Adherence to treatment and evaluation of disease and therapy knowledge in Lebanese hypertensive patients

Non-adherence to antihypertensive medications in Lebanese adults hospitalized for hypertensive urgency and its cost

BACKGROUND

Drug non-adherence is assumed to play an important role in development of hypertensive urgency, which is a common health problem resulting in frequent emergency department admissions and thus increased healthcare spending wastage. The objective of this study is to assess the rate of non-adherence to antihypertensives and to evaluate influencing factors predicting this behavior in Lebanese hypertensive adults. In addition, this study aim to estimate the cost of hospitalization for hypertensive urgency covered by the Ministry of Public Health in patients' non-adherent to their antihypertensives.

METHODS

A multi-methods approach is used comprising a cross-sectional study, additionally to an observational, retrospective, cost of illness study. A cross-sectional questionnaire based study is conducted from May to Dec, 2019 to address the study objective. Using the Ministry of Public Health hospitalization data during 2019, the cost of hospitalization for hypertensive urgency is assessed. Multivariable analysis is performed to calculate the adjusted odd ratios by fitting a logistic regression model.

RESULTS

The cross-sectional study includes 494 participants and shows that 43.0% of patients hospitalized and covered by the Ministry of Public Health are non-adherent. The univariate regression model shows that adherence to antihypertensive medications is significantly associated with age (p-value = 0.005) and follow-up visits (p-value = 0.046). The odds of adherence for participants earning more than USD 2000 was 3.27 times that for those who earn less than USD 1000 (p = 0.026). The estimated cost of hospitalization for non-adherent patients is USD 452,353 in 2019.

CONCLUSION

Non-adherence associated hospitalization costs represents a financial burden to Lebanese health system.

Knowledge, Attitude, and Practice Toward Hypertension Among Hypertensive Patients Residing in Lebanon

Background and Objectives

Hypertension (HTN) is a major health concern that leads to cardiovascular disease and premature death. Assessing HTN knowledge, attitude, and practice (KAP) is crucial for controlling HTN. This study aimed to determine HTN KAP among hypertensive patients residing in Lebanon.

Methods

This cross-sectional study involved 342 hypertensive patients. A questionnaire form was used to collect data related to patients' characteristics. SPSS was used to determine KAP scores, descriptive statistics, and correlations.

Results

Data from HTN patients was analyzed of whom 98.2% were Lebanese and 51.2% were males. The median age was 59.15 ± 13.55 years old. A proportion of 40.4% had HTN duration for at least 10 years and 67.3% had HTN family history. Patients had fair HTN knowledge and practice, but good attitude toward HTN. Only 45.3% regularly checked their blood pressure. Positive correlations were observed between HTN attitude and each of knowledge and practice. HTN knowledge and attitude were associated with many studied factors, whereas no relationship was found regarding practice.

Conclusion

Hypertensive patients had fair levels of knowledge and practice, and a good level of attitude concerning their disease. We provided a model for predictors of HTN KAP scores that will allow the development of efficient campaigns related to HTN.

Translation, Cultural Adaptation and Validation of the Hill Bone Compliance to High Blood Pressure Therapy Scale to Nepalese Language

BACKGROUND

Control of high blood pressure and prevention of cardiovascular complications among hypertensive patients depends on patients' adherence to therapy. The Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBCTS) is one of the most popular scale to assess hypertensive patients' adherence behaviour. Unfortunately, no questionnaire in the Nepalese language is available to date to assess adherence to anti-hypertensive therapy.

AIM

To translate, culturally adapt and validate the English original version of the HBCTS into Nepalese language to measure treatment adherence of Nepalese hypertensive patients.

METHODS

The cross-sectional study was conducted to translate, culturally adapt and validate the HBCTS into Nepalese version. The standard translation process was followed and was evaluated among 282 hypertensive patients visiting selected primary healthcare centers (PHCCs) of Kathmandu district, Nepal. Cronbach's alpha was measured to assess the reliability of the tool. Exploratory factor analysis using principal component analysis with varimax rotation was used to evaluate structural validity.

RESULTS

The mean±SD age of 282 participants was 58.49±12.44 years. Majority of participants were literate (75.2%), and consumed at least one anti-hypertensive medication per day (85.5%). Nearly half (42.2%) of the participants had a family history of hypertension, and almost half (48%) of them had comorbid conditions. Mean ±SD score for overall adherence was 17.85±3.87 while those of medication taking, reduced salt taking, and appointment keeping subscales were 10.63±2.55, 4.16±1.12 and 3.06±1.07, respectively. Kaiser Meyer Olkin (KMO) was found to be 0.877. Exploratory factor analysis revealed a three-component structure; however, the loading of components into medication adherence, reduced salt intake and appointment keeping constructs were not identical to the original tool. Cronbach's alpha score for the entire HBCTS scale was 0.846.

CONCLUSION

The translated Nepali version of the HBCTS demonstrated acceptable reliability and validity to measure adherence to antihypertensive therapy among hypertensive patients in clinical and community settings in Nepal.

Using the Health Belief Model to Explain the Patient's Compliance to Anti-hypertensive Treatment in Three District Hospitals - Dar Es Salaam, Tanzania: A Cross Section Study

BACKGROUND

Hypertension remains a public-health challenge globally. Its prevention, early detection, proper and adequate treatment and control should be given high consideration to prevent occurrence of cardiovascular disease and stroke. This study is guided by the Health Belief Model (HBM) to investigate the influence of treatment compliance using HBM constructs among elderly hypertensive patients in 3 regional hospitals in Dar es Salaam, Tanzania.

METHODS

An analytical cross-sectional study was conducted in 3 region hospitals in Dar es Salaam from April to May 2012. The study included patients who were on antihypertensive medications. Simple Random Sampling was used to enrol the study participants. Data was collected using structured questionnaire. Data was analysed using SPSS version 20. Linear Multiple Regression analysis was performed to identify variables which are strongest predictor of treatment compliance among variables of the Health belief Model.

RESULTS

A total of 135 participants were enrolled of whom 56% were compliant to hypertensive treatment. Multivariate analysis indicated significant model fit for the data (F=11.19 and P value <.001). The amount of variance in treatment compliance that was explained by the predictors was 30.3% (R2=0.303) with perceived barrier being the strongest predictor of treatment compliance (β=-0.477; p< .001). Other predictor variables were not statistically associated with treatment compliance.

CONCLUSION

The study showed that 56% of study participants had hypertensive treatment compliance and perceived barrier to treatment was the strongest predictor. Innovative strategy on improving patients' perception of barrier to treatment is recommended in order to improve treatment compliance.

Factors Influencing Adherence to Treatment and Quality of Life for a Group of Patients with Essential Hypertension in Romania

PURPOSE

Romania has a high prevalence of hypertension (45.1% in 2016). Whether this is attributable to a low rate of treatment adherence-which can aggravate the pathology and reduce patients' quality of life (QoL)-is unknown. To address this point, the present study investigated the factors that influence short- and long-term adherence and QoL in patients with arterial hypertension using a specially designed questionnaire.

PATIENTS AND METHODS

The study enrolled 289 patients at different stages of hypertension with or without comorbidities. The diagnosis of hypertension was established by the cardiologist, and treatment regimens were communicated by patients to the clinical pharmacist who administered the questionnaire, which comprised 7 domains with variable numbers of items.

RESULTS

The majority of surveyed patients (57.43%) considered that their capacity for effort was decreased because of their hypertension, with 65.05% reporting that they were affected by symptoms associated with high blood pressure (eg, headache and dizziness). Most patients (71.28%) understood the consequences of discontinuing their medication and the severe complications of hypertension, and 69.55% indicated that they would not stop treatment if they experienced side effects. For 53.28% of patients, social activity was significantly affected by their condition. Only 47.05% of patients underwent regular mandatory medical examinations and 55.36% periodically monitored their blood pressure at home. A regression analysis revealed correlations between specific questionnaire items and patient characteristics.

CONCLUSION

Nonpharmacologic factors that were shown to influence patients' adherence to treatment and QoL included the level of health education and knowledge of disease complications, self-monitoring of hypertension, and consultation with medical and pharmaceutical healthcare providers regarding hypertension and its treatment.

Adherence to antihypertensive fixed-dose combination among Egyptian patients presenting with essential hypertension

Background

Many patients with hypertension require more than one drug to achieve blood pressure control. They are prescribed with fixed-dose combination (FDC) antihypertensive therapy rather than monotherapies. Although it is commonly admitted that the use of FDC may improve compliance to treatment, adherence rates in patients receiving FDCs have not been documented. Therefore, the aim of this study was to assess the adherence to treatment in patients receiving FDCs of antihypertensive medications in a real-world setting in Egypt.

Results

We conducted a multi-center cross-sectional study over a period of 1 year from Jan 2017 to Jan 2018. We included patients above 21 years old with essential hypertension who were already prescribed with an FDC of antihypertensive treatment for at least 3-month duration. We assessed the adherence to treatment by patient self-assessment using the Morisky 8-Item Medication Adherence Scale (MMAS 8).

This study enrolled 2000 hypertensive Egyptian patients. The mean age of enrolled patients was 55.8 ± 10.9 years. Male to female ratio was 1.08. The mean MMAS score was 6.5 ± 1.9. Our analysis showed that 825 (41.3%) patients reached high adherence score, 523 (26.2%) medium adherence, and 652 (32.6%) low adherence.

Furthermore, Male patients showed higher adherence rate than females (56.4% versus 43.6%, p < 0.001). Out of 746 patients with controlled blood pressure (< 140/90), 387 (51.9%) patients were highly adherent to treatment. Higher level of education was significantly associated with high adherence rate; 559 (67.8%) patients were university graduates, 232 (28.1%) had primary/secondary school education, and 34 (4.1%) were illiterate (p < 0.001).

Moreover, once daily (99.2%) fixed-dose combination was associated with higher adherence rate than twice regimen daily (0.8%), p = 0.03. Multivariate logistic regression analysis showed that patients with high level of education, employed patients, and patients with controlled blood pressure have high adherence rate to medication.

Conclusions

Higher adherence to medication is associated with high level of education and employment, and it can lead to better blood pressure control. Thus, patient education programs may increase patients’ adherence to their medication.

Perceived Illness and Treatment Adherence to Hypertension Among Patients Attending a Tertiary Hospital in Kathmandu, Nepal

INTRODUCTION

Hypertension (HTN) is a silent killer, accountable for life-threatening complications. An individual's illness perception may affect adherence to treatment which is crucial to prevent complications of HTN. The objective of this study was to identify illness perception and treatment adherence among patients with HTN in a tertiary hospital in Kathmandu, Nepal.

METHODS

Descriptive correlational study was conducted in the out-patient department of Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu Nepal. Non-probability purposive sampling was used. A face-to-face interview was conducted from September to December 2018, using a structured questionnaire that included socio-demographic variables, illness perception questionnaire (revised) and Hill bone compliance to high blood pressure therapy scale. Data analysis was done by using descriptive and inferential statistics (chi-square test, Spearman rank correlation).

RESULTS

Among 204 participants, 51% were male, 77% were literate, mean ± S.D. age was 60±12. About 72% experienced headache and 88% said that headache is related to HTN. Behavioural factors and psychological factors were regarded as the leading cause of HTN. Almost 63% participants believed HTN as highly threatening illness. Higher scores in timeline (acute/chronic), personal control, and treatment control revealed that patients believed HTN as a chronic disease with a higher rate of personal and treatment control. Regarding treatment adherence, the mean score was 16.58 (SD = 2.08), and only 14.7% had perfect adherence. Participants were more adherent to medication and appointment keeping rather than reduce salt intake. Duration of HTN diagnosis (p=0.027) and duration under HTN medication (p= 0.021) were found to be significantly associated with treatment adherence. There was a significant positive correlation between illness perception and treatment adherence (ρ = 0.282, p<0.01).

CONCLUSION

Illness perception and treatment adherence are correlated. Hence, it is beneficial to improve illness perception to achieve perfect treatment adherence. Reinforcement is essential to maintain adherence to both medications and behaviour therapy.

Treatment adherence among adult hypertensive patients: a cross-sectional retrospective study in primary care in Romania

PURPOSE

This study was performed to elucidate the level of adherence to antihypertensive treatment in adult subjects attending a family medicine clinic in a city in central Romania.

PATIENTS AND METHODS

A cross-sectional, retrospective study was performed on a cohort of hypertensive adults. A total of 525 participants were selected from 1,714 adults attending a single urban family medicine practice. Assessment of adherence to therapy was performed by a chart review of prescription and clinical records over a 4-year study period.

RESULTS

The results showed that 69.8% of the patients had high adherence (>80% with therapy); 20.3% had medium adherence (20%-79%); and 9.9% had low adherence (<20%). A positive association was found (p = 0.01) between low adherence and male gender. A significant positive association (p = 0.02) was found between total cardiovascular risk and level of adherence. We found that 54.7% of the high adherence subjects had well-controlled blood pressure, and chronic kidney disease was associated with high adherence to therapy (p = 0.03). Antihypertensive regimens administered as fixed-dose combinations were positively associated with high adherence (p = 0.001). Subjects who had their antihypertensive regimen adjusted to a new drug class during the study period showed enhanced adherence compared to subjects treated with an unchanged regimen (p = 0.001).

CONCLUSION

This is the first published study assessing adherence to antihypertensive therapy in family medicine practice in Romania. It presented data derived from a primarily urban setting and targeted a geographical area where the prevalence of hypertension has increased continuously. Female gender, age, presence of cardiovascular risk factors, defined cardiovascular disease, chronic renal impairment, and good control of hypertension were positively associated with high adherence. The results provide insights to guide further strategies to improve adherence and indirect methods for blood pressure management strategies.