Factors Associated with Treatment Compliance in Hypertension at a Secondary Health Facility in Islamabad

Abstract

Background: Hypertension is a prevalent disease worldwide. Despite availability of effective treatment, it remains uncontrolled. Multiple factors are responsible but one of the important contributing factors for uncontrolled hypertension is a poor compliance to the treatment.
Objective: To determine the frequency and risk factors associated with non-compliance among hypertensive patients.
Study type, settings and duration: Cross-sectional prospective study was conducted at a secondary care health facility of Islamabad, Pakistan over period of 03 months from June to August 2017.
Methodology: All hypertensive patients visiting selected hospital for treatment were enrolled after consent Compliance to treatment was assessed by using the revised morisky 8 item medication adherence scale. A Score of 80% and above r was considered as compliant while <80% was graded as non-compliant. In addition, information on socio-demographics, education status, number of medicines, other comorbidities, illness duration, profession, source of income and monthly income were also recorded. After cleaning the data, SPSS software version 22was used for analysis.
Results: A total of 200 hypertensive patients were enrolled. Overall frequency of non-compliance was 118 (59%). Majority of participants were females 158 (74%), with male to female ratio of 1: 4. Mean age was 50.9 years. Majority 127 (63.5%) was illiterate. Out of 200, 128 (64%), 39 (19.4%), 33 (16.5%) patients were on one, two and three antihypertensive medicines respectively. Most of the patients 82 (41%) purchased medicines with support from family members and only 54 (27%) from government hospital. Fifty (50%) of the participants were from middle socio-economic status with monthly income of 10,000 to 25,000. Non-compliance was statistically associated with lower monthly income less than Pakistani rupees of 10,000, more than 1 antihypertensive medicine, and patients paying out of their pockets for the medicine (p <0.05)
Conclusion: Non-compliance is frequent in Pakistani population. Inabilities to pay out of their pockets, with lower monthly income were the main factors. To improve compliance, hypertension clinics with free supply of antihypertensive medicines should be established with good counseling by the physicians.