Medication adherence and associated factors among elderly hypertension patients with uncontrolled blood pressure in rural area, Northeast Thailand
Keywords:
Hypertension, Elderly, Medication adherence, Medication managementAbstract
Purpose - Hypertension is a common disease among elderly. Adherence to antihypertensive medication is a key predictor of optimal blood pressure control that prevents the risk of cardiovascular disease and potentially death. The purpose of this paper is to assess adherence to antihypertension and identify associated factors among the elderly in a rural area, Buengkan province, Thailand.
Design/methodology/approach - A health facilities based cross-sectional study was conducted in Buengkan district. A simple random sampling method was used to select 408 participants. A structured questionnaire adapted from the World Health Organization STEPwise approach was used to collect data. The medication adherence level was identified by pill count with percentage ⩾70 defined as good adherence. Descriptive and summary statistics were used. Bivariate analysis was done using Pearson’s χ2 test, and multivariable analyses were also carried out.
Findings - A total of 408 (143 males and 265 females) elderly hypertension patients with uncontrolled blood pressure participated in this study. Most of the participants were found to have lower adherence to medication treatment (86.8 percent), whereas the remaining ones (13.2 percent) were found to have good adherence. The multivariable logistic regression analysis showed that having a daughter as a care taker (adjust odd ratio=7.99, 95% confidence interval: 1.23–51.778) was significantly associated with high medical adherence.
Originality/value - Hypertension medication adherence among elderly patients with uncontrolled blood pressure was poor. Having a care taker, especially a daughter, is a key to improve adherence. Effective strategy to improve adherence should focus on and involve family participation into the program.
References
1. World Health Organization [WHO]. A global brief on hypertension: silent killer, global public health crisis: World Health Day 2013. Geneva: WHO; 2013.
2. Dans A, Ng N, Varghese C, Tai ES, Firestone R, Bonita R. The rise of chronic non-communicable diseases in Southeast Asia: time for action. Lancet. 2011 Feb; 377(9766): 680-9. doi: 10.1016/S0140-6736(10)61506-1
3. Gama H, Damasceno A, Silva-Matos C, Diogo D, Azevedo A, Lunet N. Low prevalence of hypertension with pharmacological treatments and associated factors. Rev Saude Publica. 2013 Apr; 47(2): 301-8. doi: 10.1590/S0034-910.2013047004328
4. Aekplakorn W, Abbott-Klafter J, Khonputsa P, Tatsanavivat P, Chongsuvivatwong V, Chariyalertsak S, et al. Prevalence and management of prehypertension and hypertension by geographic regions of Thailand: the third national health examination survey, 2004. J Hypertens. 2008 Feb; 26(2): 191-8. doi: 10.1097/HJH.0b013e3282f09f57
5. Ikeda N, Sapienza D, Guerrero R, Aekplakorn W, Naghavi M, Mokdad AH, et al. Control of hypertension with medication: a comparative analysis of national surveys in 20 countries. Bull World Health Organ. 2014 Jan; 92(1): 10-9C. doi: 10.2471/BLT.13.121954
6. Sangngern L, Kanchanakhan N, Somrongthong R. Health status and health seeking behaviours among the elderly in the Donmuang slum community, Bangkok, Thailand. J Health Res. 2014 Jun; 28(3): 205-10.
7. Jitapunkul S, Wivatvanit S. National policies and programs for the aging population in Thailand. Ageing Int. 2008 Dec; 33(1): 62-74. doi: 10.1007/s12126-009-9027-6
8. Visanuyothin S, Plianbangchang S, Somrongthong R. An integrated program with home blood-pressure monitoring and village health volunteers for treating poorly controlled hypertension at the primary care level in an urban community of Thailand. Integr Blood Press Control. 2018; 11: 25-35. doi: 10.2147/Ibpc.S160548
9. Lo SH, Chau JP, Woo J, Thompson DR, Choi KC. Adherence to antihypertensive medication in older adults with hypertension. J Cardiovasc Nurs. 2016 Jul-Aug; 31(4): 296-303. doi: 10.1097/JCN.0000000000000251
10. Agarwal R, Pappas MK, Sinha AD. Masked uncontrolled hypertension in CKD. J Am Soc Nephrol. 2016 Mar; 27(3): 924-32. doi: 10.1681/ASN.2015030243
11. Oliveria SA, Lapuerta P, McCarthy BD, L’Italien GJ, Berlowitz DR, Asch SM. Physician-related barriers to the effective management of uncontrolled hypertension. Arch Intern Med. 2002 Feb; 162(4): 413-20.
12. Brindel P, Hanon O, Dartigues JF, Ritchie K, Lacombe JM, Ducimetiere P, et al. Prevalence, awareness, treatment, and control of hypertension in the elderly: the Three City study. J Hypertens. 2006 Jan; 24(1): 51-8.
13. Sangsuwan T, Jamulitrat S. Prevalence of uncontrolled blood pressure in hypertensive patients attending the primary care unit of Songklanagarind Hospital. JHSMR. 2018; 36(1): 11-27.
14. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee ( JNC 8). JAMA. 2014 Feb; 311(5): 507-20. doi: 10.1001/jama.2013.284427
15. Cutler DM, Everett W. Thinking outside the pillbox–medication adherence as a priority for health care reform. N Engl J Med. 2010 Apr; 362(17): 1553-5. doi: 10.1056/NEJMp1002305
16. De Geest S, Ruppar T, Berben L, Schonfeld S, Hill MN. Medication non-adherence as a critical factor in the management of presumed resistant hypertension: a narrative review. Eurointervention. 2014 Jan; 9(9): 102-9. doi: 10.4244/Eijv919a185
17. Hamdidouche I, Jullien V, Boutouyrie P, Billaud E, Azizi M, Laurent S. Drug adherence in hypertension: from methodological issues to cardiovascular outcomes. J Hypertens. 2017 Jun; 35(6): 1133-44. doi: 10.1097/HJH.0000000000001299
18. Lee JK, Grace KA, Foster TG, Crawley MJ, Erowele GI, Sun HJ, et al. How should we measure medication adherence in clinical trials and practice?. Ther Clin Risk Manag. 2007 Aug; 3(4): 685-90.
19. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005 Aug; 353(5): 487-97. doi: 10.1056/NEJMra050100
20. Bosworth HB. Medication adherence. In: Bosworth HB editor. Improving patient treatment adherence: a clinicians’ guide. New York, NY: Springer; 2010. 68-94.
21. Karve S, Cleves MA, Helm M, Hudson TJ, West DS, Martin BC. Good and poor adherence: optimal cut-point for adherence measures using administrative claims data. Current Medical Research and Opinion. 2009 Sep; 25(9): 2303-10. doi: 10.1185/03007990903126833
22. Leaungsomnapa Y, Promproh S, Leaungsomnapa S, Sourthao Y. Influence of beliefs about medication on high group of medication adherence in hypertensive patients. JMPC. 2013; 30(2): 146-57.
23. Pan JJ, Lei T, Hu B, Li QG. Post-discharge evaluation of medication adherence and knowledge of hypertension among hypertensive stroke patients in northwestern China. Patient Prefer Adherence. 2017; 11: 1915-22. doi: 10.2147/Ppa.S147605
24. Venkatachalam J, Abrahm SB, Singh Z, Stalin P, Sathya GR. Determinants of patient’s adherence to hypertension medications in a rural population of Kancheepuram district in Tamil Nadu, South India. Indian J Community Med. 2015 Jan-Mar; 40(1): 33-7. doi: 10.4103/0970-0218.149267
25. Schuiling-Veninga CC, Nguyen TB, Vu TH, Wright EP, Postma MJ. Adherence to hypertension medication: quantitative and qualitative investigations in a rural Northern Vietnamese community. PloS one. 2017 Feb; 12(2): e0171203.
26. Lauffenburger JC, Landon JE, Fischer MA. Effect of combination therapy on adherence among US patients initiating therapy for hypertension: a cohort study. J Gen Intern Med. 2017 Jun; 32(6): 619-25. doi: 10.1007/s11606-016-3972-z
27. Serour M, Alqhenaei H, Al-Saqabi S, Mustafa AR, Ben-Nakhi A. Cultural factors and patients’ adherence to lifestyle measures. Br J Gen Pract. 2007 Apr; 57(537): 291-5.
28. Svensson S, Kjellgren KI, Ahlner J, Säljö R. Reasons for adherence with antihypertensive medication. Int J Cardiol. 2000 Nov-Dec; 76 Nos 2-3: 157-63.
29. Ho PM, Magid DJ, Shetterly SM, Olson KL, Maddox TM, Peterson PN, et al. Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease. Am Heart J. 2008 Apr; 155(4): 772-9. doi: 10.1016/j.ahj.2007.12.011
30. Brown MT, Bussell JK. Medication adherence: WHO cares?. Mayo Clin Proc. 2011; 86(4): 304-14. doi: 10.4065/mcp.2010.0575
31. Horne R, Graupner L, Frost S, Weinman J, Wright SM, Hankins M. Medicine in a multi-cultural society: the effect of cultural background on beliefs about medications. Soc Sci Med. 2004 Sep; 59(6): 1307-13. doi: 10.1016/j.socscimed.2004.01.009
32. Krousel-Wood M, Thomas S, Muntner P, Morisky D. Medication adherence: a key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients. Curr Opin Cardiol. 2004 Jul; 19(4): 357-62.
33. Sharma N, Chakrabarti S, Grover S. Gender differences in caregiving among family-caregivers of people with mental illnesses. World J Psychiatry. 2016 Mar; 6(1): 7-17. doi: 10.5498/wjp.v6.i1.7
2. Dans A, Ng N, Varghese C, Tai ES, Firestone R, Bonita R. The rise of chronic non-communicable diseases in Southeast Asia: time for action. Lancet. 2011 Feb; 377(9766): 680-9. doi: 10.1016/S0140-6736(10)61506-1
3. Gama H, Damasceno A, Silva-Matos C, Diogo D, Azevedo A, Lunet N. Low prevalence of hypertension with pharmacological treatments and associated factors. Rev Saude Publica. 2013 Apr; 47(2): 301-8. doi: 10.1590/S0034-910.2013047004328
4. Aekplakorn W, Abbott-Klafter J, Khonputsa P, Tatsanavivat P, Chongsuvivatwong V, Chariyalertsak S, et al. Prevalence and management of prehypertension and hypertension by geographic regions of Thailand: the third national health examination survey, 2004. J Hypertens. 2008 Feb; 26(2): 191-8. doi: 10.1097/HJH.0b013e3282f09f57
5. Ikeda N, Sapienza D, Guerrero R, Aekplakorn W, Naghavi M, Mokdad AH, et al. Control of hypertension with medication: a comparative analysis of national surveys in 20 countries. Bull World Health Organ. 2014 Jan; 92(1): 10-9C. doi: 10.2471/BLT.13.121954
6. Sangngern L, Kanchanakhan N, Somrongthong R. Health status and health seeking behaviours among the elderly in the Donmuang slum community, Bangkok, Thailand. J Health Res. 2014 Jun; 28(3): 205-10.
7. Jitapunkul S, Wivatvanit S. National policies and programs for the aging population in Thailand. Ageing Int. 2008 Dec; 33(1): 62-74. doi: 10.1007/s12126-009-9027-6
8. Visanuyothin S, Plianbangchang S, Somrongthong R. An integrated program with home blood-pressure monitoring and village health volunteers for treating poorly controlled hypertension at the primary care level in an urban community of Thailand. Integr Blood Press Control. 2018; 11: 25-35. doi: 10.2147/Ibpc.S160548
9. Lo SH, Chau JP, Woo J, Thompson DR, Choi KC. Adherence to antihypertensive medication in older adults with hypertension. J Cardiovasc Nurs. 2016 Jul-Aug; 31(4): 296-303. doi: 10.1097/JCN.0000000000000251
10. Agarwal R, Pappas MK, Sinha AD. Masked uncontrolled hypertension in CKD. J Am Soc Nephrol. 2016 Mar; 27(3): 924-32. doi: 10.1681/ASN.2015030243
11. Oliveria SA, Lapuerta P, McCarthy BD, L’Italien GJ, Berlowitz DR, Asch SM. Physician-related barriers to the effective management of uncontrolled hypertension. Arch Intern Med. 2002 Feb; 162(4): 413-20.
12. Brindel P, Hanon O, Dartigues JF, Ritchie K, Lacombe JM, Ducimetiere P, et al. Prevalence, awareness, treatment, and control of hypertension in the elderly: the Three City study. J Hypertens. 2006 Jan; 24(1): 51-8.
13. Sangsuwan T, Jamulitrat S. Prevalence of uncontrolled blood pressure in hypertensive patients attending the primary care unit of Songklanagarind Hospital. JHSMR. 2018; 36(1): 11-27.
14. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee ( JNC 8). JAMA. 2014 Feb; 311(5): 507-20. doi: 10.1001/jama.2013.284427
15. Cutler DM, Everett W. Thinking outside the pillbox–medication adherence as a priority for health care reform. N Engl J Med. 2010 Apr; 362(17): 1553-5. doi: 10.1056/NEJMp1002305
16. De Geest S, Ruppar T, Berben L, Schonfeld S, Hill MN. Medication non-adherence as a critical factor in the management of presumed resistant hypertension: a narrative review. Eurointervention. 2014 Jan; 9(9): 102-9. doi: 10.4244/Eijv919a185
17. Hamdidouche I, Jullien V, Boutouyrie P, Billaud E, Azizi M, Laurent S. Drug adherence in hypertension: from methodological issues to cardiovascular outcomes. J Hypertens. 2017 Jun; 35(6): 1133-44. doi: 10.1097/HJH.0000000000001299
18. Lee JK, Grace KA, Foster TG, Crawley MJ, Erowele GI, Sun HJ, et al. How should we measure medication adherence in clinical trials and practice?. Ther Clin Risk Manag. 2007 Aug; 3(4): 685-90.
19. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005 Aug; 353(5): 487-97. doi: 10.1056/NEJMra050100
20. Bosworth HB. Medication adherence. In: Bosworth HB editor. Improving patient treatment adherence: a clinicians’ guide. New York, NY: Springer; 2010. 68-94.
21. Karve S, Cleves MA, Helm M, Hudson TJ, West DS, Martin BC. Good and poor adherence: optimal cut-point for adherence measures using administrative claims data. Current Medical Research and Opinion. 2009 Sep; 25(9): 2303-10. doi: 10.1185/03007990903126833
22. Leaungsomnapa Y, Promproh S, Leaungsomnapa S, Sourthao Y. Influence of beliefs about medication on high group of medication adherence in hypertensive patients. JMPC. 2013; 30(2): 146-57.
23. Pan JJ, Lei T, Hu B, Li QG. Post-discharge evaluation of medication adherence and knowledge of hypertension among hypertensive stroke patients in northwestern China. Patient Prefer Adherence. 2017; 11: 1915-22. doi: 10.2147/Ppa.S147605
24. Venkatachalam J, Abrahm SB, Singh Z, Stalin P, Sathya GR. Determinants of patient’s adherence to hypertension medications in a rural population of Kancheepuram district in Tamil Nadu, South India. Indian J Community Med. 2015 Jan-Mar; 40(1): 33-7. doi: 10.4103/0970-0218.149267
25. Schuiling-Veninga CC, Nguyen TB, Vu TH, Wright EP, Postma MJ. Adherence to hypertension medication: quantitative and qualitative investigations in a rural Northern Vietnamese community. PloS one. 2017 Feb; 12(2): e0171203.
26. Lauffenburger JC, Landon JE, Fischer MA. Effect of combination therapy on adherence among US patients initiating therapy for hypertension: a cohort study. J Gen Intern Med. 2017 Jun; 32(6): 619-25. doi: 10.1007/s11606-016-3972-z
27. Serour M, Alqhenaei H, Al-Saqabi S, Mustafa AR, Ben-Nakhi A. Cultural factors and patients’ adherence to lifestyle measures. Br J Gen Pract. 2007 Apr; 57(537): 291-5.
28. Svensson S, Kjellgren KI, Ahlner J, Säljö R. Reasons for adherence with antihypertensive medication. Int J Cardiol. 2000 Nov-Dec; 76 Nos 2-3: 157-63.
29. Ho PM, Magid DJ, Shetterly SM, Olson KL, Maddox TM, Peterson PN, et al. Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease. Am Heart J. 2008 Apr; 155(4): 772-9. doi: 10.1016/j.ahj.2007.12.011
30. Brown MT, Bussell JK. Medication adherence: WHO cares?. Mayo Clin Proc. 2011; 86(4): 304-14. doi: 10.4065/mcp.2010.0575
31. Horne R, Graupner L, Frost S, Weinman J, Wright SM, Hankins M. Medicine in a multi-cultural society: the effect of cultural background on beliefs about medications. Soc Sci Med. 2004 Sep; 59(6): 1307-13. doi: 10.1016/j.socscimed.2004.01.009
32. Krousel-Wood M, Thomas S, Muntner P, Morisky D. Medication adherence: a key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients. Curr Opin Cardiol. 2004 Jul; 19(4): 357-62.
33. Sharma N, Chakrabarti S, Grover S. Gender differences in caregiving among family-caregivers of people with mental illnesses. World J Psychiatry. 2016 Mar; 6(1): 7-17. doi: 10.5498/wjp.v6.i1.7
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Published
2018-12-03
How to Cite
Woodham, N., Taneepanichskul, S., Somrongthong, R., & Auamkul, N. (2018). Medication adherence and associated factors among elderly hypertension patients with uncontrolled blood pressure in rural area, Northeast Thailand. Journal of Health Research, 32(6), 449–458. Retrieved from https://he01.tci-thaijo.org/index.php/jhealthres/article/view/164440
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ORIGINAL RESEARCH ARTICLE
