Abstract
Introductionmany hypertensive patients require two or more anti-hypertensive drugs, but in low- and middle-income countries there may be challenges with medication access or affordability. The objective of this study was to determine accessibility and affordability of anti-hypertensive medicines and their association with blood pressure (BP) control among hypertensive patients attending the Korle-Bu teaching hospital (KBTH) polyclinic.Methodsa cross-sectional study was conducted among 310 systematically sampled hypertensive patients attending the KBTH Polyclinic in Ghana. A structured questionnaire was used to obtain data on patient demographics and clinical characteristics, prices, availability and mode of payment of generic anti-hypertensive medicines.Resultsfifty-nine patients (19.4%) made out-of-pocket payments. At the private pharmacy and hospital, 123 (40.5%) and 77 patients (25.3%) respectively could not afford four anti-hypertensive medicines. Medicines availability at KBTH was 60%. Continuous access to BP drugs at KBTH was 14.8%. Overall access was 74.9% (SD ± 41.3). Out-of-pocket affordability of the medicines was positively correlated with BP control (R=0.12, p=0.037). Obtaining medicines via health insurance only was more likely to result in BP control than making any out-of-pocket payments (OR= 2.185; 95% CI, 1.215 - 3.927). Access at KBTH was more likely to result in BP control (OR=1.642; 95% C.I, 0.843 - 3.201).Conclusionthere were access challenges although most patients obtained BP medication free. Out-of-pocket affordability is a challenge for some hypertensive patients. Access to affordable BP medication can improve BP control. These findings provide an impetus for urgently evaluating access to affordable anti-hypertensive medicines in other hospitals in Ghana.
Highlights
Hypertension which is a significant cardiovascular disease risk affects over one billion people [1]
Paying for anti-hypertensive medicines with National Health Insurance Scheme (NHIS) was more likely to result in blood pressure (BP) control than using out of-of-pocket only or NHIS plus out-ofpocket payment (OR, 2.185; 95% CI 1.215 - 3.927)
Patients access to anti-hypertensive medication at the hospital was more likely to result in BP control than otherwise (OR, 1.642; 95% C.I, 0.843-3.201) Respondents with controlled BP had a higher overall access or medicine acquisition (76.95%) than those who had uncontrolled BP (73.47%) this was not statistically significant (p=0.471)
Summary
Hypertension which is a significant cardiovascular disease risk affects over one billion people [1]. Various classes of antihypertensive medicines are available in practice, blood pressure (BP) control remains poor in most developing countries, including Ghana [5,6,7]. In many low- and middle-income countries, access to medicines is a challenge [9,10]. In resource-limited countries such as Ghana, access to affordable anti-hypertensive medicines may be a challenge but is likely to have an important influence on blood pressure control. Literature on access and affordability of antihypertensive medicines and their association with blood pressure control, in Ghana is sparse. The objective of this study was to determine the affordability and accessibility of antihypertensive medicines and their association with blood pressure control in hypertensive patients. This study is expected to contribute to the development of health policy interventions targeted at improving trends in antihypertensive
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