PREDICTORS OF ADHERENCE TO ORAL ANTIHYPERTENSIVES AMONG PATIENTS ATTENDING TWO DISTRICT HOSPITALS IN NORTHERN VOLTA, GHANA BY PHARM.EMMANUEL SARKODIE CO-AUTHOR: ACP PHARM.DANIEL AFRIYIE (FPCPharm)

INTRODUCTION Hypertension is a common public health problem globally, with about 7.5 million deaths annually (WHO, 2009). Prevalence of hypertension in Ghana ranges from 19 % to 48 % (Amoah et al., 2003). Control of elevated blood pressure is poor among hypertensive patients in sub-Saharan Africa. Optimal therapy can be achieved by effectively controlling elevated blood pressure (Bosu, 2010 and Spencer et al., 2005).

INTRODUCTION Poor adherence to antihypertensive therapy is an obstacle to the management of hypertension, which results in the following: Medical complications of the disease. Reduction in patients’ quality of life. Waste scarce health care resources. Erodes public confidence in the healthcare systems (Balkrishnan, 2005).

MAIN OBJECTIVE To assess the factors influencing adherence to oral antihypertensives among patients attending two district hospitals in northern Volta, Ghana.

To determine: SPECIFIC OBJECTIVES Prevalence of adherence to oral antihypertensives. Most common antihypertensive medications used by the study participants. Predictors of adherence to antihypertensives.

METHODOLOGY Cross-sectional study was conducted on hypertensive patients (18 years and above). OPD attendance of two district hospitals in the northern Volta region; Krachi west district (n=187) Hohoe municipal (n=183). Data collection was done between March-May 2016 using a structured questionnaire and MMAS-8. Data was analyzed using SPSS(version 16) and P ≤ 0.05 was regarded statistically significant.

RESULTS A Pie Chart showing the Level of Adherence to Oral Antihypertensive Medications by Respondents

RESULTS TABLE 1.0 : FREQUENCY DISTRIBUTION AND STATISTICAL ASSOCIATION OF INDEPENDENT VARIABLES WITH ADHERENCE VARIABLES FREQUENCY (N= 370) CRAMER’S V P VALUE Male Female 88 (23.8 % ) 282 (76.2 %) 0.059 0.255 Young age (18-44 years) Middle age (45-64 years) Elderly ( >65 years) 38 (10.3%) 187 (50.5%) 145 (38.5%) 0.117 0.532 Formal education No formal education 166 (44.9%) 204 (55.1%) 0.052 0.908 Insured (NHIS) Non insured 351 (94.9%) 19 (5.1%) 0.206 0.0001 Controlled BP (< 140/90 mmHg) Uncontrolled BP (> 140/90 mmHg) 173 (46.8%) 197 (53.2%) 0.085 0.447 Good knowledge on hypertension Poor knowledge on hypertension 305 (82.4%) 65 (17.6%) 0.228 High perception of severity of hypertension Low perception of severity of hypertension 100 (27.0%) 270 (73.0%) -0.219

A Bar Chart showing the types of Antihypertensive Medications against the Percentage Frequency of Respondents

STEPWISE MULTIPLE REGRESSION Best predictive model involved the combination of three predictor variables with an R2 = 0.120. Degree of significance was [F (3,366) = 16.709; P < 0.001]. Strongest predictors of adherence were; Knowledge level of respondents on hypertension (B=0.135), Respondents perception of severity (B=-0.124) Reported daily alcohol consumption (B=0.074) .

DISCUSSIONS Three independent variables contributed significantly in predicting adherence. Knowledge level on hypertension (Ambaw et al.,2012), Perception of severity of hypertension (Glanz et al., 2002). Reported daily alcohol consumption (Bovet et al.2002). Cues to action, perception of benefits, and barriers as reported in another study were the most predictors of adherence (Edo, 2009).

Knowledge level on hypertension was the strongest predictor of adherence level. Knowledge level on hypertension influence perceptions and adherence behavior of patients(Ambaw et al., 2012; Knight et al., 2001). Hypertensive patients can be empowered; Well organized educational activities, Adherence counseling by their respective healthcare professionals.

CONCLUSION Prevalence of adherence to antihypertensive - 89.2 %. Calcium channel blockers and thiazide diuretics were the most commonly used antihypertensives. Predictors of adherence to antihypertensives were : Respondents knowledge level on hypertension, Respondents perception of severity of hypertension Reported daily alcohol consumption. Regular patient education and adherence counselling by pharmacists is recommended to improve adherence levels.

ADHERENCE CLINICS(PHARMACISTS) WAY FORWARD ADHERENCE CLINICS(PHARMACISTS)

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