Factors associated with nonadherence to antihypertensive medication

Differences in knowledge, attitude, and practice regarding hypertension by access to a community-based screening program (POSBINDU): A cross-sectional study from four districts in Indonesia

BACKGROUND

A high prevalence of hypertension is found in Low- and Middle-income Countries (LMICs) including in Indonesia. However, hypertension awareness, treatment, and control are relativity poor. A community-based program to screen and educate people on non-communicable disease prevention (POSBINDU) was launched by the Indonesian government. However, the association between participation in the POSBINDU program with increasing knowledge, attitude, and practice of hypertension has not been widely assessed. In this study, we compared the knowledge, attitudes, and practices among people who accessed the POSBINDU and those who did not access the POSBINDU program. Subsequently, factors associated with the knowledge, attitudes, and practices among people who accessed the POSBINDU and those who did not access the POSBINDU were explored.

METHODS

This was an observational study with a cross-sectional design measuring the knowledge, attitudes, and practices for hypertension control in four districts in Indonesia from October 2019 to January 2020. A total of 1,988 respondents were included in this study. A questionnaire was used to assess the knowledge, attitudes, and practices of hypertension. Simple logistic regression was used to investigate the correlation between the characteristics of respondents and knowledge, attitudes, and practice status. Multiple logistic regression tests were conducted to investigate factors associated with knowledge, attitudes, and practice status.

RESULTS

We found that people who accessed POSBINDU had higher odds of having better knowledge (aOR:1.4; 95%CI:1.2-1.8), however, accessed to POSBINDU was associated with lower attitudes (aOR:0.6; 85%CI: 0.5-0.7) and had no association with hypertension-related practice.

CONCLUSION

People who accessed POSBINDU have an association with good knowledge, but the association with good attitude and practice was less clear. Therefore, an improvement in the POSBINDU program is needed to increase the attitudes and practices of hypertension.

Factors Affecting the Level of Adherence to Hypertension Medications: A Cross-Sectional Study Using the Hill-Bone Questionnaire

Background

The adherence to antihypertensive therapy plays a significant role in determining the clinical outcomes of hypertension. We aim to evaluate the level of adherence to antihypertensive medications among patients and to assess the effect of different sociodemographic factors on the level of adherence using the Hill-Bone scale for indirect assessment.

Methodology

In this cross-sectional study, we utilized a validated, face-to-face interview questionnaire to collect data on sociodemographic characteristics, participants' attitudes, and disease knowledge. The Hill-Bone questionnaire was employed to assess treatment adherence. The statistical analysis was conducted using SPSS version 28.0, where mean, standard deviation, and range were utilized for variability analysis.

Results

A total of 390 patients were included in this study. The sample comprised 56.9% of females and 56.4% of participants aged 60 years or older. Approximately 80% of participants were currently married, and 46.7% had a higher education level. The average Hill-Bone CHBPTS score was 21.23± 4.95 and indicated good adherence in 63.8% of participants. The findings showed that several factors were significantly associated with higher adherence rates, including older age (COR = 3.41, 95% CI = 1.10-10.54, p = 0.03), higher educational level (COR = 1.72, 95% CI = 1.05-2.83, p = 0.03), regular blood pressure monitoring (COR = 1.90, 95% CI = 1.10-3.30, p = 0.03), and knowledge about their medications (COR = 2.12, 95% CI = 1.14-3.94, p = 0.02).

Conclusion

The medication adherence within our population falls below the desired level. Enhanced counselling and further research are necessary to identify additional factors influencing adherence and develop effective strategies for promoting adherence to antihypertensive medications.

Productivity-adjusted life-years and correlates of uncontrolled hypertension at two health facilities in Zambia

BACKGROUND

Hypertension has in the recent past surfaced as one of the conditions that has a significant impact on workforce productivity in emerging economies. Zambia is no different and has in the recent past recorded increasing cases. Despite the impact of hypertension being of great importance in regards to productivity, we have scarcity of data and studies on hypertension-related Productivity-Adjusted Life-Years (PALYs) in Zambia and Africa at large. This study assessed the impact of hypertension on PALYs lost and socioeconomic factors associated with nonadherence to antihypertensive medication (NATAM).

METHODS

This was a cross-sectional study of 198 participants from Livingstone University Teaching Hospital and Maramba Clinic situated in Livingstone, Zambia. Structured questionnaires were used to collect data. Productivity index multiplied by years lived was used to calculate PALYs and descriptive statistics were used to summarize sociodemographic, clinical and economic variables. Multivariable logistic regression was used to determine factors associated with NATAM.

RESULTS

The participants had a median age (interquartile range (IQR)) of 49 years (41, 59) and 60.1% (n = 119) were females while 39.9% (n = 79) were male. Our estimated PALYs lost per person due to hypertension were 0.2 (IQR 0.0, 2.7). Cumulative PALYs value lost due to the burden of hypertension was estimated to be at $871,239.58 in gross domestic product (GDP). The prevalence of NATAM was 48% (n = 95). The factors that were significantly associated with NATAM were age (odds ratio (OR) 0.94; 95% confidence interval (CI) 0.90, 0.98), female sex (OR 2.52; 95%CI 1.18, 5.40), self-employment (OR 2.57; 95%CI 1.02, 6.45) and absenteeism from work (OR 3.60; 95%CI 1.16, 11.22).

CONCLUSIONS

Findings in our study highlight a high economic loss of PALYs due to hypertension with a potential to impact GDP negatively. We also found that NATAM reduced productivity and income among individuals of working age further impacting PALYs lost due to hypertension. The factors associated with NATAM were age, sex, employment status and absenteeism from work. This study underscores the need for interventions targeting young people, females, self-employed individuals, and absentees at work to improve adherence to antihypertensive drugs in order to reduce PALYs lost due to hypertension.

Impact of prescription length supply policy on patient medication adherence in Thailand

BACKGROUND

Phramongkutklao Hospital is one of the largest military hospitals in Thailand. Beginning in 2016, an institutional policy was implemented in which medication prescription length was increased from 30 to 90 days. However, there have been no formal investigations into how this policy has impacted medication adherence among patients in hospitals. As such, this study evaluated how prescription length impacted medication adherence among dyslipidemia and type-2 diabetes patients who were treated at Phramongkutklao Hospital.

METHODS

This pre-post implementation study compared patients who received prescription lengths of 30 and 90 days based on information recorded in the hospital database between 2014 and 2017. Therein, we used the medication possession ratio (MPR) to estimate patient adherence. Focusing on patients with universal coverage insurance, we employed the difference-in-difference method to examine changes in adherence from before and after policy implementation, then conducted a logistic regression to test for associations between the predictors and adherence.

RESULTS

We analyzed data from a total of 2,046 patients, with equal amounts of 1,023 placed into the control group (no change to 90-day prescription length) and intervention group (change from 30 to 90-day prescription length). First, we found that increased prescription length was associated with 4% and 5% higher MPRs among dyslipidemia and diabetes patients in the intervention group, respectively. Second, we found that medication adherence was correlated with sex, comorbidities, history of hospitalization, and the number of prescribed medications.

CONCLUSION

Increasing the prescription length from 30 to 90 days improved medication adherence in both the dyslipidemia and type-2 diabetes patients. This shows that the policy change was successful for patients in the hospital considered for this study.

Medication regimen complexity and its association with adherence and blood pressure control among hypertensive patients at selected hospitals of South Gondar Zone: A hospital based cross sectional study

INTRODUCTION

Despite the availability of effective antihypertensive medications, blood pressure (BP) control is suboptimal. High medication regimen complexity index (MRCI) is known to reduce adherence and may be the reason for poor BP control. However, there is no data in the present study areas. Hence, the aim of this study was to assess MRCI and its association with adherence and BP control among hypertensive patients at selected hospitals of South Gondar Zone.

METHODS

A hospital based cross sectional study was conducted from December 1, 2020 to February 30, 2021 at selected hospitals of South Gondar Zone. Medication regimen complexity and adherence was evaluated using 65-item validated tool called MRCI (Text removed at time of retraction. See retraction notice for more information.). Multivariable logistic regression analysis was done to determine the association between predictive and outcome variables.

RESULTS

About 3.3% of participants were classified as having high HTN specific MRCI whereas 34.75% of participants were classified as having high patient level MRCI. (Text removed at time of retraction. See retraction notice for more information.) Being illiterate, and having low HTN MRCI were more likely to have controlled BP in adjusted analyses. On the contrary, (Text removed at time of retraction. See retraction notice for more information.) not having health insurance, and having lower monthly income were less likely to have controlled BP.

CONCLUSION

A considerable proportion of patients had high MRCI. Having low HTN MRCI was more likely to have controlled BP. Simplification of a complex medication regimen for patients with HTN should be sought by physicians and pharmacists to improve BP control.

Women's Reports of Barriers to and Facilitators of Oral Medication Adherence During Ovarian Stimulation: A Mixed Methods Pilot Study

Background:

Adherence to lifestyle modification recommendations remains problematic for women undergoing fertility treatment, raising concerns about the extent to which women adhere to prescribed medication regimens. Limited data have shown suboptimal oral medication adherence rates of 19% to 74%. The objective of this study was to explore what women perceive as barriers to and facilitators of oral medication adherence during fertility treatment cycles.

Methods:

An exploratory mixed methods pilot study was conducted among a sample of 30 women who were actively taking one to two cycles of letrozole or clomiphene citrate for ovarian stimulation in conjunction with intrauterine insemination cycles. Medication adherence barriers were measured using a 20-item survey. Medication adherence facilitators and personal experiences with fertility treatment were assessed with structured interviews. Medication adherence was assessed with electronic event monitoring.

Results:

The overall medication adherence median was 0.97 with a range of 0.75 to 1.00, and nine women (50%) demonstrated perfect adherence. The most commonly reported barriers were recently feeling sad, down, or blue (53%), and taking medication more than once per day (40%). Women with higher barrier scores had significantly lower medication adherence scores (p=0.02) compared to women with lower total barrier scores. Facilitators included using physical aides as reminders (60%) and establishing a daily routine (50%). No significant correlation was found between medication adherence scores and facilitators.

Conclusion:

The dynamic interplay between perceived barriers and facilitators and women’s medication-taking patterns could influence whether or not medication regimens are followed correctly.

Nonadherence to Self-Care Practices, Antihypertensive Medications, and Associated Factors among Hypertensive Patients in a Follow-up Clinic at Asella Referral and Teaching Hospital, Ethiopia: A Cross-Sectional Study

Background

Hypertension is one of the most common noncommunicable diseases affecting several individuals globally. However, the level of nonadherence to self-care practices, antihypertensive medications, and associated factors among hypertensive patients in a follow-up clinic at Asella Referral and Teaching Hospital is unknown.

Objective

To assess the level of nonadherence to self-care practices, antihypertensive medications, and associated factors among hypertensive patients in a follow-up clinic at Asella Referral and Teaching Hospital, Arsi Zone, Oromia Regional State, Ethiopia, in 2020.

Methods

An institution-based cross-sectional survey was conducted on 115 hypertensive patients who visited the follow-up clinic at Asella Referral and Teaching Hospital from December 24, 2020, to January 15, 2021. Data were entered into EpiData version 4.2.0.0 and exported to SPSS version 21.0 for statistical analysis. Binary and multivariable logistic regression analysis was used to assess the presence of statistical association between dependent and independent variables.

Results

A total of 115 hypertensive patients were enrolled into the study, giving a response rate of 98.29%. The mean age of the study participants was 55.17 years (SD = 17.986). More than half of them (59 (51.3%)) were females. More than half of them (58 (50.4%)) were married. Nearly two-thirds of them (79 (68.7%)) had formal education. The level of nonadherence to self-care practices was 67.0% (n = 77, 95% CI: 60.0, 75.7). Meanwhile, the patient's level of nonadherence to antihypertensive medications was 16.5% (n = 19, 95% CI: 10.4, 24.3). The multivariable logistic regression analysis showed that age >45 years (AOR = 2.89, 95% CI: 1.16, 7.18), having no formal education (AOR = 1.67, 95% CI: 1.32, 3.74), and having ≤5 years' duration since diagnoses of hypertension (AOR = 1.56, 95% CI: 1.07, 3.25) were factors significantly associated with nonadherence to self-care practices. Being male (AOR = 2.09, 95% CI: 1.93, 9.59), being married (AOR = 4.22, 95% CI: 1.29, 13.76), and having an average monthly income of ≤2500 ETB (AOR = 1.58, 95% CI: 1.09, 7.08) were factors significantly associated with nonadherence to medications.

Conclusion

In the present study, the level of both nonadherence to self-care practices and antihypertensive medications was relatively high. There is a need to initiate programs that could create awareness about adherence to self-care practices and antihypertensive medications among hypertensive patients to improve their level of adherence.

Impact of socioeconomic deprivation on incidence and outcomes of acute type A aortic dissection repair in New Zealand

BACKGROUND

Socioeconomic deprivation (SED) has been associated with increased 30-day mortality and reduced long-term survival after surgical repair of acute type A aortic dissection (ATAAD). The study aimed to determine the incidence rate ratio of ATAAD in New Zealand population with higher and lower SED indices and to evaluate any association between SED and outcomes after ATAAD repair.

METHODS

This was a retrospective cohort study. Patients who underwent ATAAD repair from March 2003 to May 2020 were identified. Overseas patients, those with chronic aortic dissection, and those who died in hospital before the operation were excluded. The total number of New Zealand residents was estimated based on the national 2018 Census.

RESULTS

A total of 363 ATAAD patients met the eligibility criteria. The incidence of ATAAD was 70% greater in those who were more socioeconomically deprived (higher SED) compared with less socioeconomically deprived (lower SED) New Zealanders (odds ratio = 1.7; 95% confidence interval [CI] = 1.4-2.1; p < .0005). Postoperative cardiogenic shock, renal failure, pulmonary embolism, and respiratory failure were more common in the higher than in the lower SED group. Both groups had similar operative and in-hospital mortality and time intervals in the intensive care unit and hospital. Both groups had similar freedom from reoperation (hazards ratio [HR] = 1.1; 95% CI = 0.5-2.6; p = .746) and long-term survival (HR = 0.73; 95% CI = 0.5-1.1; p = .115).

CONCLUSION

The incidence of ATAAD is greater in more socioeconomically deprived New Zealand residents. Following ATAAD repair, SED is not associated with worse short- or long-term outcomes in the universal health care system.

Adherence to antihypertensive medication after referral to secondary healthcare: A prospective cohort study

BACKGROUND

Nonadherence (NAd) to antihypertensive medication is associated with lack of blood pressure control and worsened long-term outcomes. Increased access to a programme for high-risk cardiovascular patients has the potential to reduce NAd and improve clinical outcomes. We evaluated implementation NAd prevalence and risk factors among severely hypertensive patients after 12-month-long access to secondary healthcare centres.

METHODS

The Morisky Green Levine Scale (MGLS) was used to analyse antihypertensive medication NAd in a prospective cohort of 485 patients. Logistic regression models evaluated the influence of ecological model factors on NAd.

RESULTS

The majority of patients were female, had low health literacy, a low family income and a mean age of 61.8 ± 12.5 years. Prevalence of NAd fell from 57.1% at programme entry to 28.3% (P < .001) at the end of the study. After access to a secondary healthcare centre, we observed better blood pressure control, an increase in the number of pills/day and a higher number of antihypertensive medications. Predictive variables of NAd were age (OR 1.027; CI 1.003-1.051; P = .023), low health literacy (OR 1.987; CI 1.009-3.913; P = .047), systolic blood pressure (OR 1.010; CI 1.003-1.021; P = .049), dosages ≥ 2 times/day (OR 1.941; CI 1.091-3.451; P = .024) and patient satisfaction with the healthcare team (OR 0.711; IC 0.516-0.980; P = .037).

CONCLUSIONS

Greater access to health services is associated with a reduction in NAd to antihypertensive medication and better blood pressure control. NAd was correlated with modifiable variables such as treatment complexity and, for the first time, team satisfaction, suggesting that implementation of similar programmes may limit NAd in similar patient groups.

Treatment and adherence to antihypertensive therapy in France: the roles of socioeconomic factors and primary care medicine in the ESTEBAN survey

Antihypertensive drugs remain one of the main beneficial strategies for cardiovascular disease prevention. The objective of our study was to investigate the associations of different clinical and socioeconomic (SES) factors, and the use of primary care medicine with treatment and adherence (proportion of days covered (PDC) by treatment) to hypertension management in French participants aware of their hypertension. Cross-sectional analyses of treatment for hypertension and adherence to treatment were performed using data from 396 participants from the ESTEBAN survey, a representative sample of the French population. Logistic regression analyses were performed to investigate associations between SES factors (age, sex, education, income, civil status), clinical factors, health care (general practitioner (GP) visits, cardiologist visits, number of consultations, home blood pressure measurement (HBPM)), treatment and adherence. A total of 265 of the 396 hypertensive patients were treated. Antihypertensive drug use was more common among elderly individuals (OR: 2.73 [1.14; 4.32), diabetic patients (OR: 4.18 [1.92; 6.44] and overweight hypertensive patients (OR = 3.04 [1.09; 4.99]). GP consultations and HBPM were associated with increased treatment (OR: 1.03 [1.01; 1.05]; OR: 1.97 [1.06; 2.61], respectively). The PDC was higher among men (p = 0.045) and couples living together (p = 0.018) but lower among diabetic patients (p = 0.012) and patients visiting a cardiologist (p = 0.008). Education and income levels were not associated with either treatment or the PDC. In France, SES factors seemed to have little impact on treatment and adherence to antihypertensive drug regimens. However, treatment administered by GPs and HBPM may play key roles in hypertension management. Although the PDC was quite low, both the number of GP consultations and HBPM were positively associated with pharmacological treatment.

Group-Based Trajectory Modeling to Identify Patterns of Adherence and Its Predictors Among Older Adults on Angiotensin-Converting Enzyme Inhibitors (ACEIs)/Angiotensin Receptor Blockers (ARBs)

PURPOSE

Commonly prescribed medications among patients with comorbid diabetes mellitus and hypertension include ARBs and ACEIs. However, these medications are associated with suboptimal adherence leading to inadequately controlled blood pressure. Unlike traditional single estimates of proportion of days covered (PDC), group-based trajectory modeling (GBTM) can graphically display the dynamic nature of adherence. The objective of this study was to evaluate adherence using GBTMs among patients prescribed ACEI/ARBs and identify predictors associated with each adherence trajectory.

PATIENTS AND METHODS

Patients with an ACEI/ARBs prescription were identified between July 2017 and December 2017 using a Medicare Advantage dataset. PDC was used to measure monthly patient adherence during the one-year follow-up period. The monthly PDC was added to a logistic group-based trajectory model to provide distinct patterns of adherence. Further, a multinomial logistic regression was conducted to determine predictors of each identified adherence trajectory. Predictors included various socio-demographic and clinical patient characteristics.

RESULTS

A total of 22,774 patients were included in the analysis and categorized into 4 distinct adherence trajectories: rapid decline (12.6%); adherent (58.5%); gaps in adherence (12.2%), and gradual decline (16.6%). Significant predictors associated with all lower adherence trajectories included 90 days refill, >2 number of other medications, ≥1 hospitalizations, and prevalent users. Significant predictors associated with the rapid decline trajectory included male sex, comorbidities, and increased CMS risk score. Further, significant predictors associated with the gaps in adherence trajectory included increasing age, and comorbidities. Lastly, significant predictors associated with the gradual decline trajectory included increasing age, no health plan subsidy, comorbidities, and increasing CMS risk score.

CONCLUSION

Identifying various patient characteristics associated with non-adherent trajectories can guide the development of tailored interventions to enhance adherence to ACEI/ARBs.

Previously undiagnosed risk factors and medication nonadherence are prevalent in young adults with first-ever stroke

PURPOSE

The incidence of stroke and prevalence of traditional vascular risk factors (VRFs) in young adults (age < 55 y) are both increasing. Young patients tend to be unaware of their VRFs and to have lower medication adherence. We examined how age affects the prevalence of previously undiagnosed VRFs and the extent of medication nonadherence among stroke patients.

METHODS

Using Taiwan's National Health Insurance Research Database, we identified consecutive adult patients with first-ever stroke between 2000 and 2013. Diagnosis of hypertension, diabetes, and hyperlipidemia was ascertained using validated methods. We investigated (1) the proportion of patients who had undiagnosed VRFs within 3 years before stroke and (2) the proportion of nonadherence to medications among patients who had a previously diagnosed VRF.

RESULTS

Among stroke patients with hypertension (n = 9722), diabetes (n = 4751), and hyperlipidemia (n = 4486), 24.9%, 20.8%, and 55.0%, respectively, had not been diagnosed before stroke, whereas 56.0%, 66.7%, and 32.5%, respectively, had been diagnosed at least 1 year before stroke. The proportions of medication nonadherence were 71.5%, 64.3%, and 88.4% in patients with previously diagnosed hypertension, diabetes, and hyperlipidemia, respectively. In multivariate analysis, younger age was independently associated with undiagnosed hypertension before stroke as well as medication nonadherence in patients with previously diagnosed hypertension or diabetes.

CONCLUSIONS

Previously undiagnosed hypertension and nonadherence to treatment of hypertension and diabetes were more prevalent in young adult patients with first-ever stroke in Taiwan. Interventions targeting young people to promote early detection and adequate control of VRFs should be encouraged.

Factors affecting treatment compliance in new hypertensive patients in Korea

This study aims to analyze continuity of care according to complications and examine the relationship between the continuity of care and health outcomes (hospitalization, emergency department visits, and complications) using data of new hypertensive patients from Korea's National Health Insurance Claims database. There were a total of 715,053 new hypertensive patients followed up for three years until 2011. Indices of continuity of care were Continuity of Care Index (COC), Modified, Modified Continuity Index (MMCI), and Most Frequent Provider Continuity (MFPC). The mean values of COC, MMCI, and MFPC were 0.79, 0.77, and 0.87, respectively, in new hypertensive patients with complications, and 0.80, 0.79, and 0.87, respectively, in those without complications. The factors affecting the continuity of care were sex, ambulatory care visits, number of providers, main medical institution, and Charlson's comorbidity score. Following analysis of the correlation between the treatment compliance and health outcomes, the low COC group had a higher association with hospitalization, the emergency department visit, and complications as compared with the high COC group. COC and medication adherence were associated with a reduction of hospitalization, emergency department visits, and complications. This indicates it would be mandatory to manage the patients' continuity of care.

Translation and validation of the Greek version of the hypertension knowledge-level scale

AIMS AND OBJECTIVES

To translate and validate a Greek version of the Hypertension Knowledge-Level Scale.

BACKGROUND

The major barrier in the management of hypertension is the lack of adherence to medications and lifestyle adjustments. Patients' knowledge of the nature of hypertension and cardiovascular risk factors is a significant factor affecting individuals' adherence. However, few instruments have been developed to assess patients' knowledge level and no one has been translated into Greek.

DESIGN

This study used a case control study design.

METHODS

Data collection for this research occurred between February 7, 2013 and March 10, 2013. The sample included both hypertensives and non-hypertensives. Participants simultaneously completed the version of the Hypertension Knowledge-Level Scale. A total of 68 individuals completed the questionnaire.

RESULTS

Coefficient alpha was 0·66 for hypertensives and 0·79 for non-hypertensives. The difference for the mean scores in the entire scale between the two samples was statistically significant. In addition, significant differences were observed in many sub-dimensions and no correlation was found between level, knowledge and age, gender and education level.

CONCLUSIONS

Findings provide support for the validity of the Greek version of the Hypertension Knowledge-Level Scale.

RELEVANCE TO CLINICAL PRACTICE

The translation and validation of an instrument evaluating the level of knowledge of hypertension contribute to assessing the provided educational intervention. Low knowledge level should lead to the development of new methods of education, therefore nurses will have the opportunity to amplify their role in patients' education and develop relationships based on honesty and respect.