Rational pharmacotherapy of hypertension in the elderly: analysis of the choice and dosage of drugs

Determinants affecting medication adherence in the elderly: A qualitative study

OBJECTIVE

Due to high rates of irrational use of medicines and low rates of medication adherence among older Iranian patients, this study aimed to explore the determinants of medication adherence in the elderly.

METHODS

This qualitative study was conducted in 2019 via 20 semi-structured interviews with a purposeful sample of elderly people and health-care personnel. Transcript data were analyzed applying thematic analysis. MAXQDA10 was used for thematic analysis and presenting a thematic map.

RESULTS

Two main themes appeared as the main determinants of medication adherence: individual determinants and external determinants. Other results show that there were six sub-themes and 23 main categories in this regard. The sub-themes were as follows: consumption disorder, consumption acceptance, delinquency, forgetfulness, sociocultural factors, and others' impacts.

CONCLUSIONS

Different individual and external factors can affect elderly people's medication adherence. Considering the significance of this issue for the health of elderly people and the whole community, positive changes are needed to manage the medication-adherence process. Basic and scientific planning, appropriate interventions, and comprehensive collaboration among all health-system levels are required for implementing such changes.

Antihypertensive Drug Utilization in Two Districts of Northern Cyprus

Aim. Since the irrational use of medicine increases the risk of morbidity and mortality in hypertension, this study was aimed to evaluate antihypertensive pharmacotherapy at two districts of Northern Cyprus (NC).

Material and methods. A total of 148 prescriptions including antihypertensive drugs (n=181) were obtained by the aid of five pharmacists between November 2017 August 2018 and evaluated regarding the antihypertensive drug choices and good prescribing principles. The prescribed antihypertensive agents were classified according to the Anatomical Therapeutic Chemical Classification System (ATC) 2, 3 and 5 and the prescriptions were evaluated regarding the availability of format information.

Results. The mean of antihypertensive agents per prescription was 1.2±0.6. According to the ATC-3 subclassification, beta-blockers (22.1%), angiotensin receptor blockers (ARBs) (22.1%), calcium channel blockers (20.4%), angiotensin converting enzyme inhibitor (ACE) inhibitors (17.7%), diuretics (13.8%) and anti-adrenergic drugs (3.9%) were prescribed. According to the ATC-5 subclassification, the most common prescribed antihypertensives were metoprolol (16.6%), amlodipine (16.0%), furosemide (8.8%), captopril (7.7%) and losartan (6.6%). There were no significant relation between the prescribed antihypertensive agents and gender and the physicians serving either in governmental or private hospitals. There were shortcomings in the prescriptions such as age, diagnosis and drug information which were crucial for the chosen of an appropriate antihypertensive agent.

Conclusion. This first pharmacoepidemiological study about antihypertensive drug utilization in NC indicates the imperfections of physicians in terms of prescribing antihypertensive agents according to the guidelines and writing a “legible and good” prescription that contains full information. These findings underline necessity of educational interventions for physicians to disseminate rational use of medicine (RUM) in the NC.

Clinical and nonclinical correlates of adherence to prescribing guidelines for hypertension in a large managed care organization

To examine correlates of guideline adherence in a population with access to health care and prescription drug benefits, the authors conducted a cross-sectional analysis among 5789 patients undergoing hypertension treatment with a single medication in a large New England managed care organization. Logistic regression was used to determine correlates of adherence, defined as use of diuretics or beta blocker as antihypertensive monotherapy during the 1-year study period. Women were more likely than men to receive guideline-adherent therapy (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.45-1.85). Compared with patients covered by health maintenance organization plans, Medicare coverage was positively associated with guideline adherence (OR, 1.38; 95% CI, 1.13-1.69), but fee-for-service coverage was negatively associated (OR, 0.66; 95% CI, 0.48-0.91). Patient age was not a significant correlate of adherence to guidelines (OR, 1.01; 95% CI, 0.94-1.09). Understanding these observations may lead to strategies to improve guideline adherence and reduce health care disparities.