8 publications

(6 citation statements)

References 10 publications

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“…A large proportion (30.4%) of the respondents in this study did not routinely check the BP of their adult patients in consultation, with this practice commoner among the younger graduates. This is less than 52.4% reported by Olubodun in a study of 42 Nigerian GPs [ 19 ]. A practice audit of 400 Italian GPs by Filippi et al showed that 27.8% of the patients seen over a period of 1 year had no recorded BP values [ 20 ].…”

Section: Discussioncontrasting

confidence: 55%

The approach of general practitioners in Lagos to the detection and evaluation of hypertension

2015

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IntroductionHypertension (HTN) control is a major public health and clinical challenge. A number of guidelines exist globally to assist in tackling this challenge. The aim of this study was to determine conformity of the HTN detection and evaluation practices of a sample of Lagos-based general practitioners (GPs) to international guidelines.MethodsSelf-administered structured questionnaires were used to collect data from a cohort of GPs attending continuing medical education programs in Lagos.ResultsOut of the 460 GPs that were approached, 435 agreed to participate in the study, with questionnaires from 403 GPs analyzed. The average age and number of years post-registration of the GPs were 40.0 ± 11.3 years and 14.3 ± 11.1 years, respectively. Two thirds (n = 269) were in private practice. Their daily average total and HTN patients’ loads were 17.4 ± 14.3 and 4.4 ± 3.5, respectively. Awareness of HTN guidelines was 46.7% (n = 188), while 18.1% (n = 73) was able to name one or more HTN guidelines. The approaches of these GPs to the detection and evaluation of HTN and their relationships to the GPs’ experience were heterogeneous.DiscussionThe approach of the GPs to detection and evaluation of HTN though heterogeneous is unsatisfactory and may partly contribute to poor HTN control in Nigeria. Strengthening the capacity of GPs in this regard through continuous medical education may greatly improve HTN control.

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Section: Discussioncontrasting

confidence: 55%

The approach of general practitioners in Lagos to the detection and evaluation of hypertension

2015

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“…It is known that patient education is a very important aspect of HBP management and yet, a study in Nigeria found that up to 40% of physicians within a hospital setting do not educate their hypertensive patients properly on the need for regular treatment and follow-up. [27] Thus, patient education should be taken more seriously in managing people with HBP if the course of HBP in blacks would improve rather than worsen, because even in developed nations, where health insurance policy is stable and practiced, just about 50 to 60% of people with HBP are said to be on treatment and just about 35% achieve control. [24] In this study, the overall prevalence of global obesity was 13.3% while abdominal obesity was 29.4%.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of blood pressure and indices of obesity in a typical rural community in eastern Nigeria

et al. 2011

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The prevalence of both hypertension and obesity seems to be increasing in rural communities in Nigeria and thus, the available prevalence documented in previous studies for rural communities may no longer represent the current trend. Awareness of the participants about these major cardiovascular risk factors is still very low. Higher BMI was associated with higher values of both systolic and diastolic BP.

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“…[27][28][29] Our findings, however, suggest that this overestimation might not be entirely due to an inadequacy of self-report, as an adherence-measuring method, but that other factors such as the depth and quality of clinician/patient interactions and the comprehensiveness of the process of ascertaining the true level of patient adherence with drug therapy may be at play. This is particularly important in settings where physicians are often overworked due to high patient workload, and the consulting environment is less than adequate, [41][42][43] as it is unlikely that a fatigued and overworked physician will have the patience and time to adequately interact with patients during consultation. Our findings therefore suggest that as pharmacist interviews have been shown to uncover drug-use problems, including non-adherence, [44][45][46] the adoption of a brief structured format of pharmacist interviews, before hypertensive patients are seen by physicians, may improve the overall quality of assessment of patients' adherence to anti-hypertensive drug therapy.…”

Section: Discussion Of Findingsmentioning

confidence: 99%

Assessing patient adherence to anti-hypertensive drug therapy: can a structured pharmacist-conducted interview separate the wheat from the chaff?

Yusuff

2007

International Journal of Pharmacy Practice

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Objective To identify determinants of adherence and assess the impact of structured pharmacistconducted interviews in determining patients' adherence to prescribed anti-hypertensive medications in a secondary care setting in Nigeria. Method The study was conducted in a secondary care facility located in Ibadan, Southwestern Nigeria. Two methodological approaches were employed. The first phase was pharmacistconducted, pre-physician consultation, cross-sectional interviews of 400 hypertensive patients who presented at the study site within the 2-month study period. The second phase was a follow-up review of case notes of these patients after they had left the physician's office. Key findings The outcome of the pharmacist-conducted pre-physician consultation interview shows that financial difficulty was the most frequently identified factor responsible for patients' non-adherence to anti-hypertensive drug therapy (64%). A drug holiday, varying from 5-14 days per month, was the coping strategy adopted by patients to circumvent this difficulty. Only 48% (192) of patients were aware of the negative consequences of non-adherence with anti-hypertensive drug therapy, and of these, 75% were adherent. The level of awareness was significantly higher in adherent patients (P < 0.001). Sixty-seven per cent (268) of patients use a daily medication reminder (DMR) to assist them in taking their anti-hypertensive drugs, and of these 65.7% were adherent. The use of DMRs was significantly higher among adherent patients (P < 0.01). A meal time was the most frequently used DMR (88%). Forty-one per cent (164) of patients had additional measurement of their blood pressure at pharmacies (65.9%) and neighbourhood private hospital (34.1%), and of these 75.6% were judged to be adherent with their prescribed drug therapy. Additional measurement of blood pressure was significantly higher in adherent patients (P < 0.001). Fifty-one per cent of the cohort were judged by pharmacists as non-adherent during pre-consultation interviews (phase 1), while physicians judged 25% of the same cohort as non-adherent during consultation (phase 2). The structured pharmacist-conducted pre-physician consultation interviews were significantly better at identifying patients who were non-adherent with prescribed anti-hypertensive drugs (P < 0.01). Conclusion A brief structured pharmacist-conducted interview can be a valuable tool in assessing and/or identifying determinants of adherence with anti-hypertensive drug therapy.Hypertension has been shown consistently to be a major cerebrovascular and cardiovascular risk factor. 1-4 Despite the availability of increasing numbers of pharmacological and non-pharmacological options for management of hypertension, many patients remain untreated or inadequately treated, and it is only in a minority of patients (about 30%) that good blood pressure control is achieved. [5][6][7][8] Studies have shown that it is only when blood pressure levels are adequately controlled that patients are at reduced risk of cardiovascular and cer...

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Physicians' approach to the management of hypertension in a developing community

Cited by 8 publications

References 10 publications

The approach of general practitioners in Lagos to the detection and evaluation of hypertension

The approach of general practitioners in Lagos to the detection and evaluation of hypertension

Evaluation of blood pressure and indices of obesity in a typical rural community in eastern Nigeria

Assessing patient adherence to anti-hypertensive drug therapy: can a structured pharmacist-conducted interview separate the wheat from the chaff?

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