Background. Adherence to treatment is a primary determinant of treatment success. Nonadherence attenuates clinical benefits to the recipients of the treatment. However, monitoring adherence to long treatment regimens is not given due emphasis in low-income contexts. This study aimed to assess adherence to antihypertensive treatment and factors associated with it in Central Ethiopia. Method. This is an institution-based cross-sectional study conducted in 4 public hospitals in Central Ethiopia from December 4, 2016, to September 25, 2017. The Morisky Medication Adherence Scale (MMAS-8) was used to assess the level of adherence. The Revised Illness Perception Questionnaire (IPQ-R) was used to assess illness perception. The MMAS-8 score ranges from 0 to 8, a score of 8 reflects high adherence, 6 to 7 medium adherence, and <6 low adherence. Results. A total of 989 hypertensive patients participated in the study, of which 36.0% were assessed to have high adherence, 31.7% medium adherence, and 32.3% low adherence. We found that treatment adherence was significantly and positively associated with having family support (AOR: 1.65; 95% CI = 1.23, 2.22), high perception about consequences of hypertension (AOR: 1.51; 95% CI = 1.17, 1.95), and high perception about the severity of the disease (AOR: 1.42; 95% CI = 1.09, 1.86). Conclusion. The treatment adherence to antihypertensive medications is low in Central Ethiopia. Engaging family members in the treatment plan and improving patients’ understanding of the illness are critical in achieving high adherence to medication in this context.

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Adherence to Antihypertensive Treatment and Associated Factors in Central Ethiopia.

Medication Adherence In Patients With Arterial Hypertension: The Relationship With Healthcare Systems’ Organizational Factors

Purpose Arterial hypertension is one of the most common diseases in the world, presenting a great impact on global mortality. Despite having good medication, the best control depends on patient's adherence. Our aim is to characterize the relationship of adherence to medication in hypertensive patients with consultation length and other organizational factors of healthcare systems. Patients and methods We performed a comprehensive review of literature using the MeSH terms "hypertension" and "medication adherence". 61 articles were selected for inclusion and adherence parameters were extracted, allowing us to estimate the mean adherence for each country. The adherence was then correlated with organizational aspects of healthcare systems: consultation length, number of health providers (doctors, nurses and pharmacists), number of hospital beds, health expenditure and general government expenditure. Results Adherence to medication ranged between 11.8% in Indonesia and 85.0% in Australia. There is much heterogeneity in methodology, but the Morisky Medication Adherence Scale was the preferred method, used in 63.6% of the cases. We found no relation with consultation length, but a significant one with the greater number of health professionals available. Some differences were observed when considering European countries or Morisky Medication Adherence Scale alone. Conclusion The better the drugs, the better the control of blood pressure, if patients take them. Rather than investing in the prescription of more drugs, it is important to address non-adherence and reduce it to promote better blood pressure control. Organizational factors are relevant constraints and depend on administrative and political decisions. Although they are not always considered, they greatly impact the adherence to medication.

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Medication Adherence In Patients With Arterial Hypertension: The Relationship With Healthcare Systems' Organizational Factors.

Abstract Background Non-communicable diseases are a growing burden in many African countries; cardiovascular disease is the main disease. Antihypertensive medicines (AHM) are a common treatment option but we know little about community use in most low- and medium-income countries (LMIC). We aimed to describe the use of antihypertensive medicines (AHM) in Ghana and Nigeria using a novel data source. Methods We used data from mPharma—a health and pharmaceutical company which distributes pharmaceuticals to hospital and retail pharmacies. We extracted data using the anatomical therapeutic chemical (ATC) classification codes and calculated use in defined daily doses and explored patterns by class, medicines, dose, and originator or generic product. Results AHM use differed between Ghana and Nigeria. The most used classes in Ghana were angiotensin receptor blockers (ARB) followed by calcium channel blockers (CCB) and angiotensin-converting-enzyme inhibitors (ACEi). The five most used products were 16 mg candesartan, 30 mg nifedipine, 10 mg lisinopril, 5 mg amlodipine and 50 mg losartan. In Nigeria ARB, CCB and diuretics were widely used; the top five products were 50 mg losartan, 10 mg lisinopril, 30 mg nifedipine, 40 mg furosemide, and 5 mg amlodipine. More originator products were used in Ghana than Nigeria. Conclusion The differences between Ghana and Nigeria may result from a combination of medical, contextual and policy evidence and reflect factors related to clinical guidance (e.g. standard treatment guidelines), accessibility to prescribers and the role of community pharmacies, and structure of the health system and universal health coverage including funding for medicines. We show the feasibility of using novel data sources to gain insights on medicines use in the community. 

/pdf/antihypertensive-medicine-use-differs-between-ghana-and-3m4itm8p.pdf

Antihypertensive medicine use differs between Ghana and Nigeria

Consistent control of blood pressure requires that patients with hypertension follow medication regimen  and lifestyle modification. However, many patients fail to adhere to treatment recommendations  resulting in less than optimal treatment. While most studies have focused on medication adherence and  its associations among hypertensive patients seen in the hospital setting, little is known about this in the community. Knowledge of this will aid clinicians and health policy makers in designing community-based  intervention programme to improve medication adherence in the populace. A cross-sectional  communitybased study carried out among individuals known to be hypertensive for more than 3 months and on antihypertensive medications. Modified version of the hypertension fact questionnaire and the  8-item Morisky Medication Assessment Scale was used to assess knowledge and adherence to  medication respectively. Complete data was available for 252 participants. This included 143 (56.7%) males and 109 (43.3%) females with a mean age of 56.6 ± 12.7 years. Blood pressure control was  optimal in 33%, good knowledge of hypertension was found in 52% while only 31.8% were adherent to  prescribed medications. Duration of hypertension from time of diagnosis, systolic and diastolic blood  pressures and total number of pills swallowed per time were found to  independently correlate with medication adherence, albeit negatively. Education program and use of single pill combination regimen can be effective in promoting adherence to medication in our population.

/pdf/adherence-to-antihypertensive-medication-and-its-correlates-3psx9oz2fb.pdf

Adherence to antihypertensive medication and its correlates among individuals with hypertension in a semi-urban community of Southern Nigeria

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Adherence to antihypertensive medication and its correlates among individuals with hypertension in a semi-urban community of Southern Nigeria