Directorate of Central Health Establishments, Prime Minister's Health Complex, National Institutes of Health Premises, Islamabad, Pakistan (
Pakistan Health Research Council, National Institute of Health, Islamabad, Pakistan.
Prev Chronic Dis. 2023 May 25;20:E42. doi: 10.5888/pcd20.220231.
Medication nonadherence leads to poor health outcomes, frequent complications, and high economic impact. Our objective was to assess the determinants of adherence to medication regimens among patients with hypertension.
We conducted a cross-sectional study of patients with hypertension attending the cardiology clinic of a tertiary care hospital in Islamabad, Pakistan. Data were collected by using semistructured questionnaires. A score of 7 or 8 on the 8-item Morisky Medication Adherence Scale was classified as good adherence, 6 as moderate, and less than 6 as nonadherence. Logistic regression was performed to determine covariates associated with medication adherence.
We enrolled 450 patients with hypertension (mean age, 54.5 y; SD, 10.6). Medication adherence was good among 115 (25.6%) patients and moderate among 165 (36.7%); 170 (37.8%) patients were nonadherent. Most patients (72.7%) had uncontrolled hypertension. Nearly half (49.6%) were unable to afford monthly medication. In bivariate analysis, nonadherence was associated with female sex (odds ratio [OR], 1.44; P = .003) and long waiting times in the health care facility (OR, 2.93; P = .005); the presence of comorbidities (OR, 0.62; P = .01) was associated with good adherence. In multivariate analysis, nonadherence was associated with unaffordability of treatment (OR, 2.25; P = .002) and uncontrolled hypertension (OR, 3.16; P < .001). Good adherence determinants included adequate counseling (OR, 0.29; P < .001) and education (OR, 0.61; P = .02).
Addressing identified barriers, including medication affordability and patient counseling, should be included in Pakistan's national policy on noncommunicable disease.
药物不依从会导致健康状况不佳、频繁出现并发症和经济负担加重。本研究旨在评估高血压患者药物治疗依从性的决定因素。
我们对在巴基斯坦伊斯兰堡一家三级医院心内科就诊的高血压患者进行了横断面研究。数据通过半结构式问卷收集。Morisky 药物依从量表的 8 项中得分为 7 或 8 分被归类为依从性良好，6 分为中等，小于 6 分为不依从。采用 logistic 回归分析确定与药物依从性相关的协变量。
我们纳入了 450 例高血压患者（平均年龄 54.5 岁，标准差 10.6 岁）。115 例（25.6%）患者药物依从性良好，165 例（36.7%）患者药物依从性中等；170 例（37.8%）患者药物不依从。大多数患者（72.7%）血压未得到控制。近一半（49.6%）患者无法负担每月的药物费用。在单因素分析中，女性（比值比 [OR]，1.44；P =.003）和在医疗保健机构等待时间较长（OR，2.93；P =.005）与不依从相关；共存疾病（OR，0.62；P =.01）与良好的依从性相关。在多因素分析中，无法负担治疗费用（OR，2.25；P =.002）和血压未控制（OR，3.16；P <.001）与不依从相关。良好依从性的决定因素包括充分的咨询（OR，0.29；P <.001）和教育（OR，0.61；P =.02）。
应将确定的障碍，包括药物可负担性和患者咨询，纳入巴基斯坦的非传染性疾病国家政策中。
