ADHERENCE TO MEDICATION AMONG HYPERTENSIVE OUTPATIENTS IN THE PENANG GENERAL HOSPITAL, MALAYSIA
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Date
2010-06
Authors
Turki Suleiman, Amal Khalil
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Abstract
Adherence to antihypertensive medications in general is not well documented in
developing countries, and what is known is far from encouraging. Despite the
effectiveness of antihypertensive treatment, medication adherence is often suboptimal in
hypertensive Malaysian population. This retro-prospective coh011 study aimed to assess
the medication adherence, and factors affecting this. A cohort of 380 hypertensive
patients was conveniently recmited from the outpatient hypertension clinic at Penang
General Hospita], lv1alaysia. The Morisky self-rep011 scale revealed that 51.3% patients
(n= 195) had poor adherence to prescribed antihypertensive medication. A Semistmctured
interview revealed forgetfulness due to a lack of symptoms; poor social
supp011, medication side effects, and the perception that long-term medication may be
addictive were principal factors of poor adherence to medication. The structural equation
modelling (SEM), which identified the multivariate hypothesized predictors of poor
adherence to medication, showed that a lack of self discipline, aversion towards
medication, and a negative attitude towards medication in general negatively accounted
for 75% of factors affecting medication adherence. The one-way ANOVA and
independent t-tests of independent samples revealed no statistically significant
differences (p>0.05 for all) between adherent and non-adherent patients with regards to
demographic variables, including age, gender, family history of hypertension, race,
educational level, and income. A significant association was found between patients had
signit1cantly better adherence if they had an increased daily frequency of doses than
XVII
once daily regimens (p<O.OO 1 ). The linear regressiOn analysis showed that poor
medication adherence was a statistically significant (p<O.O 1) independent predictor of
uncontrolled blood pressure. Uncontrolled blood pressure was also a significant
independent predictor of abnormalities in the lipid profile and glucose levels (p<0.05).
Finally, a significant association \vas found in this cohort between poor adherence to
medication and an increased risk of hospital admission (p<O.OOI). Based on these
results, health care providers should aim to enhance the awareness of patients about the
importance of antihypertensive medications and assess the level of social support to
optimize their adherence to medication. The healthcare provider may tailor more
sensitive interventions programs to suit the unique needs of each patient. They are more
at risk of coronary and cerebrovascular diseases and are more likely to experience
hospital admission. Therefore, medication adherence is one of the crucial mediators
between the aims of medical practice and the ultimate outcome for patients.
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ADHERENCE TO MEDICATION AMONG HYPERTENSIVE