Jobin Koshy, (2018) Study on Medication Adherence and Factors affecting it in Patients treated for Hypertension at a Tertiary Care Hospital. Masters thesis, College of Pharmacy, Sri Ramakrishna Institute of Paramedical Sciences, Coimbatore.
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Abstract
Hypertension is one of the most common non communicable diseases globally. It represents a major cause of cardiovascular morbidity and mortality and affects approximately 1 billion individuals world wide. Blood pressure varies from person to person and from time to time for individuals, however if the blood pressure constantly elevated above 140/90 mmHg at different times of measurement, it is regarded as high blood pressure (hypertension). prevalence is predicted to increase by approximately 60% by 2025. Therefore international guidelines mandate not only an assessment of the global cardiovascular risk, but also a risk based approach to antihypertensive therapy. WHO describes poor adherence is one of the most important cause of uncontrolled BP and it increases the risk of ischemic heart disease 3-4 fold and the overall cardiovascular risk by 2-3 fold. A number of studies conducted internationally have reported significant association between medication adherence and blood pressure control. Poor medication adherence is associated with various medical/psychosocial complications, poorer health-related quality of life and increased the health care costs. The effectiveness of antihypertensive agents must be achieved by optimal adherence to prescribed medications according to health care providers instructions. The study was carried out to document the medication adherence and factors affecting it in patients treated for hypertension in the study site. The study was conducted in the department of cardiology and general medicine of a 1000 bedded multi specialty hospital. After ensuring the scope of the study in the department of cardiology and general medicine of the study hospital, the study protocol was prepared and submitted to hospital ethics committee and official approval was obtained to carry out the study in the hospital. After receiving the official approval, the study was conducted for a period of 10 months from December 2017 to September 2018. Study population of 132 patients were included as per the inclusion criteria and data were collected in a specially designed data entry form. The medication adherence were calculated through the Morisky Medication Adherence Scale (MMAS-8) and Medication Adherence Rating Scale (MARS). From the study it was found that male [77 (55.3%)] patients are mostly affected than female [59 (44.7%)]. Analysis for the reason for admission revealed that the chief complaints include head ache, followed by nausea, vomiting, chest pain and shortness of breath. 44 (33.3%) patients belong to the age group between 60-69 years. From the study it was found that apart from ageing, diet or eating habits (54.5%), alcohol consumption (36.4) and smoking (27.3%) were the major risk factors which may contributed to HTN. The category of anti-hypertensive drugs most prescribed in the study site includes calcium channel blocker (50.8%) followed by ARBs 44 (33.3%). In the study population 121 (91.7%) had past medical history and 122 patients had at least one co-morbid disease. Most common are diabetes 62(46.9%), followed by dyslipidemia 27 (20.4%) and renal disorder 23 (17.4%). According to JNC-7 guidelines, we found that most of the patients were in stage I hypertension. The study observed medication adherence through The Morisky Medication Adherence Scale (MMAS-8) and Medication Adherence Rating Scale (MARS). According to Morisky scale 76 (57.6%)) were having medium adherence followed by 39 (29.5%), 17 (12.9%) low adherence and high adherence respectively. Based on the MARS, 45 (34.1%) were having compliance over the medication and 87 (65.9%) were having non-compliance and were having [56 (42.4%), 45 (34.1%), 31 (23.5%)] partial, low and high adherence respectively. Apart from the risk factors the intentional non adherence and non intentional adherence factors also was found to have a major role in adherence. The adherence between the variables in each scale were calculated by oneway ANOVA. The mean standard deviation of MMAS is 6.03±1.73 and the f-ratio is 189.17. The mean S.D of MARS is 4.94±2.7 and the f-ratio value is 73.243. Both the fvalue of MMAS and MARS is ˂ 0.0001, which is significant at p ˂ 0.05. The comparison of adherence between MMAS and MARS has been done by chi-square and found that the chi-square statistical value is 7.5422 and the p-value is 0.0230, which is significant at p˂0.05. Non adherence to the therapeutic regimen remains a major limiting factor of hyper tension management in India. Overall the hypertensive patients was having medium adherence.
| Item Type: | Thesis (Masters) |
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| Additional Information: | REG. No.261640104 |
| Uncontrolled Keywords: | Medication Adherence ; Factors affecting ; treatment ; Hypertension ; Tertiary Care Hospital. |
| Subjects: | PHARMACY > Pharmacy Practice |
| Depositing User: | Subramani R |
| Date Deposited: | 02 Jul 2019 14:51 |
| Last Modified: | 03 Jul 2019 01:29 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/10683 |
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