EVALUATION OF HYPERTENSION KNOWLEDGE AND DRUG ADHERENCE AMONG SOUTH INDIAN POPULATIONHTML Full Text
EVALUATION OF HYPERTENSION KNOWLEDGE AND DRUG ADHERENCE AMONG SOUTH INDIAN POPULATION
G. Karthikeyan * and D. Ranganayakulu
Sri Padmavathi School of Pharmacy Tirupati - 517503, Andhra Pradesh, India.
ABSTRACT: Objective: To investigate the patient’s knowledge of hypertension fact with validated Morisky questionnaires and management of drug adherence. Materials and Methods: The aim of one present study was undertaken 100 patients attending the cardiology, outpatient department in various private sector hospitals in southern Tamilnadu and to assess the patient’s medication knowledge and drug adherence on hypertension with validated questionnaires method. Results: Out of 100 hypertensive patients (17%) of the subjects had adequate, (21%) of the patients had moderate medication knowledge about hypertension or maximum while (62%) were categorized as poor medication and adherence 35% of the people are in medium adherence only 3% are in high adherence. Conclusion: The disease knowledge of subjects’ rate was low, and patients were unsure of the benefits of continuous medication use and resulted in non-adherence. Educating hypertensive patients clarifying doubt regarding the benefits of adherence, medication uses, and control hypertension.
Drug Adherence, Hypertension Knowledge, Morisky Scale and Correlation
INTRODUCTION: Hypertension is a widely prevalent disease and a major risk factor for adverse cardiovascular events, including stroke, coronary artery diseases, peripheral vascular disease, heart failure, and chronic kidney disease. In primary prevention studies, there is a continuous relationship between blood pressure and adverse cardiovascular outcomes, including. This relationship holds even within the level of blood pressure previously defined as normal. The growing appreciation of the importance of even mild hypertension has contributed to periodic revisions in the clinical approach to this disease, including criteria for the diagnosis of hypertension, stratification of hypertension severity and indications for treatment 1.
Hypertension remains significant complication and challenge in growing public and around the world2. Prescription of the drugs and poor compliance of the patients is a common and important complication in clinical practices which can fail the result in treatment of hypertension 3. Poor compliance with treatment of drugs is a barrier to the effective management of hypertension 4.
This study aimed to investigate the patient’s knowledge of hypertension fact with validated Morisky questionnaires and management of drug adherence.
MATERIALS AND METHODS:
Study Design: A Cross-sectional descriptive comparative study
Study Site: General medicine department of tertiary care teaching hospitals in Tamilnadu.
Study Settings: Patients for this study were obtained from four hospitals in Tamil Nadu, India. All these hospitals are situated in a low socioeconomic area with the middle class population. Hence we hope the knowledge, perception, attitudes, and lifestyle practices of the community will be representative of the area.
Sample Size: The sample size of 100 patients recruited from four hospitals in southern Tamil Nadu.
Sampling Method: In the various health facilities used, eligible respondents were randomly selected.
Study Period: The study was conducted for a period of 8 months from May 2012 to December 2012.
Ethics: The Independent ethics committee approved the study in a proper forum. After proper approval, one hundred patients who accepted to participate were included in the study. After obtaining patient consent, the subjects were interviewed to gather clinical and demographic details.
Diagnosis of Hypertension: Hypertension was diagnosed by measurement of systolic and diastolic BP with a standard mercury sphygmomanometer on both arms at the same period of the day on at least two occasions using standardized methods
Inclusion and Exclusion Criteria: Those who were eligible for inclusion into this descriptive cross-sectional, qualitative phenomenological survey were a cohort of 100 adult male and female hypertensive patients drawn from 4 randomly selected health facilities in Tamil Nadu. Participants with a systolic blood pressure (SBP) above120 mmHg and diastolic blood pressure (DBP) above 80 mmHg and who were willing to participate in the study were included whereas patients who were pregnant excluded.
Development of Questionnaires:
Hypertension Fact Questionnaire: Hypertension Fact Questionnaire on hypertension was developed as a tool to assess knowledge among hypertensive patients. The questionnaire was initially developed in English and then translated into the language as Tamil. The questionnaire consists of 15 questions to assess the patients’ knowledge of hypertension. The questionnaires were then given to the patients who met the inclusion criteria, and their knowledge about hypertension was assessed.
Morisky Medication Adherence Scale: Their medication adherence behavior and the reasons for non-adherence were studied using Morisky self-report measure of medication adherence.
Morisky scale consists of 8-point questions (never / rarely / sometimes / often / always) and a set of open-ended questions regarding reasons for non- adherence. Scores for the scale range from Low Adherence (< 6), Medium Adherence (6 to <8) and High Adherence (= 8)
Higher the scores are indicative of worse adherence. All the subjects answered ‘YES’ for at least one question, and they were considered as non- adherent.
RESULTS AND DISCUSSION:
Disease Knowledge with Hypertensive Patients: Disease knowledge with hypertensive patients and validated questionnaires were pivot tested with 100 established subjects. Table 1 described out of the 100 patients, 62 (62%) were within the poor medication knowledge and 21 (21%) moderately, and only 4 (4%) showed adequate disease knowledge about hypertension 5.
Hypertension control begins with detection and continued surveillance; initial readings should be confirmed with subsequent readings for several weeks unless the pressure is dangerously high at the first reading. The goal of therapy is to prevent the morbidity and mortality associated with high blood pressure and reduces the pressure by the least intrusive means possible 3.
In the present study, diseases knowledge suggesting that there are other factors for the hypertensive patients who need to the explored6. Hypertensive patients had minimum knowledge about diseases. In the content of the south Indian population, the effect of responses to hypertension knowledge possessed by the subjects on medication is still uncertain as there was no previous study in the same location that can compare with present status 7.
Nonadherence patients have improving diseases knowledge may require an adequate multi-dimensional approach aimed at meeting 9.
TABLE 1: PATIENT’S KNOWLEDGE OF HYPERTENSION FACT WITH MORISKY QUESTIONNAIRES
|1||Do you know the normal values of blood pressure?||100||37||63||37%||63%|
|2||Increased BP is called as hypertension||100||22||78||22%||78%|
|3||Hypertension is a condition which can progress along with age||100||44||56||44%||56%|
|4||Both men and women have equal chances of developing hypertension||100||37||63||37%||63%|
|5||Hypertension is a treatable condition||100||94||6||94%||6%|
|6||If someone have a family history of hypertension, member of the family are at risk for developing the same condition.||100||87||12||87%||12%|
|7||The older a person is, the greater their risk of having hypertension||100||86||14||86%||14%|
|8||Smoking is a risk factor for hypertension||100||88||12||88%||12%|
|9||Eating fatty foods does not affect blood cholesterol levels which is a risk factor for developing hypertension||100||37||63||37%||63%|
|10||Being overweight increases risks for hypertension||100||85||15||85%||15%|
|11||Regular physical activity will lower a person’s chance of getting hypertension||100||36||64||36%||64%|
|12||Eating more salt has no effect on blood pressure||100||31||69||31%||69%|
|13||While meat is as good as read meat in hypertension||100||32||68||32%||68%|
|14||Medication alone can control hypertension?||100||50||50||50%||50%|
|15||Hypertension can lead to other life threatening disease||100||19||81||19%||81%|
CHART 1: PERCENTAGE RESPONSE OF HYPERTENSIVE PATIENTS KNOWLEDGE
Reason for Nonadherence: 100 patients were asked to understand their reason for nonadherence to the treatment for HBP. 15 universal reasons has been listed and asked the patients to select Table 2.
TABLE 2: AND CHART 2 REPRESENTS REASONS FOR NON ADHERENCE
|S. no.||Reason for non Adherence||Total sample||No. of patients||%|
|1||Poor knowledge of the disease and ignorance of need for long-term treatment||100||62||62%|
|2||Religious practices and cultural belief||100||23||23%|
|3||Adverse drug reactions||100||12||12%|
|4||Patients do not believe that the health depends on medicine||100||0||0%|
|5||Worry about having to take medicine or are concerned about the side effects of the medicine||100||0||0%|
|7||Drugs out of supply||100||0||0%|
|8||Poor communication with physician, insufficient patient information/education||100||0||0%|
|9||Expenses: Doctor’s fee, transport, medicine, hospitalization||100||29||29%|
|10||Interruption of daily routine||100||0||0%|
|11||Lack of remainders||100||0||0%|
|12||Was busy and or late for work||100||16||16%|
|13||Was away on weekend or vacation||100||0||0%|
|14||Too many medication to take||100||0||0%|
|15||Taking medication wrong time||100||0||0%|
CHART 2: REPRESENT REASONS FOR NON ADHERENCE
Out of 15 reasons, only 6 reasons got one of the responses.
- Among 100 patients, 62% of the people have not undergone any treatment for high blood pressure due to lack of knowledge about seriousness and effects of the disease.
- Out of 100 16%, people said they are busy with their work, and 29% felt that the treatment is very expensive and costly that they are not affordable to undergo.
- 12% also said it might be a possibility for the adverse reaction because of medicine used for this treatment and also due to their poor memory.
From the above questionnaire response, we can conclude that there are two major responses for the nonadherence that is Poor knowledge about the disease and their side effects and also the affordability or the perception towards the treatment expenses.
Drug Adherence: The Table 3 described drug adherence response had been interviewed with 100 patients to know about their seriousness in taking the pills as per doctor’s advice. The questionnaire contains eight questions out of which seven are yes or no questions, and the eighth one is the multiple choice question. The following table and chart represent the drug adherence of the patients 10.
TABLE 3: REPRESENTS DRUG ADHERENCE SCALE QUESTIONS
|S. no.||Drug Adherence Scale Questions||Total no. of patient||Yes||No||%Yes||%No|
|1||Do you sometimes forget to take your [health concern] pills?||100||36||64||36%||64%|
|2||People sometimes miss taking their medications for reason other than forgetting. Thinking over the past two weeks, were there any days when you did not take your [health concern] medicine?||100||38||62||38%||62%|
|3||Have you ever cut back or stopped taking your medication without telling your doctor, because you felt worse when you took it?||100||58||42||58%||42%|
|4||When you travel or leave home, do you sometime forget to bring along your [health concern] medication?||100||3||97||3%||97%|
|5||Did you take your [health concern] medicine yesterday?||100||0||100||0%||100%|
|6||When you feel like your [health concern] is under control, do you sometimes stop taking your medicine?||100||100||0||100%||0%|
|7||Taking medication everyday is a real inconvenience for some people. Do you ever feel hassled about sticking to your [health concern] treatment plan?||100||82||18||82%||18%|
|8||How often do you have difficulty remembering to take all your medication?||100|
|Once in a while......||100||26||26%|
CHART 3: REPRESENTS DRUG ADHERENCE RESPONSE
Total Points used to find out the level of adherence is mentioned in the below Table 4.
The above Chart 4 represents 62% of the people are in low adherence, and 35% of the people are in medium adherence; only 3% are in high adherence.
CONCLUSION: The current study estimated adequate reasons for disease knowledge and medication non- adherence to be greater than that of unintentional non-adherence.
CONFLICT OF INTEREST: Nil
- Golan DE, Tashjian AH, Armstrong EJ and Armstrong AW: Principles of Pharmacology. The Pathophysiologic basis of drug therapy II Edition -2008 & Wilkins.
- Dawesa MG, Kaczorowskib J, Swansonc G, = Hickeyd J and Karwalajtysc T: The effect of a patient education booklet and BP ‘tracker’ on knowledge about hypertension. A randomized controlled trial Family Practice 2010; 27: 472-78.
- Chobanian AV, Bakris GL, Black HR, Cushman WC and Green LA: The Seventh Report of the Joint National Committee on Prevention Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 Report. JAMA, 2003; 289: 2560-72.
- Busari OA, Olanrewaju TO, Desalu OO, Opadijo OG, Jimoh AK, Agboola SM, Busari OE and Olalekan O: Impact of Patients’ Knowledge, Attitude and Practices on Hypertension on Compliance with Antihypertensive Drugs in a Resource-poor Setting. TAF Prev Med Bull 2010; 9(2): 87-92.
- Lim TO, Ngah BA, Rahman RA, Suppiah A, Ismail F, Chako P and Na HH: The Mentakab Hypertension Study Project Part V- Drug Compliance in Hypertensive Patients. SINGAPORE MED J 1992; 33: 63-66.
- Saleem F, Hassali MA, Shafie AA, Awad AG and Bashir S: Association between knowledge and drug adherence in patients with hypertension in Quetta, Pakistan. Trop J Pharm Res 2011; 10(2): 125.
- Ballington DA and Laughlin MM: Pharmacology. USA: CBS publishers by EMC Corporation 2006.
- Al-Mehza AM, Al –Muhailije FA, Khalfan MM and Al- Yahya AA: Drug compliance among Hypertensive Patient; An Area Based Study. Eur J Gen Med 2009; 6(1): 6-10.
- Sanne S, Muntner P, Kawasaki L, Hyre A and De Salvo KB: Hypertension knowledge among patients from an urban clinic. Ethnicity & Disease 2008; 18.
- Okeahialam BN: Adherence and Preference Issues in Anti-hypertensive Therapy: Experience from Private medical Facility in Jos, Nigeria. Journal of Medicine in the Tropics.
How to cite this article:
Karthikeyan G and Ranganayakulu D: Evaluation of hypertension knowledge and drug adherence among south Indian population. Int J Pharm Sci & Res 2014; 5(9): 4056-60. doi: 10.13040/IJPSR.0975-8232.5(9).4056-60.
All © 2013 are reserved by International Journal of Pharmaceutical Sciences and Research. This Journal licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
G. Karthikeyan * and D. Ranganayakulu
Sri Padmavathi School of Pharmacy Tirupati, Andhra Pradesh, India.
23 March 2014
19 August 2014
26 August 2013
01 September 2014