‘PATIENT’S COMPLIANCE TOWARDS ANTIHYPERTENSIVE DRUGS AT HOSPITAL SULTANAH

NORA ISMAIL

PREPARED BY: FILZA NAJIHA BINTI SAMSUDIN & NUR AZIEMAH BINTI MOHD. FAUZI

DIPLOMA IN PHARMACYUNIVERSITY TEKNOLOGY MARA (UiTM)

1

INTODUCTION AIM & OBJECTIVES

LITERATURE REVIEW

METHODOLOGYRESULTSDISCUSSION

REFERENCES CONCLUSION

OUTLINE

INTRODUCTION

Hypertension prevalence is rising across the region and is of growing public health concern in both the developed and developing countries.

The rise in Malaysia over the past 10 years and now affects an estimated 4.8 million Malaysians.

Elevation of the arterial blood pressure above the

normal range expected (120/80mmHg).

May be of unknown cause.

Drugs used include diuretics, ACE inhibitors,

calcium-channel blockers, beta blockers and alpha

blockers.

Can lead to many other related diseases such as

stroke and kidney malfunction.

HYPERTENSION

• Compliance can be defined as taking the correct amount of the prescribed medicine at the proper time

• Cramer et al. (2008) - refers to the act of conforming to the recommendations made by provider with respect to timing, dosage, and frequency of medication taking

• Can be defined as “the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen”.

• Medicine will be effective only when taken as prescribed by the physician

• Medication non-compliance is a failure to take drugs on time in the dosage prescribed, is as dangerous and costly as many other illnesses.Cramer, J.A., Roy, A., Burrel, A. Et al. Medication Compliance And Persistence : Terminology And Definitions. Value Health [online] 2008, 11:45-46. Available

at http://www.ispor.org/workpaper/research_practices/Cramer.pdf [Accessed on July 2012]

LITERATURE REVIEW

• Research from Jurnal Kesihatan Negeri Johor, 2012.• Title : The evaluation of quality of life in hypertensive

patients by using Short Form-36 in the Muar district, Johor.

• Objective : To determine the impacts of quality of life among hypertensive patients using Short Form-36.

• Carried out at the government clinics from 1st November 2010 to 31st January 2011.

• Evaluation : Physical and Mental component.

• Results : Affects more on their physical component compare to mental component.

• Conclusion: The longer the patient suffers from hypertension, the lower will be his or her quality of life either from the physical or mental aspect.

MohdAnuar AR, KhatijahI :. Analysis On Evaluation Of Quality Of Life In Hypertensive Patients By Using Short Form 36 In The Muar District,Johor . JurnalKesihatanNegeri Johor,2012; 10: 13-17.

AIM & OBJECTIVES

• To assess the level of compliance of hypertension patients in Hospital Sultanah Nora Ismail towards antihypertensive drugs.

Aim

• To evaluate the percentage of hypertension patients whom are not comply with the antihypertensive medications.

• To evaluate patient’s main problem regarding non-compliance to their medications.

• To suggest a good strategy to increase patient’s compliance and understanding towards the importance of medication intake

Objectives

METHODOLOGY

Type of study Prospective study

Settings Farmasi Pakar 1 Hospital

Sultanah Nora Ismail

Duration 4 months (20th August 2012 until 19th December

2012)

Sample size 100

• Subjects were enrolled to the study based on the following inclusion and exclusion criteria:

• Subjects will be recruited using convenience sampling.

• Subjects will be required to provide verbal consent to participate in the study.

Inclusion criteria

• Patient who have been diagnosed with hypertension.

• Patient that receive the medication from the Outpatient Pharmacy Department of Hospital Sultanah Nora Ismail.

• Patient who come back for follow up.

Exclusion criteria

• Patient who have a normal blood pressure.

• Paediatric patients.• Warded patients.

DATA COLLECTION :Using self-administered questionnaire

containing three parts :1. Demographics.2. Four questions to assess their compliance.3. Reasons why they are not compliance.

DATA ANALYSIS : SPSS software (version 15.0) Microsoft Excel 2007

RESULTS

DEMOGRAPHIC INFORMATION

Age Number of patients Percentage (%)31-40 2 241-50 18 1851-60 27 2761-70 24 2471-80 20 20>80 9 9

GenderMale 52 52Female 48 48

RaceMalay 52 52Chinese 36 36Indian 12 12Others 0 0

Group of medication Number of patient (percentage (%))

Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor) 6 (6%)β-blocker 5 (5%)Calcium Channel Blocker 8 (8%)Angiotensin-II Receptor Antagonist 3 (3%)β-blocker + Angiotensin Converting Enzyme Inhibitor 9 (9%)β-blocker + Diuretic 3 (3%)Angiotensin Converting Enzyme Inhibitor + Diuretic 3 (3%)Angiotensin Converting Enzyme Inhibitor + Calcium Channel Blocker 6 (6%)

Calcium Channel Blocker + Diuretic 2 (2%)Calcium Channel Blocker + β-blocker 2 (2%)Angiotensin-II Receptor Antagonist + β-blocker + Diuretic 3 (3%)β-blocker + Calcium Channel Blocker + α antagonist 1 (1%)Angiotensin Converting Enzyme Inhibitor + Calcium Channel Blocker + Diuretic

6 (6%)

Calcium Channel Blocker + Diuretic + α antagonist 2 (2%)Calcium Channel Blocker + Diuretic + β-blocker 5 (5%)Angiotensin-II Receptor Antagonist + Calcium Channel Blocker + β-blocker 3 (3%)

Angiotensin-II Receptor Antagonist + Calcium Channel Blocker + Diuretic 5 (5%)

Angiotensin Converting Enzyme Inhibitor +Diuretic + β-blocker 6 (6%)

β-blocker + Calcium Channel Blocker +Angiotensin Converting Enzyme Inhibitor

14 (14%)

Calcium Channel Blocker + Angiotensin Converting Enzyme Inhibitor + α antagonist

2 (2%)

Angiotensin-II Receptor Antagonist + Calcium Channel Blocker + Diuretic+ β-blocker

2 (2%)

Calcium Channel Blocker + Diuretic + β-blocker +Angiotensin Converting Enzyme Inhibitor

4 (4%)

38

17

27

9 9

A B C D E F G0

10

20

30

40

50

60

70

80

90

22.6

59.7

83.9

21

16.119.4

27.4

REASONS FOR NON-COMPLIANT

Reasons

Perc

enta

ge (%

)

Keywords :A : Do not understand the intake of the medicineB :Taking too much medication at same time as antihypertensive drugsC : Forgetfulness /careless to take medicineD : Lack of awareness on the importance of taking healthE : Preferred more to traditional medicineF : Worry about the side effect of the medicine takenG : Time/place constraint to get the medicine

PERCENTAGE OF PATIENTS THAT KNOW THE PRICE OF THEIR MEDICINES

35 %

65 %

PERCENTAGE OF PATIENTS THAT KNOW THE PRICE OF THEIR MEDICINES

yesno

DISCUSSION

Reasons of noncompliance

Taking too much of

medication

Failure to take the

medication

Taking a drug for the wrong

reason

Incorrect time of

administration Hassan NB,C I Hasanah, S B Ismail, K Foong, Li Naing,R Awang,A.Ishak . Identification of psychosocial factors of noncompliance in hypertensive patients. Journal Of Human Hypertension [online] 2005 ;20: 23-29 . Aavailable from http://www.nature.com/jhh/journal/v20/n1/full/1001930a.html [Accessed on 21 Disember 2012]

How to increase the level of compliance?

Pharmacist Physician

PHARMACIST.• Implement the system at community-based

pharmacy.

WHY??• A DIRECT INVOLVEMENT in patient’s treatment

plan.• The OPPORTUNITY TO PROPOSE to the physician

on the best medication regimen patients have to take by changing or altering the patient’s medical regimen under the supervision by the physician.

• The only member of the health care team who has ACCESS to information about all the patient’s drugs.

PHYSICIAN

• Use the SIMPLE LANGUAGE while give the explanation to the patient regarding on their medication.

• A consideration on PATIENT’S OPINION because patient’s themselves are the one who take the medication.

PHYSICIAN + PHARMACIST• DISCUSS - so that the best method

can be implement to improve the patient compliance.

• SHARES their knowledge to improve patient’s care and compliance.

• Ask the patient to buy and use the medication container, make an alarm on their phone as well as, stick a note so that they will not forget or careless to take the medication at the right time.

EXAMPLE OF MEDICATION CONTAINER

ALARM ON PHONE STICKY NOTE

Limitation• Limited budget and number of workforce.• Limited time– We cannot include the warded patient (need a lot

of time to get the approval).

CONCLUSION

• Most or 38% of the respondents at Hospital Sultanah Nora Ismail is compliance towards their medications.

• Only 9% of the respondents is not compliance.• Among those of non-compliant patients, the

main reason for being noncompliance is forgetfulness or careless to take the medication.

• Compliance is important to ensure the goal of the treatment is achieved as medicine will be effective only when taken as prescribed by physician.

REFERENCES

1. Cramer, J.A., Roy, A., Burrel, A. Et al. Medication Compliance And Persistence : Terminology And Definitions. Value Health [online] 2008, 11:45-46. Available at http://www.ispor.org/workpaper/research_practices/Cramer.pdf [Accessed on July 2012]

2. Hammond SL, Lambert BL: Communicating about medications .Directions for research.Health Common. [online] United States: US Ntional Library of Medicine; 2007. Available from http://www.ncbi.nlm.nih.gov/pubmed/21690430 [Accessed November 2012]

3. Hassan NB,C I Hasanah, S B Ismail, K Foong, Li Naing,RAwang,A.Ishak .Identification of psychosocial factors of noncompliance in hypertensive patients.Journal Of Human Hypertension [online] 2005 ;20: 23-29 . Aavailable from http://www.nature.com/jhh/journal/v20/n1/full/1001930a.html [Accessed on 21 Disember 2012]

4. Hayes RB, Taylor DW, SackettDL :Compliancce in health care. John Hopkins University Press Baltimore MD.2010

5. Kyngas, Helvi RN, Lahdenpera. Compliance of patients with hypertension and other associated factors. Journal Of Advanced Nursing [online] 2008; 5: 65-68. Available at http://202.186.179.7/ovidweb.cgi [Accessed November 2012].

6. Marieb EN. Essentials of Human Anatomy and Physiology. San Fransisco : Pearson Benjamin Cummings ; 2009

7. Martin J ed. Jordan B ed.British National Formulary. 61. London : BMJ Group and Pharmaceutical Press ;2011

8. MohdAnuar AR, KhatijahI :. Analysis On Evaluation Of Quality Of Life In Hypertensive Patients By Using Short Form 36 In The Muar District,Johor . JurnalKesihatanNegeri Johor,2012; 10: 13-17.

9. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence [online]. Available at http://www.tcyh.org/medications/downloads/pfizer/MedicationMatters.pdf [Accessed July 2012]

10. Shaun H ,Hypertansion on the rise . [online] Kuala Lumpur : The Star ; 2010. Available from http://thestar.com.my/news/story.asp?file=/2010/1/29/nation/20100129142214&sec=nation [Accessed 8th November 2012].

11. The Oxford Medical Dictionary (2010) vol.5, Oxford: Oxford University Press.

12. Wee HL, Cheung YB, Li Sc. The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life : Is the whole greater than the sum of its parts? Pub Med Central Journal [online] 2005 ; 3:2 .Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC548134/ [Accessed November 2012].

THANK YOU