To what extent do prescribing practices for hypertension in the private sector in Zimbabwe follow the national treatment guidelines? An analysis of insurance medical claims

Abstract

BackgroundHypertension is the most prevalent cardiovascular disease in Zimbabwe. The prevalence of Hypertension in the country is above 30% regardless of the cut off used. Currently, majority of patients in Zimbabwe seek health care from the private sector due to limited government funding for the public health sector. However, Standard treatment guidelines for hypertension are only available in the public sector and are optional in the private sector. This study assesses compliance of private sector prescribing to Standard Treatment guidelines for hypertension.MethodsWe reviewed hypertension prescription claims to a private health insurance company in Zimbabwe for the period Jan 1-Dec 31 2015. We used the last prescription claimed in the year on the assumption that it represented the patient’s current treatment. Prescription data was analyzed by comparing medicines prescribed to those recommended in the Zimbabwe 7th Essential Medicines List and Standard Treatment Guidelines 2015. We used Microsoft Excel© 2010 to conduct the analysis.ResultsA total of 1019 prescriptions were reviewed. Most patients were either on mono or dual therapy (76%). The mostly prescribed class of antihypertensive as first line were Angiotensin Converting Enzyme Inhibitors /Angiotensin Receptor Blockers. Regardless of whether they were being used as first, second or third line this class of antihypertensives emerged as the most prescribed (639 times). Only 358 (35%) prescriptions were compliant with standard treatment guidelines; the rest (661) did not meet several criteria. Areas of non-compliance included use of second line medicines as first line, failure to consider patient characteristics when prescribing, use of contraindicated medicines for certain patients, clinically significant interactions among prescribed medicines and illogical combinations that predispose patients to toxicity.ConclusionThe poor compliance to standard treatment guidelines observed in our study indicates need to improve prescription practices for Hypertension in the private sector in Zimbabwe for its cost-effective management among the covered patients. However, further investigation is needed to understand the drivers of the prescribing habits and the non-compliance to the Essential Medicines List and Standard Treatment guidelines observed. This will enable design of appropriate educational, managerial and economic interventions to improve compliance.

Adherence to Essential Hypertension Treatment Guidelines in a Tertiary Hospital in Nigeria

“…ACEI/Angiotensin receptor blockers were the most prescribed agents (63 times), unlike in this study that had diuretics. Only 358 (35%) prescriptions complied with guidelines, which indicates poor compliance [7]. The findings of the study are similar to those found in other countries, as was in the present study [8,9].…”

“…In Zimbabwe, research by Basopo et al (2017) assessed the prescribing practices for hypertensive patients in the private sector to verify whether it followed the national treatment guidelines. The majority of the populace in Zimbabwe seek medical care from the private sector.…”

Reasons for poor blood pressure control in Eastern Sub-Saharan Africa: looking into 4P’s (primary care, professional, patient, and public health policy) for improving blood pressure control: a scoping review

“…Health facility capacity to manage hypertension in the Uganda survey showed the need of additional training on hypertension management by all health workers [ 70 ]. A similar study from Zimbabwe showed that professional knowledge was poor among 47.7% of health workers [ 105 , 106 ]. Another study from Rwanda showed that 43% of clinicians had poor knowledge [ 107 ].…”

Evaluation of blood pressure control and associated factors among patients with hypertension in Iraq: a prospective cross-sectional study

“…The most commonly prescribed antihypertensive medications were ACEIs/ARBs, a prescribing pattern that has been reported in several other studies. [252728] Besides being first-line medications, it has been shown that ACEI/ARB therapy helps to delay or prevent the progression of CKD, and guidelines accordingly emphasize this approach as a compelling indication for patients with CKD or diabetes mellitus without contraindications. [12] More than one-third of this study population were diabetic and this could explain the high trend of ACE/ARB use.…”