Assessment of Adherence to Anti-hypertensive Treatment among Patients Attending a Urban Health Care Facility of a Medical College, Tumkur

Copyright © 2019 Phcog.Net. This is an openaccess article distributed under the terms of the Creative Commons Attribution 4.0 International license. Cite this article : Gowda CGK, Savitha RBB, Iyengar K, Venkatesh P, Vinay KS. Assessment of Adherence to Antihypertensive Treatment among Patients Attending a Urban Health Care Facility of a Medical College, Tumkur. Int J Med Public Health. 2019;9(2):42-5. ABSTRACT Chronic non-communicable diseases are posing a serious threat to public health throughout the world, irrespective of whether developed and developing and thus deserve to be treated as a global health priority. Hypertension is the leading modifiable risk factor for cardiovascular diseases. Poor compliance to antihypertensive therapies has been linked to a variety of problems, including poor blood pressure control, rehospitalisation and increased healthcare resource utilization. Methodology: This Cross-Sectional study was carried out among all adult hypertensive patients from September to October 2018 visiting Urban Health Training Centre of Sri Siddhartha Medical College. Results: Out of 150 study subjects Majority of them 66 (44%) were having hypertension for 10-15 yrs and least 18 (12%) were having Hypertension for >5 yrs, 81 (54%) were Purchasing drugs from Private sectors and others from Government sector. 30 (20%) were taking 2 tablets per day, 109 (72.7%) were taking 1 tablet per day. 90 (60%) were having Low adherence, 36 (24%) were having Medium adherence and 24 (16%) High adherence for Drugs using Morisky Adherence scale. When we studied association between Adherence to drugs with other Socio-demographic characteristics, we got statistically significant results with Socioeconomic status, residence and Place of Purchase of drugs (P=0.0). Conclusion: Adherence to drugs was found to be low in the present study. The level of adherence to treatment among the participants can be achieved by educating the Patients and creating awareness.


INTRODUCTION
Hypertension is one of the major Public Health problem in both the developed and developing countries. Increased blood pressure is a leading risk factor for premature death, stroke and heart disease worldwide. Hypertension is the leading modifiable risk factor for cardiovascular diseases and was the topmost leading risk factor for global disease burden in 2010. 1 Chronic non-communicable diseases are posing a serious threat to public health throughout the world and thus deserve to be treated as a global health priority. 2 Hypertension accounts for 7.1 million deaths worldwide every year of which 57% is due to stroke and 43% is due to ischemic heart disease. 2 WHO defines adherence as "the extent to which a person's behaviour in taking medication, following a diet and /or executing lifestyle changes". 3 World Health Organization (WHO) describes poor adherence as the most important cause of uncontrolled blood pressure and estimates that 50% of people do not take their antihypertensive medication as prescribed. The poorest of the people are at the highest risk of developing and dying prematurely from chronic diseases because their exposure to risk is high, whereas their access to health care services is low: "chronic diseases and poverty are interconnected in a vicious cycle". Inability to buy drugs is a major determinant and is significantly associated with poor compliance and poor health outcomes in the developing world. 4 Non-adherence to the medical regimens is a major concern in the management of patients with chronic illness like hypertension and is a major cause for treatment failure. 4,5 The present studies is conducted with the aim to assess adherence to drugs in a Hypertensive patients.

METHODOLOGY
This Cross-Sectional study will be carried out among adult hypertensive patients visiting Urban Health Training Centre (UHTC) of Sri Siddhartha Medical College during September to October 2018.

Sample size
All Hypertensive Patients attending Urban Health centre during September and October were taken for study.

Sampling Technique
Convenient sampling, all the consecutive diabetic subjects who attended Urban Health centre were included during that period.

Method of data collection
Medication adherence will be measured using the 8 item Morisky Medication Adherence Scale (MMAS-8) consisting of 8 items each of which measures a specific medication taking behaviour. Response categories are yes/no for 7 items and a 5 point Likert response for the last item. Socio-demographic characteristics will be recorded of all the eligible patients like age, gender, history of duration of hypertension, socioeconomic status, education level using pretested semi structured questionnaire. Questions will also be asked on number and frequency of the drugs and any side effects of drugs as experienced by patient. Data will be collected by direct face to face interview by using semi structured questionnaire. The degree of adherence will be determined according to the score resulting from the sum of all the correct answers: high adherence (8 points), average adherence (6 to < 8 points) and poor adherence (< 6 points). In this study, patients will be considered adherent when they have a score equal to eight in the MMAS-8.

Statistical Analysis
Data thus obtained was coded and entered into Microsoft Excel Work sheet. This was analysed using SPSS 22 version. Analysis done by descriptive statistics like frequency distribution of the study subjects according to age, sex, marital status, educational status, employment, type of occupation and Socioeconomic status, To find out the association of Adherence of drugs with above factors, chi-square test was applied for each factor. The statistical significance was evaluated at 5% level of significance.
Adherence to drugs 90 (60%) were having Low adherence, 36 (24%) were having Medium adherence and 24 (16%) High adherence for Drugs using Morisky Adherence scale. (Table 5) When we studied association between Adherence to drugs with other Socio-demographic characteristics, we got statistically significant results      with Socio-economic status, residence and Place of Purchase of drugs (P=0.0) ( Table 6).

DISCUSSION
Hypertension, is a chronic disease that requires lifestyle interventions and pharmacotherapy for life, adherence to the therapy and its assessment is a major challenge to be addressed.
In a hospital based study by Hema K et al.  In Present study their was no association with Age, gender, education, Occupation, duration of disease, number of tablets taken and place of purchase of drugs with adherence to drugs.
In contrast, a study by Rao BB et al. showed that adherence rate towards antihypertensive Medication was better among patient above 60 years of age (67.2%) and this was found to be statistically significant (p=0.02). 10  In present study their was association between number of drugs taken and adherence to drugs, Similar findings were reported from a study by Nagarkar AM et al. in which there was no significance found between adherence and number of drugs taken(p=0.631). 14 Patients who were hypertensive for a period of 5 years or more were 3 times more likely to be adherent compared with those suffering from hypertension for less than 5 years, emphasizing the fact that longer duration of the disease helps the patient to accept the diseased state as well as to adapt to the adherence behavior over time, consistent with findings from previous studies. Longer duration of hypertension helped these patients build up a habit of regularly consuming their pills. 15

CONCLUSION
The study concludes with observation of 60% of Low adherence to drugs and statistically Significant results with Socio-economic status, However hypertension being a chronic and dynamic disease, adherence to the medication needs to be maintained continuously and fully optimized.