Drug adherence for antihypertensive medications and its determinants among adult hypertensive patients attending in chronic clinics of referral hospitals in Northwest Ethiopia
Drug adherence for antihypertensive medications and its determinants among adult hypertensive patients attending in chronic clinics of referral hospitals in Northwest Ethiopia
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DOI：
10.1186/s40360-017-0134-9
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发表时间：
2017-04-05
影响因子：
2.9
通讯作者：
Gelagay, Abebaw Addis
中科院分区：
文献类型：
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作者：
Mekonnen, Habtamu Sewunet;Gebrie, Mignote Hailu;Gelagay, Abebaw Addis
背景：遵守处方药物是一个紧迫的问题，它可以直接与高血压等慢性病的管理有关；如果不遵守，可能会影响药物治疗的效果以及卫生保健系统的效率。在埃塞俄比亚，特别是在研究地区，关于抗高血压药物及其决定因素的药物依从性水平的信息很少。因此，本研究的目的是评估埃塞俄比亚西北部转诊医院慢性病门诊的成年高血压患者的降压药物依从性及其影响因素。方法：于2016年3月至4月进行机构横断面研究。采用系统随机抽样的方法，从三家转诊医院抽取了409名研究对象。问卷是利用世界卫生组织(世卫组织)的概念模型并通过查阅国际文献编制的。这些数据是通过面试者管理的问卷收集的。这些数据被输入Epi-Info版本7，然后传输到社会科学统计包(SPSS)版本20进行数据清理和分析。首先进行双变量分析，以了解每个自变量和因变量之间的关系。将双变量分析中P值小于0.2的变量输入到多变量Logistic回归模型中进行最终分析。多因素分析采用反向Logistic回归方法。P值小于0.05被认为是确定相关性的统计学意义，并使用95%可信区间的优势比来确定协变量(解释变量)和结果变量之间的相关性的存在、强度和方向。用莫里斯基服药依从性评定量表评定服药依从性，以服药依从性和非依从性得分。结果：409(40 9)名研究对象接受了访谈，应答率为100%。调查对象的平均年龄为54.5岁，标准差(SD)+/-13.58。总依从性优良率为67.2%(95%CI=62.8，71.6)。受试者对降压药持积极态度(调整后优势比(AOR)=9.88，95%可信区间(CI)：5.34，18.27)，有良好的医患关系(AOR=4.25，95%CI：2.32，7.86)，有一种(AOR=4.36，95%CI：1.34，14.12)或无(AOR=3.38，95%CI：1.01，11.31)合并症，疗程长(AOR=1.89，95%CI：1.07，3.35)，较低的医疗费用(AOR=2.06，95%CI：1.13，3.76)与降压药依从性好有关。结论：本研究中降压药依从性好的比例较高。预防合并症，使医疗服务可用，并保持良好的客户-提供者互动，对于良好的药物依从性至关重要。
Background: Adherence to prescribed medication is an imperative issue which can be directly linked with the management of chronic diseases like hypertension; failure to adhere can affect the effectiveness of medication as well as the efficiency of the health care system. There is scarcity of information regarding the level of drug adherence for antihypertensive medications and its determinants in Ethiopia, particularly in the study area. Therefore, the aim of this study was to assess adherence level and its determinants for antihypertensive medications among adult hypertensive patients attending the chronic illness clinics of the referral hospitals in northwest Ethiopia.Methods: Institution based cross sectional study was conducted from March to April, 2016. The systematic random sampling technique was used to select 409 study participants from three referral hospitals. The questionnaire was prepared using the World Health Organization (WHO) conceptual model and by reviewing international literature. The data were collected using an interviewer administered questionnaire. The data were entered in to Epi - Info version 7 and then transferred to the statistical package for social science (SPSS) version 20 for data cleaning and analysis. Bivariate analysis was first done to see the association between each independent variables and dependent variable. Variables with a P-value of less than 0.2 in the bivariate analysis were entered in to the multivariate logistic regression model for final analysis. Multivariate analysis was done using Backward logistic regression method. P-value less than 0.05 was considered to determine the statistical significance of the association and odds ratio with a 95% confidence interval was used to determine the presence, strength, and direction of association between covariates (explanatory variables) and the outcome variable. The Morisky medication adherence scale was used to assess the adherence status using > = 6 as adherent or < 6 as non adherent score.Results: Four hundred and nine (409) study participants were interviewed with a response rate of 100%. The mean age of the respondents was 54.5 years with (Standard Deviation (SD) +/- 13.58). The overall rate of good adherence was 67.2% (95% Cl = 62.8, 71.6). Participants who had a favourable attitude towards antihypertensive medications (Adjusted odds ratio (AOR) = 9.88, 95% confidence interval (Cl): 5.34, 18.27), having good patient-provider relationship (AOR = 4.25, 95% Cl: 2.32, 7.86), having one (AOR = 4.36, 95% Cl: 1.34, 14.12) or no (AOR = 3.38, 95% Cl: 1.01,11.31) co-morbidities, a long duration of treatment (AOR = 1.89, 95% Cl: 1.07, 3.35), and a low medical cost (AOR = 2.06, 95% Cl: 1.13, 3.76) had associations with good drug adherence for antihypertensive medication/s.Conclusions: The prevalence of good drug adherence for anti-hypertensive medications in this study was high. Prevention of co-morbidities, making medical services accessible, and maintaining good client-provider interaction are of paramount importance for good drug adherence.