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Factors Associated With Poor Medication Adherence In Hypertensive Patients In Lusaka, Zambia
Abstract
Objectives: To determine the prevalence of drug adherence and factors associated with poor adherence to antihypertensive treatment among adults seen in the department of medicine at UTH. To investigate patient related and health care system related factors associated with poor adherence to antihypertensive Drugs.
Methods: 237 adult patients aged 18 and above with previous diagnosis of essential hypertension receiving out patient care in the University Teaching Hospital (UTH) were recruited from the first week of November to the second week of December 2010. Information was collected regarding health care system related factors and care giver related factors to patient non adherence using self report and modified Hill-Bone compliance scale.
Results: The prevalence of adherence was 83% by self report and 70% using modified Hill-Bone scale. The mean age was 57.8 ± 12.0 SD. Patients on three antihypertensive drugs were less likely to be nonadherent (OR 0.21; 95% 95% CI 0.06-0.79) than patients taking only one drug. Majority (60%) of the patients were reviewed at least twice in the last 6 months at the time of the interview. 195 (83%) patients reported that drugs prescribed were not available at the hospital pharmacy, but 186 (79%) of these were able to purchase the drugs elsewhere. Patients counseled by the nurse were more likely to be adherent than those not counseled by the nurse (OR 2.7: 95% CI1.0-7.3). Those who were counseled for more than 5 minutes had three fold likelihood of less non-adherence as reported by both self report and modified Hill-Bone with OR 0.3: 95% CI 0.2-0.8 and 0.3: 95% CI 0.1-0.5, respectively. Multivariable analysis showed that; participants were more likely to be non-adherent by self-report if they had attained a primary level of education, had missed appointments due to lack of transport, or had experienced the side effect of dizziness. Patients with heart failure were more likely to be nonadherent based on the modified Hill-Bone score.
Conclusion: The prevalence of adherence among hypertensive patients was found to be higher than anticipated. The factors associated with nonadherence included side effect of dizziness, missed appointment due to lack of transport, and living at a distance of more than 10 km from the hospital. Taking 3 BP drugs and receiving more than 5 minutes of counseling about how to take medications were both associated with decreased likelihood of non-adherence.
Methods: 237 adult patients aged 18 and above with previous diagnosis of essential hypertension receiving out patient care in the University Teaching Hospital (UTH) were recruited from the first week of November to the second week of December 2010. Information was collected regarding health care system related factors and care giver related factors to patient non adherence using self report and modified Hill-Bone compliance scale.
Results: The prevalence of adherence was 83% by self report and 70% using modified Hill-Bone scale. The mean age was 57.8 ± 12.0 SD. Patients on three antihypertensive drugs were less likely to be nonadherent (OR 0.21; 95% 95% CI 0.06-0.79) than patients taking only one drug. Majority (60%) of the patients were reviewed at least twice in the last 6 months at the time of the interview. 195 (83%) patients reported that drugs prescribed were not available at the hospital pharmacy, but 186 (79%) of these were able to purchase the drugs elsewhere. Patients counseled by the nurse were more likely to be adherent than those not counseled by the nurse (OR 2.7: 95% CI1.0-7.3). Those who were counseled for more than 5 minutes had three fold likelihood of less non-adherence as reported by both self report and modified Hill-Bone with OR 0.3: 95% CI 0.2-0.8 and 0.3: 95% CI 0.1-0.5, respectively. Multivariable analysis showed that; participants were more likely to be non-adherent by self-report if they had attained a primary level of education, had missed appointments due to lack of transport, or had experienced the side effect of dizziness. Patients with heart failure were more likely to be nonadherent based on the modified Hill-Bone score.
Conclusion: The prevalence of adherence among hypertensive patients was found to be higher than anticipated. The factors associated with nonadherence included side effect of dizziness, missed appointment due to lack of transport, and living at a distance of more than 10 km from the hospital. Taking 3 BP drugs and receiving more than 5 minutes of counseling about how to take medications were both associated with decreased likelihood of non-adherence.
