DETERMINANTS OF ADHERENCE TO ANTIHYPERTENSIVE MEDICATIONS AMONG PATIENTS ATTENDING TERTIARY CARE HOSPITALS IN ISLAMABAD

Abstract

Objective: Hypertension is one of the non-communicable diseases which reduces life expectancy and decreases productive years, accounting for almost 9·4 million deaths annually and 7·0% of global DALYs. The economic burden associated with NCD deaths will rise from $152 million in the year 2010 to $296 million in 2025. Nonadherence to medications leads to poor health outcomes. The annual cost of nonadherence was estimated to be at 100 million US dollars in 2011 or 70% of healthcare expenditure on drugs worldwide. We conducted this study to have an insight into our patient's behavior towards their treatment regimes. Design and method: A hospital-based analytical cross-sectional study involving adult hypertensive patients attending the cardiology clinic of tertiary care hospital in Islamabad Capital Territory (ICT), conducted from July 2019 to October 2019. The data was collected using a semi-structured pretested questionnaire. Proportionate to target population sample was calculated and 418 subjects were enrolled through systematic random sampling technique. Data analysis was done as descriptive statistics Bivariate analysis was carried out and a p-value of less than 0.05 considered as significant. Logistic regression was done to identify independent predictors of adherence Results: The mean age of respondents was 54.4 years SD ± 10.61. Participants were predominately male (56.2%). 327 (72.7%) of the respondents had High Bp Grade I, uncontrolled blood pressure. 218 (48.44%) were not able to afford to buy monthly medication, Average monthly cost of the medication was 7.42 USD (1150 PKR) ± 1136 Pak Rupees, with 28.89% were not able to buy the medications on their own. Multivariate logistic regression analysis revealed non-affordability of treatment (OR 2.2 p-value 0.0002) and testing, uncontrolled hypertension (OR 3.1 p-value 0.0001), as statistically significant determinants for being nonadherent, whereas being educated (OR O.6 p-value 0.02))and adequate counseling by a health practitioner (OR 0.2 p-value 0.000) were protective factors. Conclusions: For improving adherence to antihypertensive therapy, we concluded the prevalent paradigm of healthcare is nonsupportive in terms of enhanced and non-affordable treatment regimes, long waiting hours, non-availability of universal health coverage. Further, education and better counseling had a positive impact on the patient's altered attitude towards medications.