AN INTERVENTIONAL STUDY ON ADHERENCE AND BLOOD PRESSURE CONTROL IN A TERTIARY HEALTH FACILITY IN NORTH-WEST NIGERIA
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ABSTRACT
The prevalence of hypertension in Sub-Saharan Africa has experienced a tremendous increase due to low awareness, treatment and control rates. Despite the scientific and medical advancements, many people are not aware that they have the disease, and fewer than half of those who are aware are adequately treated, thereby leading to increased morbidity and mortality due to complications such as stroke, ischaemic heart disease and renal failure. Non-adherence to antihypertensive medicines is the most important barrier to achieving target blood pressure control. However, in Africa, 63% of hypertensive patients on treatment were non-adherent even though successful treatment of hypertension reduces its burden and mortality. The aim of this research was to determine the impact of pharmacist intervention on adherence to antihypertensives and blood pressure control among patients attending a tertiary facility in North-west Nigeria. This was achieved through an interventional longitudinal study conducted between February, 2016 and February, 2017. The study examined the positive influence of pharmacistdelivered telephone voice call medication education and counselling on treatment adherence among hypertensive patients attending the Cardiac Clinic of the Medical OutPatient Department of Ahmadu Bello University Teaching Hospital Zaria, North-west Nigeria. Ethical approval was obtained from the Hospital Research and Ethics Committee. The study was conducted on a sample of 130 hypertensive patients who were 18 years or older, had active telephone lines and consented to participate. At baseline and at six weeks, blood pressure values were examined and data on self-reported adherence and its patient-related determinants was collected with the aid of validated questionnaires. The pharmacist-delivered telephone-based education and counselling was provided weekly for a period of six weeks. Patients received six structured education and counselling sessions concerning hypertension, medication instructions, potential side viii effects, adherence to healthy lifestyle, medication handling and the benefit of adherence. Statistical analyses were carried out with the IBM® SPSS for Windows statistical software package version 20 (Chicago, IL USA). Chi square tests were used to compare relationships between categorical variables. The t-tests or ANOVA were used to compare two or more groups of parametric data respectively, while multivariate logistic regression analysis was conducted to assess the association between determinants of adherence. Statistical significance was set at p ≤ .05. Out of the 130 patients, fifty-one (39%) were males and 79 (61%) were females. The mean±SD age was 53.7±13.1 years. Majority (58%) of the patients’ age was between 41 and 60 years. Majority (91%) of the patients were married and of the Islamic faith (83%). Most (38%) of the patients were house wives, and the majority (44%) had no formal education. Adherence and blood pressure control were found to be low before the pharmacist intervention, with fewer than half of the patients being adherent (38%) and controlled (47%). Patients’ adherence rate and blood pressure control rate were increased to 66% and 70% respectively after the pharmacist intervention. Low level of education, old age and short hypertension duration were found to be associated with better adherence. A misconception about hypertension management, affordability of antihypertensives, and strong concerns about the cost and consequences of antihypertensives were found to be associated with low adherence and poor blood pressure control. The pharmacist intervention improved patients’ adherence to antihypertensive medicines and blood pressure control. Patients’ systolic and diastolic blood pressures were reduced by 10.6±3.1 mmHg and 2.3±1.9 mmHg respectively, with 70% of the patients achieving target blood pressure control at six weeks. Therefore, provision of a pharmacist-delivered telephone-based medication education and counselling service in health care facilities may go a long way in helping patients take their antihypertensive medicines appropriately as well as achieve target blood pressure control.
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