Patient-related beliefs and adherence toward their medications among the adult hypertensive outpatients in Tanzania

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.

Lipid control and its associated factors among patients with dyslipidaemia in Jordan

BACKGROUND

Lipid control represents a cornerstone in the management of atherosclerotic cardiovascular disease (ASCVD). Nevertheless, little research has explored the factors associated with poor lipid control in patients with dyslipidaemia.

OBJECTIVE

The study aim was to investigate the variables associated with poor lipid control among patients with dyslipidaemia in Jordan.

METHOD

In addition to socio-demographics, disease and medication-related variables, lipid profile including total cholesterol, LDL-C, HDL-C and triglyceride and other biomedical variables were collected for patients diagnosed with dyslipidaemia using hospital medical charts at three major outpatient clinics in Jordan. The validated 4-item medication adherence scale and the beliefs about medications questionnaire were used to evaluate medication adherence and medication beliefs among the study participants. The participants were classified to have controlled and uncontrolled dyslipidaemia using recent AHA guidelines. A stepwise forward conditional binary regression was conducted to explore the variables significantly and independently associated with dyslipidaemia control. A P-value of < .05 was considered statistically significant.

RESULTS

A total of 228 patients participated in the study. Most of the study participants (61%) were classified to have uncontrolled lipid profile and 60.1% of them were found to have ASCVD. Regression analysis revealed that increased necessity for dyslipidaemia medications increased the odds of dyslipidaemia control (OR = 1.14), whereas active smoking (OR = 0.42), low medication adherence (OR = 0.0.8) and the presence of ASCVD (odd ratio = 0.24) were significantly associated with poor dyslipidaemia control.

CONCLUSION

Lipid profile has considerable scope for improvement in patients with dyslipidaemia in Jordan. Improving medication adherence by emphasising on medication necessity and simplifying the prescribed dosage regimen, particularly in smoking patients and those who have ASCVD, should be particularly considered in future clinical pharmacy service programmes aim at improving lipid control and health outcomes in patients with dyslipidaemia.

A Cost Analysis of Haemodialysis and Peritoneal Dialysis for the Management of End-Stage Renal Failure At an Academic Hospital in Pretoria, South Africa

BACKGROUND

Haemodialysis (HD) and peritoneal dialysis (PD) are commonly used treatments for the management of patients with end-stage renal disease (ESRD). The costs of managing these patients have grown in recent years with increasing rates of non-communicable diseases, which will adversely impact on national health budgets unless addressed. Currently, there is limited knowledge of the costs of ESRD within the public healthcare system in South Africa.

OBJECTIVE

The aim of this study was to examine the direct costs of HD and PD in South Africa from a healthcare provider's perspective.

METHODS

A prospective, observational study was undertaken at a leading public hospital in South Africa. A micro-costing approach was applied to estimate healthcare costs using 46 adult patients with ESRD who had been receiving HD and PD for at least 3 months.

RESULTS

The highest proportion of patients (35%) were aged 40-50 years. Patients aged 29-39 years were mostly on HD (28% vs. 21% on PD) while those aged 51-59 years mostly used PD (29% vs. 16% on HD). The average age of patients on HD and PD were 41 and 42 years, respectively. Fixed costs were the principal cost driver for HD ($16,231.45) while variable costs were the principal cost driver for PD (US$20,488.79). The annual cost of HD per patient (US$31,993.12) was higher than PD (US$25,282.00 per patient), even though the difference was not statistically significant (p = 0.816).

CONCLUSION

HD costs more than PD from the provider's perspective. These cost estimates may be useful for carrying out future cost-effectiveness and cost-utility analyses in South Africa.

Association Between Medication Literacy and Medication Adherence Among Patients With Hypertension

Background: Few studies have investigated the association between medication literacy and medication adherence as well as the influence of medication literacy on medication adherence in hypertensive patients. Thus, the goal of the present study was to determine the association between medication literacy and medication adherence in hypertensive patients. Methods: A cross-sectional survey was conducted between August 2016 and December 2016. Self-administered questionnaires were completed, including a self-developed and structured socio-demographic questionnaire; a self-developed, validated, and self-reported Medication Literacy Scale for Hypertensive Patients (C-MLSHP) used for medication literacy measurement; and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8), an eight-item validated, self-report scale for adherence measurement with a total score range of 0-8. A cut-off of 6 was applied to differentiate adherence levels, including patients with an MMAS score <6 (low adherence), MMAS score = 8 (high adherence), and MMAS score ≥6 and <8 (moderate adherence). In this study, hypertensive patients' medication literacy levels and adherence to antihypertensive agents were identified. Pearson correlation analysis was carried out to identify the correlation between medication literacy and adherence. Binary logistic regression analysis was performed with medication adherence as the outcome variable in order to confirm factors associated with medication adherence. Results: A total of 420 hypertensive patients, including 198 women and 222 men with a mean age of 60.6 years (SD = 12.4), were recruited. The mean score of hypertensive patients on the medication literacy scale was 24.03 (SD = 5.13). The mean scores of the four dimensions of knowledge, attitude, skill, and behavior on the medication literacy scale of this study were 6.22 ± 2.22, 5.04 ± 1.16, 4.50 ± 2.21, and 8.27 ± 1.90, respectively. Regarding medication adherence, the mean score of the C-MMAS-8 in this study was 4.82 (SD = 2.11). A total of 63.6% of patients presented with low adherence, 29.5% presented with moderate adherence, and 7.6% presented with high adherence. The Pearson correlation results showed that medication literacy (r = 0.342, P < 0.01) as a whole variable and the three dimensions of knowledge (r = 0.284, P < 0.01), attitude (r = 0.405, P < 0.01), and behavior (r = 0.237, P < 0.01) were significantly associated with medication adherence. Binary logistic regression analysis indicated that annual income [OR 1.199 (95% CI: 1.011-1.421); P = 0.037] and two dimensions of attitude [OR 2.174 (95% CI: 1.748-2.706); P = 0.000] and behavior [OR 1.139 (95% CI: 1.002-1.294); P = 0.046] in medication literacy were found to be independent predictors of medication adherence. Individuals with better attitudes and behavior literacy in medication literacy were more likely to adhere to the use of antihypertensive agents. Those who had higher annual incomes were more likely to adhere to the use of antihypertensive agents. Conclusion: The levels of medication literacy and medication adherence of hypertensive patients are suboptimal and need to be improved in China. The level of medication literacy in patients with hypertension could affect their adherence to antihypertensive drugs. It was suggested that hypertensive patients' medication adherence could be improved and driven by increasing the medication literacy level, especially in the attitude and behavior domains. Pertinent strategies that are specific to several dimensions of medication literacy should be developed and implemented in order to promote full medication literacy among hypertensive patients, thus facilitating optimal adherence and blood pressure control.

Reported needs of information resources, research tools, connectivity and infrastructure among African Pharmacological Scientists to improve future patient care and health

INTRODUCTION

The potentials of Africa for growth and economic transformation through science remains challenging because of existing gaps in knowledge and infrastructure. The Africa Pharmacological Science Gateway project and the Medicines Utilization Research in Africa Group seek to meet the research needs of African pharmacologists. This study aimed at identifying priority needs that might be met by access to information and tools through e-infrastructure.

METHODS

A web-based cross-sectional study among 472 members of pharmacological societies in Africa to obtain information on their research interests and skills, available resources, needs, and knowledge gaps. Descriptive analyses were done.

RESULTS

A total of 118 responses from 13 countries were received, mostly from Nigeria (48.3%) and South Africa (21.3%). Respondents had wide ranges of research interests predominantly in drug utilization research. The desired resources included drug utilization research training and tools, pharmacokinetics and pharmacometrics modeling training and tools, drug-drug interaction and medicine prices resources, statistical analysis resources, access to journals, training in specific laboratory techniques, equipment and funding for research-related activities.

CONCLUSIONS

Key areas of needs not currently provided by the African Pharmacological Science Gateway e-infrastructure were identified to guide the further provision of resources on the e-infrastructure and potentially enhance research capacity within the continent.

Knowledge regarding medicines management of type 2 diabetes amongst patients attending a Community Health Centre in South Africa

Objective

The prevalence of type 2 diabetes mellitus (T2DM) is growing in Sub-Saharan countries including South Africa. This is a concern given its appreciable impact on morbidity, mortality and costs with the recent introduction of universal health care in South Africa. The purpose of the study was to assess the knowledge of patients with T2DM attending a typical community health centre (CHC) regarding the management of their disease including risk factors and prevention to guide future initiatives. Typically, patients with T2DM in South Africa are managed in ambulatory care including CHCs.

Method

A quantitative, descriptive study in a CHC. The sample included 217 adults with T2DM who have visited a physician as well as the pharmacy. Face-to-face patient exit interviews were conducted using a structured questionnaire.

Key findings

Females predominated (65%), with the majority of patients &gt;60 years (38.2%) and more than half from the Indian racial category. Most patients did not know how their medication controls their diabetes (79.3%) or did not know any of the side effects (83.9%) from their medication. Less than half of the patients knew how to take their medication, and more than a third of patients indicated that they were not practicing any form of self-care.

Conclusion

The results indicate that these T2DM patients lacked sufficient knowledge regarding the management of their disease. Healthcare managers should consider instigating programmes to improve patients’ knowledge about the management of their disease as part of general initiatives within South Africa to improve the management of patients with chronic diseases in the public sector.

Prevalence of chronic kidney disease using estimated glomerular filtration rate among diabetes patients attending a tertiary clinic in Botswana

OBJECTIVES

Diabetes mellitus (DM) is one of the most common contributors of chronic kidney disease (CKD). The epidemiology of CKD, a concern among patients with DM, has not been studied in Botswana. Consequently, the objective of this study was to estimate its prevalence among these patients in Botswana to provide future guidance to both government personnel and physicians.

METHODS

Observational cross-sectional study in a leading clinic in Botswana. Demographic and clinical data were obtained from patients through interviews and from their notes using a standard questionnaire. The study was conducted from July to October 2015. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet for Renal Disease equation. CKD was defined as an eGFR < 60 ml/min/1.73 m². Multivariable logistic regression analyses were performed to assess the associations between CKD and potential factors.

RESULTS

The mean age and duration of DM among study participants were 54.67 years (range 21-92 years) and 5.0 years, respectively. Over half, i.e. 213/370 (57.6%) and 232/370 (62.7%), had an average blood pressure greater than 140/90 mmHg and poor glycemic control (HbA1c > 7%), respectively. 31/370 patients (8.4%) had CKD. However, only 18/370 (4.9%) had a diagnosis of CKD documented in their charts. Age, level of education, and duration of diabetes were independently associated with CKD.

CONCLUSION

The prevalence of CKD by estimated eGFR was low compared to most previous studies. However, half of patients with CKD are not documented resulting in the potential for prescription errors and drug toxicity. A substantial number of our patients had uncontrolled hypertension and poor glycemic control. Older age, low level of education and longer duration of DM were associated with CKD. There is a need to carry out prospective studies to determine the association and role of glycemic and blood pressure control in CKD causation among patients with DM in Botswana.

Evaluation of antihypertensive adherence and its determinants at primary healthcare facilities in rural South Africa

Aim: To evaluate adherence to antihypertensive treatment in rural South Africa and identify potential determinants given concerns with adherence and its impact in this priority disease area. Patients & methods: Face-to-face interviews with hypertensive patients and rating their adherence to treatment using defined categorized responses. Associations between adherence and patient characteristics assessed and sensitivity analyses performed. Results: 54.6% of patients were adherent to treatment. Controlled blood pressure (BP; odds ratios [OR] = 2.1; 95% CI: 1.1, 3.8; p = 0.019), comorbidity (OR = 2.0; 95% CI: 1.1, 3.6; p = 0.032) and smoking (OR = 0.3; 95% CI: 0.1, 0.8; p = 0.018) were associated with adherence. Conclusion: Adherence and BP control were suboptimal, only smoking was an independent risk factor for adherence. Adherent patients were twice as likely to have controlled BP, although results were sensitive to the definition of adherence. Initiatives are in place to improve adherence, which will be monitored.