Effect of Patient-Centered Care on Medication Adherence among Hypertensive Patients attending General Outpatient Clinic at University of Abuja Teaching Hospital, Abuja Nigeria

Godiya Andrew Bwala, Nicholas Daboer Baamlong, Lamkur Gabriel Shedul, Rukayat Adenike Abdulkareem, Yalma Ramsey Msheliza, Rebecca Nanna Ripiye

Abstract


Background

Adherence to medication is poor among adult hypertensive patients and is a factor that influences the control of hypertension. The objective of this study is to assess the effects of patient centered clinical care [PCC] on adherence to antihypertensive medications among adult patients at the general outpatient clinic, University of Abuja Teaching Hospital, Nigeria.

Methods

The study was a single-blinded randomized controlled trial involving 64 hypertensive adults. Participants were assigned using simple random sampling technique into an intervention and a control group. The intervention offered was patient centered clinical care. The control group received the traditional biomedical care for hypertension. Medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8) at baseline and after twelve weeks of follow up. Data was analyzed using SPSS software and t-test and Chi square test were used to assess significant statistical differences between variables and proportions at 5% significance level.

Results

At baseline, 15.6% of participants in the intervention group and 25.0% of participants in the control group had high medication adherence. At baseline, the difference was not statistically significant (p-value 0.351). However, after twelve weeks of intervention, 75.0% of participants in the intervention group were adherent while only 37.5% in the control group were adherent and this difference was statistically significant (p-value 0.002).

Conclusion

Patient centered care improved medication adherence among adult hypertensive patients. Therefore the use of patient-cared care is recommended in this setting to reduce the risk of cardiovascular events and death.

Keywords


Patient-centered care, Hypertension, Medication adherence, Morisky medication adherence scale, Out-patient clinic.

Full Text:

PDF

References


. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure: The JNC 7 report. JAMA. 2003; 289(19): 2560-572.

A global brief on hypertension. World health day 2013. World Health Organisation Document number: WHO/DCO/WHD/2013.2. Available from https://apps.who.int/iris/bitstream/handle/10665/79059/WHO_DCO_WHD_2013.2_eng.pdf;jsessionid=63E041B2448B9C59A13F6AA12425AEDD?sequence=1. Accessed 19th February 2020

Whelton PK, Carey RM, Aronow WS, Casey Jr DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2017; 00: e000-e000.

Adeloye D, Basquill C, Aderemi AV, Thompson JY, Obi FA. An estimate of the prevalence of hypertension in Nigeria: A systematic review and meta-analysis. J Hypertens. 2015; 33(2):230-42.

Adediran SO, Okpara CI, Adeniyi SO, Jimoh KA. Hypertension prevalence in an Urban and Rural area of Nigeria. J Med Med Sci. 2013; 4(4): 149-54.

Ogah OS, Okpechi I, Chukwuonye II, Akinyemi JO, Onwubere BJC, Falase AO, et al. Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review. World J Cardiol. 2012; 4(12): 327-40.

Abdulsalam S, Olugbenga-Bello A, Olarewaju O, Abdusalam I. Sociodemographic correlates of modifiable risk factors for hypertension in a rural Local Government Area of Oyo State South West Nigeria. Int J Hypertens. 2014; 2014: 842028.

Berlowitz DR, Foy CG, Kazis LE, Bolin L, Conroy LB, Fitzpatrick P, et al. for the SPRINT Study Research Group. Impact of Intensive Blood Pressure Therapy on Patient-Reported Outcomes: Outcomes Results from the SPRINT Study. N Engl J Med 2017; 377:733-44.

Bress AP, Bellows BK, King J, Hess R, Beddhu S, Zhang Z, et al, for the SPRINT Research Group and the SPRINT Economics and Health Related Quality of Life Subcommittee. Cost-Effectiveness of Intensive versus Standard Blood Pressure Control. N Engl J Med 2017; 377:745-55.

Zyoud SH, Al-Jabi SW, Sweileh SW, Morisky DE. Relationship of treatment satisfaction to medication adherence: findings from a cross-sectional survey among hypertensive patients in Palestine. Health Qual Life Outcomes. 2013; 11: 191-97.

Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin hypertens. 2008; 10(5): 348–54.

Conn VS, Hafdhal AR, Cooper PS, Ruppar TM, Mehr DR, Russel CL. Interventions to improve medication adherence among older adults: meta-analysis of adherence outcomes among randomized controlled trials. Gerontologist. 2009; 49(4): 447–62.

Roumie CL, Greevy R, Wallston KA, Elasy TA, Kaltenbach L, Kotter E et al. Patient centered primary care is associated with patient hypertension medication adherence. J Behav Med. 2011; 34(4): 244–53.

Lam WY, Fresco P. Medication adherence measures: an overview. BioMed Res Int. 2015; 2015:217047.

Sabaté E, ed. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003.

Tan CSL, Teng GG, Chong KJ, Cheung PP, Lim AYN, Wee HL, et al. Utility of the Morisky Medication Adherence Scale in gout: a prospective study. patient preference and adherence. 2016; 10: 2449-57.

Mahmoudian A, Zamani A, Tavakoli N, Farajzadegan Z, Fathollahi-Dehkordi F. Medication adherence in patients with hypertension: Does satisfaction with doctor-patient relationship work? J Res Med Sci. 2017; 22(1): 48-53.

Smith RC, Fortin AH, Dwamena F, Frankel RM. An evidence-based patient-centered method makes the biopsychosocial model scientific. Patient Educ Couns. 2013; 91(1) 265–70.

Stewart M. The patient-centered clinical method: a family medicine perspective. Turk Aile Hek Derg. 2013; 17(2): 73-85.

Pelzang R. Time to learn: understanding patient-centred care. Br J Nurs. 2010; 19(14): 912-17.

Bardes CL. Defining patient-centered medicine. N Engl J Med. 2012; 366(9): 782-83.

Man JD, Mayega RW, Sarkar N, Waweru E, Leys M, Olmen JV et al. Patient centred care and people-centered health systems in Sub-saharan Africa: why so little of something so badly needed? IJPCM. 2016; 6(3): 162-73.

Birhanu Z, Assefa T, Woldie M, Morankar S. Predictors of perceived empathy among patients visiting primary healthcare centres in Central Ethiopia. Int J Qual Heal Care. 2012; 24: 161-68.

Hudon C, Fortin M, Haggerty JL, Lambert M, Poitras ME. Measuring patients’ perceptions of patient-centered care: a systematic review of tools for family medicine. Ann Fam Med. 2011; 9(2):155-64.

Brown JB, Stewart M, Weston WW, Freeman TR. Introduction In: Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-centered medicine: transforming the clinical method. 2nd ed. Radcliffe Medical Press. Abingdon. 2003. 1-16.

Bamgboye E. A Compendium of Medical Statistics. Fulbam Publishers. 3rd Ed, 2007: 166.

Shittu RO, Musa SA, Louis OO, Sule AG, Aremu IB, Isiaka-Lawal S et al. Adherence To Antihypertensive Medications And Associated Factors Among Patients In A Nigerian Family Practice Setting. IJMPS. 2015; 2(5): 1-12.

Osamor PE, Owumi B. Factors Associated with Treatment Compliance in Hypertension in Southwest Nigeria. J Health Popul Nutr. 2011; 29(6): 619-28.

Iloh GUP, Ofoedu JN, Njoku PU, Amadi AN, Godswill-Uko EU. Medication adherence and blood pressure control amongst adults with primary hypertension attending a tertiary hospital primary care clinic in Eastern Nigeria. Afr J Prm Health Care Fam Med. 2013; 5(1): 446-51.

Iyalomhe GBS, Iyalomhe SI. Hypertension-related knowledge, attitudes and life-style practices among hypertensive patients in a sub-urban Nigerian community. J Public Health Epidemiol. 2010: 2(4); 71-7.

Ogah SO, Madukwe OO, Chukwuonye II, Onyeonoro UU, Ukegbu AU, Akhimien MO et al. Prevalence and determinants of hypertension in Abia state Nigeria: results from the Abia state non-communicable diseases and cardiovascular risk factors survey. Ethnicity & Disease. 2013; 23: 161-67.

Ratner NL, Davis EB, Lhotka LL, Wille SM, Walls ML. Patient-Centered Care, Diabetes Empowerment, and Type 2 Diabetes Medication Adherence Among American Indian Patients. Clin Diabetes. 2017;35(5):281–285.

Ratner N, Davis E, Lhotka L, Wille S, Walls M. Patient Centered Care: a tool topromote empowerment and medication adherence among American Indian patientwith type 2 diabetes. Available at https://c.ymcdn.com/sites/mafp.org/ resource/collection/41736

Stewart M. The patient-centered clinical method: a family medicine perspective. Turk Aile Hek Derg. 2013; 17(2): 73-85.

Cooper LA, Roter DL, Carson KA, Bone LR, Larson SM, Miller ER et al. A randomised trial to improve patient-centered care and hypertension control in underserved primary care patients. J Gen Int Med. 2011; 26(11): 1297-304.

Muntner P, Levitan EB, Joyce C, Holt E, Mann D, Oparil S et al. Association between antihypertensive medication adherence and visit-to-visit variability of blood pressure. J Clin Hypertens. 2013;15(2): 112-17.

Matsumura K, Arima H, Tominaga M, Ohtsubo T, Sasaguri T, Fujii K et al. The Comfort Investigators; Impact of antihypertensive medication adherence on blood pressure control in hypertension: the COMFORT study. QJM-Int J Med. 2013; 106(10): 909–914.

Alhalaiqa F, Deane KHO, Nawafleh AH, Clark A, Gray R. Adherence therapy for medication non-compliant patients with hypertension: a randomised controlled trial. J Hum Hypertens. 2012; 26(2): 117–26.

Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: A meta-analysis. Med Care. 2009; 47(8): 826–34.

Zhao Y, Bin W, Weilin Q, Aifang Y. Effect of medication adherence on blood pressure control and risk factors for antihypertensive medication adherence. J Eval Clin Pract. 2015; 21(1): 166-72.


Refbacks

  • There are currently no refbacks.


Copyright (c) 2020 Godiya Andrew Bwala, Nicholas Daboer Baamlong, Lamkur Gabriel Shedul, Rukayat Adenike Abdulkareem, Yalma Ramsey Msheliza, Rebecca Nanna Ripiye

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.