PRESCRIPTION KNOWLEDGE AMONG PATIENTS WITH CARDIOVASCULAR DISEASES AT THE MOI TEACHING AND REFERRAL HOSPITAL, KENYA

PRESCRIPTION KNOWLEDGE AMONG PATIENTS WITH CARDIOVASCULAR DISEASES AT THE MOI TEACHING AND REFERRAL HOSPITAL, KENYA

Paul Olesikamoi ¹, Patrick O. Onyango ^{1, * 2} and Wilson Odero ³

School of Public Health and Community Development ¹, School of Physical and Biological Sciences ², School of Medicine ³, Maseno University, Private Bag, Maseno University, Kenya.

ABSTRACT: Cardiovascular diseases (CVDs) cause 30% of deaths globally and are reported to be on the increase in sub-Saharan Africa. Medications prescribed for a CVD require a lifetime commitment. As a result patient must adhere to prescribed medication. However, prescription adherence is influenced to a large part by prescription knowledge. Although disease outcome is influenced by prescription knowledge, estimates of prescription knowledge and of factors that influence it are largely unknown in developing countries such as Kenya. The goal of the present study was to investigate factors that influence the level of prescription knowledge among patients with CVD at the Moi Teaching and Referral Hospital (MTRH). Specifically, the study determined the level of prescription knowledge, the association between socio-demographic characteristics of patients and their prescription knowledge, and whether prescribing clinicians explain prescriptions given to patients with CVD. The study used a cross-sectional study design with a sample size of 204. Data were collected using questionnaires. There was a significant difference (X² = 144.75, p = 0.000) in the frequencies between patients with high level and those with a moderate level of prescription knowledge such that more respondents had a high level of prescription knowledge. However, socio-demographic factors were not associated with prescription knowledge. Nearly 98% of respondents indicated that clinicians explained prescriptions to them and there was a significant association between the language of communication by the respondents and the level of prescription knowledge (P=0.043). Overall, the results of the present study provide an important springboard for future efforts aimed at enhancing prescription adherence.

Prescription, Knowledge, Cardiovascular disease, Prescribing, Clinicians

INTRODUCTION: Cardiovascular diseases cause 17.6 million deaths globally ¹. Although there is a trend toward a decrease in the burden of CVD in developed countries, due in part to a parallel decrease in the prevalence of risk factors and improved care of patients with known CVD, the burden of CVD in Sub-Saharan Africa has increased to alarming proportions ^1-3.

Management of CVD is through lifelong medication that requires patients to adhere to treatment regimens. However, patients are less likely to adhere to medication if they do not understand their prescription including having information on indications, contraindications and dosing ^4-6.

Low medication knowledge is associated with high chances of non-adherence to medication regimens ^{4, 7-10}, which can lead to more frequent hospitalizations, increased healthcare expenditures and a higher risk of adverse health outcomes ^{11, 12}. Despite the overwhelming evidence on the relationship between medication knowledge and adherence, there is an absence of evidence on interventions that use such knowledge to reduce the increasing burden of non-communicable disease in developing countries. Where evidence on patient-level risk factors is available, some socio-demographic factors have been shown to predict medication knowledge: age ¹³, education ^{7, 13} race ⁷, living arrangement or social support ^{7, 13, 14}. However, it is important to point out the role of context on the extent to which socioeconomic and demographic factors predict medication knowledge. Consequently, efforts to reduce morbidity and mortality associated with chronic diseases such as CVDs will require context-specific evidence.

It is equally important to note that effective communication between patients and physicians is key for patients to understand both their disease state and prescribed medication ^{4, 15-17}. Although medication knowledge and thus medication adherence begins with prescribing clinicians ^{15, 18, 19}, it is not known whether prescribing clinicians explain prescriptions to patients with cardiovascular disease in developing countries such as Kenya. Also, whether patients understand prescriptions even when prescribing clinicians offer explanations remain unknown. This gap in knowledge is particularly worrying in Sub-Saharan Africa that faces the twin challenges of a rising burden of non-communicable disease ¹ and health care system constraints including the absence of prescription guidelines for the management of chronic diseases.

The present study investigated prescription knowledge and its socio-demographic predictors among cardiovascular patients at the Moi Teaching and Referral Hospital, Kenya. Specifically, the study aimed to determine the level of prescription awareness, the association between socio-demographic factors and the level of prescription knowledge, and assess whether clinicians’ explain prescription plans to cardiovascular patients.

METHODOLOGY: The study was conducted at the Moi Teaching and Referral Hospital (MTRH), Kenya. It adopted a cross-sectional study design and used a structured questionnaire to collect quantitative data. The target population for the study was all patients presenting with cardiovascular diseases at MTRH cardiovascular clinic.

Cardiovascular clinics are conducted twice every week at the hospital. A total of 2056 patients with cardio-vascular disease attend the clinic in MTRH per year translating to 172 patients per month. The study sought to target patients visiting the facility within two months and this a target population of 344 from which a random sample of 204 respondents was drawn. Study participants were aged 18 years of age and above.

The level of prescription knowledge and specific knowledge variables were measured on a 15-point scale where scores below 5.0 points indicated a low level of awareness, between 5-9 points indicated were a moderate level of awareness while 10 points and above indicated a high level of awareness. The scoring of the points was determined by a coding decision on whether the answer given by the patient depicted prescription knowledge or ignorance. Socio-demographic factors that we investigated were gender, age, marital status, occupation, educational level, settlement and living arrangement (whether the patient lived alone or not). The effectiveness of clinicians’ communication of prescription plan to cardiovascular patients was measured on a 9-point scale where scores below 0-3 points indicated a low level of communication effectiveness, between 4-6 points indicated a moderate level of communication effectiveness while 7-9 points indicated a high level of communication effectiveness.

Data Analysis: Descriptive statistics were used to summarize level of knowledge, whether prescribing clinicians explained prescriptions and whether patients were the explanations to be effective. Chi-square test of goodness-of-fit was used to compare frequencies of respondents with a moderate and high level of prescription knowledge. Chi-square test of independence was used to determine the association between socio-demographic factors and the level of medication knowledge. Statistical significance was set at p≤0.05. The data was analyzed in SPSS Version 21.0. Ethical approval for the study was obtained from the Moi Teaching and Referral Hospital Ethical Committee, IREC/2016/252 Approval Number 0001925.

RESULTS: The socio-demographic characteristics of the respondents are presented in Table 1.

TABLE 1: SOCIO-DEMOGRAPHIC CHARACTERISTIC OF THE RESPONDENTS

Level of Prescription Knowledge: The 15-item instrument used to measure the level of prescription awareness and respondent responses is shown in Table 2. Overall, the findings show that 87.3% of the respondents had a high level of prescription knowledge, 12.7% had a moderate level of knowledge while 0% had a low level of knowledge.

A chi-square analysis of the frequencies (excluding the low level of prescription knowledge) showed that there was a significant difference between the two categories of prescription awareness (X² = 144.75, p = 0.000), with more respondents having a high level of prescription awareness that would be expected by chance.

Association between Socio-Demographic Factors and Level of Prescription Knowledge: The findings indicate that of all the socio-demographic factors considered, only the patient’s language of communication was significantly associated with the level of prescription knowledge (X²₃ =8.141, p=0.043) as illustrated in Table 3.

TABLE 2: KNOWLEDGE OF PRESCRIPTION

TABLE 3: ASSOCIATION BETWEEN SOCIO-DEMOGRAPHIC FACTORS AND LEVEL OF PRESCRIPTION KNOWLEDGE

Communication of Prescription Plan to Cardiovascular Patients: With regards to the question of whether prescribing clinicians explained prescriptions to the patients, the results indicate that according to 93.5% (191) of the respondents, health care providers provided information on prescriptions. Prescriptions were verbally communicated to 58.6%, written or verbally explained to 27.9%, and written to 13.5% of the respondents. Almost all respondents, 99.6%, said that the prescription explanation was understandable.

The 9-item instrument was used to assess the level of prescription communication by medical practitioners. The responses are shown in Table 4 and suggest that prescribing clinicians’ explanations were, for the most part, detailed and dealt with issues of dosing, drug interactions, safe storage of drugs, and availability of drugs in the market. Overall, according to 97.7% of the respondents, prescription explanations by prescribing clinicians were highly understandable while 2.3% of respondents indicated that the explanations were moderately understandable.

TABLE 4: PRESCRIPTION PLAN COMMUNICATION BY MEDICAL PRACTITIONERS

DISCUSSION: Three major results emerged from the present study. First, a majority of the respondents had a high level of prescription knowledge. Second, gender, age, marital status, occupation, educational level, settlement, and living arrangement (whether one lived alone or not) were not significantly associated with prescription knowledge. However, the language used by the respondents to communicate influenced their level of prescription knowledge. Third, according to a majority of the respondents, prescribing clinicians provided explanations on prescriptions and that the respondents found the explanations to be understandable.

The high level of prescription knowledge among cardiovascular patients attending the Moi Teaching and Referral Hospital implies that they had an understanding of dosing and counter-indications of the drugs they were prescribed.  This is a rather surprising result given that the focus on non-communicable diseases in sub-Saharan Africa is only beginning to get traction. Medical education and the changing trends of information consumption in the country could have had a significant role in patient health care literacy. The high level of prescription knowledge reported for the present study contrasts with that reported by Chin and colleagues ¹⁴.

However, it is noteworthy to mention that the apparent inconsistency in results between the two studies may derive from differences in nature of questions participants were asked. Unlike Chin and colleagues ¹⁴, we did not match patients’ responses to prescriptions in their possession and could therefore not accurately confirm their prescription knowledge.

Further research should be conducted targeting the patient’s adherence to their specific medications prescribed. Nonetheless, whether the high level of prescription knowledge translates to medication adherence and thus improved health outcomes among cardiovascular patients who in most cases must use medication for the rest of their lives remains an open question.

The absence of an association between socio-demographic factors and level of prescription knowledge suggests that prescription knowledge is primarily an informational issue. This interpretation is supported by the significant association between the language of communication by the respondents and level of prescription awareness as well as the fact that nearly 94% of respondents confirmed that prescribing clinicians explained prescriptions. Furthermore, nearly all the respondents reported that prescription explanations were understandable.

However, these results contrast previous studies that demonstrated that age ¹³, education ^{7, 13}, living arrangement ^{7, 13, 14} are associated with medication knowledge. In addition to contextual issues on the association between socio-demographic factors and medication knowledge, another potential source of inconsistent results across studies is the apparent differences in the elements of medication knowledge. There is, therefore, need to standard elements or constructs of medication knowledge, which will allow for comparisons across studies.

Findings of the present study support several studies that have shown that effective communication between patients and physicians is important for patients to understand their disease state and to fully understand and appreciate the need for medication and medication adherence ^{6, 15-17}. The high communication effectiveness can, therefore, be the reason why a majority of the patients had a high level of prescription awareness. These findings, however, differ from findings by ²⁰ who evaluated audiotaped office visits and found major shortfalls in the quality of information communicated to patients about their prescribed medicines; physicians explained adverse effects and duration of therapy in only about a third of the discussions and provided patients with instructions for use in only 55% of the discussions. The study by ²⁰ also indicated that communication with pharmacists is also inadequate and as a result, many patients rely on written information, either on labels or in package inserts.

CONCLUSION: Results of the present study support the accumulating body of evidence on the role of prescribing clinicians on medication knowledge. In light of the rising burden of chronic diseases continues to in sub-Saharan African these findings provide a starting point for targeted interventions aimed at enhancing medication adherence and thus in improving health outcomes among patients suffering from chronic diseases such as cardiovascular disease.

ACKNOWLEDGEMENT: We thank Carol Mukami for help with a statistical component of the study and our research assistants Patricia Kamau and Donnah Wafula.

CONFLICT OF INTEREST: The authors declare no conflict of interest.

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    How to cite this article:

    Olesikamoi P, Onyango PO and Odero W: Prescription knowledge among patients with cardiovascular diseases at the Moi Teaching and Referral Hospital, Kenya. Int J Pharm Sci & Res 2019; 10(2): 769-74. doi: 10.13040/IJPSR.0975-8232.10(2).769-74.

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