Comprehensive Patients’ Self-reported Causes of Non-compliance to Antihypertensive Medications in Maiduguri, Nigeria
John David Ohieku *
Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Maiduguri, P.M.B.1069, Maiduguri, Borno State, Nigeria
Jabir Said Suleiman
Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Maiduguri, P.M.B.1069, Maiduguri, Borno State, Nigeria
*Author to whom correspondence should be addressed.
Abstract
Background: Many strategies have been employed to improve compliances to antihypertensive medications but these efforts are not translated into good compliances with several patients leading to high cases of morbidity and mortality. The study probes into the medication compliance of patients in order to guide patient-focussed care.
Aims and Objectives: The objectives of the study are to identify compliance cases, their causes and factors influencing the pattern. The study also assesses the extent to which compliance problems are discussed with health professionals.
Methods: A total of 225 patients comprising 95 males and 130 females on clinic visit were studied. A cross-sectional descriptive design through questionnaires was used. Data were collected over a period of 48 clinic days.
Results: Primary non-compliance such as not filling prescription occurred in 8.0% proportion while non-conforming category of non-compliance such as taking incorrect doses (26.2%), taking medication at the wrong times (53.8%), altering the dosing frequency (19.1%) and failing to follow instructions (7.6%) were similarly identified. However, the major worrisome cases of concern are those showing non-persistence compliance such as stopping medication too soon (19.1%), taking drug holidays without medical advice (3.1%), partial filling of prescription (7.1%) resuming medication only when close to the clinic visits (3.1%). A total of 25 reasons were identified as the causes of non-compliance with forgetfulness accounting for highest (25.8%) followed by unavailability of drugs (16.4%). Perceived wellness and medication side effects were reported in 8.0% and 2.2% cases respectively. About 2.7% and 1.8% cases of unaffordability and perceived ineffectiveness of drugs were reported respectively. Preference for herbal agents (4.4%), drug holidays (3.1%) and incomplete prescription filling (7.1%) among others were similarly identified. Out of the 33 identified reasons for non-compliance, only in about 10 (less than one-third) cases recorded high number of patients above average reporting the problem to experts.
Conclusion: The category of non-compliance involves primary, non-conforming and non-persistent compliances. The reasons for non-compliance vary widely and diverse factors including those of healthcare system related, patients’ behaviour, environmental and socio-economic factors were identified. The patients who reported their compliance problems to health care were below average in all groups of cases.
Keywords: Antihypertensive medications, hypertensive patients, non-compliance, hypertension