ACCESS TO AFFORDABLE ANTI-HYPERTENSIVE MEDICINES AND ITS ASSOCIATION WITH ADHERENCE AND BLOOD PRESSURE CONTROL AMONG HYPERTENSIVE PATIENTS AT A TEACHING HOSPITAL IN GHANA

Abstract

Objective: To determine multiple anti-hypertensive medicines affordability and accessibility and their association with adherence and blood pressure control among hypertensive patients attending the Korle Bu Teaching Hospital. Design and method: It was a cross-sectional study of hypertensive patients attending the Korle Bu Teaching Hospital Polyclinic in Ghana. Systematic sampling was used to administer a questionnaire to 310 patients treated for hypertension. Data on ten generic anti-hypertensive medicine prices at the hospital and two private pharmacies were collected to determine out-of-pocket affordability. Availability of the medicines at the hospital and percentage available at patients’ home or acquired by them was collected to determine accessibility. Adherence was measured using a validated 8-item scale. Results: Questionnaires retrieved were 304. Some health insurance patients (19.4%) made out-of-pocket payments. One hundred and twenty three (40.5%) and 77 patients (25.3%) could not afford 4 anti-hypertensive medicines at the private pharmacy and the hospital respectively. Availability at the hospital was 60%. Continuous access at the hospital was 14.8%. Overall access (medicine acquisition or percentage available at patients’ home) was 74.9% (SD ± 41.3). Only 18.1% were highly medication adherent. Blood pressure control was 41.8%. Out-of-pocket affordability was not significantly associated with adherence (regression beta coefficient = 0.005; p-value = 0.281) but it was positively associated with blood pressure control with statistical significance (R = 0.12, p = 0.037). Obtaining medicines with health insurance only was more likely to result in blood pressure control than with health insurance plus out-of-pocket payments (OR = 2.185; 95% CI, 1.215 – 3.927). Access was positively associated with adherence, and this was statistically significant (R = 0.17; p = 0.03). Access at the hospital was more likely to result in blood pressure control (OR = 1.642; 95% C.I, 0.843 – 3.201). Patients who had controlled blood pressure had a higher adherence score than those who had uncontrolled blood pressure [6.048 (1.701) versus 5.847 (1.744); p = 0.319]. Conclusions: Accessibility was lower than the WHO target. A significant proportion of patients didn’t have out-of-pocket affordability. Obtaining drugs free was more likely to result in blood pressure control. Access to affordable anti-hypertensive medicines is associated with adherence and blood pressure control.