Medication adherence and associated factors among elderly hypertension patients with uncontrolled blood pressure in rural area, Northeast Thailand

Costs of the HEARTS hypertension program in primary care in Lampang province, Thailand

BACKGROUND

In 2020, a pilot program for hypertension control was initiated in primary care facilities in Lampang Province, Thailand. The program followed the framework of the HEARTS program for standardized hypertension treatment, but the financial costs of the program are not well understood. This study evaluates the costs of the HEARTS approach compared to usual care to inform future scale-up efforts of the program.

METHODS

Cost data were collected and analyzed using the HEARTS costing tool, a Microsoft Excel-based tool that supports activity-based costing of the HEARTS program from the health system perspective. Three scenarios were considered: usual care, the HEARTS regimen using standardized hypertension treatment with single-agent pills, and a sub-scenario of the HEARTS regimen using single-pill dual-drug combination pills. Costs are estimated as annual costs from the health system perspective in all Lampang primary care facilities.

RESULTS

For the usual care scenario, the HEARTS single-pill scenario, and the HEARTS combination-pill sub-scenario, the average annual medication cost per treated patient was USD 14.0 (THB 485), USD 13.8 (THB 479), and USD 14.3 (THB 497), respectively. Total program cost per primary care user was USD 13.6 (THB 472.7), THB USD 14.3 (494.5), and USD 14.4 (THB 499.9) across the three scenarios, respectively. The largest program cost driver (45-47% across the examined scenarios) was attributed to a comprehensive package of laboratory tests applied to all hypertension patients. Hypothetically, reducing test coverage from all hypertension patients (27% of primary care users) to 15% of primary care users (corresponding to the proportion of patients aged 65+) would reduce program cost per user from USD 14.3 to USD 12.0 in the HEARTS combination-pill scenario.

CONCLUSIONS

Compared to usual care, HEARTS implementation costs include additional costs for staff training, which are balanced by lower medication expenditures using the HEARTS standardized regimen with single-agent pills. The HEARTS regimen using dual-drug combination pills was estimated to be slightly more costly due to the higher price of combination pills. Optimizing coverage of diagnostic tests and lowering the purchasing prices of combination-pill medicines are key areas for cost reduction in future scale-up efforts.

Projected Cost Savings With Optimal Medication Adherence in Patients With Cardiovascular Disease Requiring Lipid-Lowering Therapy: A Multinational Economic Evaluation Study

BACKGROUND

Poor adherence to chronic cardiovascular treatments can impede targeted clinical outcomes. This study estimates the potential benefits of improving adherence among patients with cardiovascular disease requiring secondary prevention in Mexico, Thailand, and China.

METHODS AND RESULTS

We performed Markov model simulation for patients with cardiovascular disease in 3 countries from health care and societal perspectives over a lifetime horizon. Two scenarios were compared: (1) optimal adherence based on a meta-analysis of 51 randomized controlled trials and (2) status quo. The association between adherence and cardiovascular disease outcomes derives from a dose-response meta-analysis of 4 051 338 patients. Outcomes include the accumulated number of cardiovascular events and associated costs in 2022 US dollars, life years, and quality-adjusted life years. Optimal adherence could prevent 42 (95% credible interval [CrI], 29-56) cardiovascular events in Mexico, 34 (95% CrI, 24-50) in Thailand, and 63 (95% CrI, 43-89) in China per 1000 patients over a lifetime. Incremental effectiveness per patient was 0.60 (95% CrI, 0.47-0.74) life-years in Mexico, 0.68 (95% CrI, 0.37-0.94) quality-adjusted life years in Thailand, and 0.93 (95% CrI, 0.44-1.27) quality-adjusted life years in China. Cost savings from societal perspective amounted to $412 (95% CrI, $211-$723), $316 (95% CrI, $187-$541), and $700 (95% CrI, $355-$1144) per patient for Mexico, Thailand, and China, respectively. Findings remained cost saving in deterministic and probabilistic sensitivity analyses.

CONCLUSIONS

Achieving optimal adherence in patients with cardiovascular disease requiring lipid-lowering therapy saves costs and improves health outcomes in Mexico, Thailand, and China. These findings support national health care systems implementing strategies to improve adherence in these countries.

Warfarin Adherence and Its Associated Factors in Thai Older Adults with Atrial Fibrillation

Introduction

Older people mostly found unable to adhere with warfarin treatment guidelines. The health service system is challenged in order to improve medication adherence in older population under limited health resources. The purpose of this study was to explore health systems factors on warfarin adherence in older population, particularly in resources constraint setting.

Methods

This study was a cross-sectional predictive study that enrolled older people who experienced atrial fibrillation (AF) and treated by warfarin, aged 60 years and over, and followed up at the warfarin clinic.

Results

A total of 197 participants with the mean age of 72.03 years (SD = 8.84) was recruited. Almost of them (85.8%) reported adhered to warfarin prescription. More than a half (60.5%) were able to report their targeted INR. Participants who stayed with the family had 5.54 times (95% CI 1.79-19.33), took regular daily dose warfarin had 5.07 times (95% CI 1.05-24.49), perceived targeted INR had 2.94 times (95% CI 1.04-8.29), and received family support had 1.33 times (95% CI 1.11-1.60) increased odds of warfarin adherence than those who did not. Participants who perceived a barrier to taking medication had 0.93 times decreased odds of warfarin adherence than those who did not (95% CI 0.86-0.99).

Conclusion

Healthcare system should encourage family to support the older population with AF in order to increase warfarin adherence. Future research should develop intervention combining family support to promote warfarin adherence.

Examining the relationship between depression and medication adherence among elderlies suffering from cardiovascular disease referring to the clinics affiliated with Kermanshah University of Medical Sciences: A cross-sectional study

Background

In recent years, around 30% of all mortalities worldwide has been related to cardiovascular disease (CVD). The most important predictor solution of cardiovascular events is enhancing medication adherence. Meanwhile, the main reason behind development of physical disorders among the elderly is depression. In this regard, the present research was performed to determine the relationship between depression and medication adherence among the elderly suffering from CVD.

Methods

A cross-sectional study was done via an analytical approach on 188 elderlies fulfilling the inclusion criteria. The participants were chosen through convenience nonrandomized sampling from March to July 2022. The data were collected through demographic and healthcare information form plus Madanloo chronic disease medication adherence and geriatric depression scale. The analysis of the data was done by SPSS 26 plus Stata 14.2.

Results

The mean depression score was 5.6(4.3) and the mean score of medication adherence in the elderlies was 168.03(23.85). The prevalence of depression was higher in women than in men (p = 0.015), and the elderlies differing from heart failure reported the minimum extent of medication adherence. The findings obtained from analysis of variance showed that age, level of education, and monthly level of income were among the effective demographic factors in the extent of depression and medication adherence (p < 0.05). Meanwhile, 26% of changes in medication adherence can be attributed to depression. Further, the results of the multiple linear regression model reported that depression, age, and polypharmacy are among the predictors of medication adherence.

Discussion and Conclusion

A weak to moderate relationship existed between depression and medication adherence among these elderlies. Given the growing elderly population, the importance of depression, and lack of medication adherence in incidence of CVD events, it is recommended to train the healthcare team to monitor the elderly regarding depression symptoms.

Equipping pharmacists for delivering pharmaceutical care to seniors: a qualitative systematic review of Asian seniors' social support

BACKGROUND

Pharmacists must cater to seniors' needs and communicate better in delivering pharmaceutical care. However, pharmaceutical care for seniors is unique since they commonly depend on support from their social environment. Our study aimed to collect perceptions and experiences of Asian seniors regarding social support.

METHODS

A qualitative systematic review of peer-reviewed articles between January 2012 and January 2022 was conducted using PubMed, Scopus, Academic Search Complete via EBSCOhost, ProQuest, and Google Scholar. Selected studies were extracted, and thematic synthesis was performed.

RESULTS

A total of 23 qualitative studies with diverse rigor were included in this review. Themes that emerged around perceptions and experiences of social support were (1) family orientation, (2) having faith in religion, (3) the importance of the elderly providing support, (4) taboos, (5) elderly self-reliance, (6) elderly fear of being a burden, and (7) differences on perceptions and experiences regarding social support. A discussion on how these results may contribute to pharmacy practice is provided.

CONCLUSION

This study reviews the available social support for seniors and highlights its importance for pharmacists.

What Do Seniors Believe About Medication Adherence? A Qualitative Study Among Seniors with Chronic Conditions in Yogyakarta, Indonesia

Purpose

This qualitative study elicited beliefs about medication adherence among hypertensive seniors with polypharmacy.

Methods

Twenty-one participants aged 60 or older with hypertension and other chronic conditions, with or without their family caregivers, residing surrounding Yogyakarta province, using five medicines or more routinely, were semi-structuredly interviewed by one researcher or one research assistant in January to April 2022. Behavioral, normative, and control beliefs were elicited using an interview guideline which was developed based on the Theory of Planned Behavior approach. Thematic analysis was applied.

Results

The participants believed that taking medicines routinely was advantageous because the medicines kept their body in good condition and prevented disease worsening. However, there were concerns about the medications' harmful effects on kidneys, gastric, and the whole body, and that the medicines would not be effective anymore. Prescribers, family, and friends would likely approve of medication adherence. However, non-prescriber doctors, family, and neighbors, mainly those with experience with complementary/alternative medicines, would likely disapprove of medication adherence. Good physical and cognitive function, help from family and technology, mealtime regularity, a simple regimen and easy-to-read medication labeling, and good communication with prescribers were among the facilitators of medication adherence. Physical and cognitive decline, mealtime irregularity, tablets that must be cut before taken, insurance that does not cover all medicines, change in dosage regimen, and hard-to-tear-off medication packaging were among the barriers to medication adherence.

Conclusion

Understanding these beliefs yields insights into the health communication approaches to improving seniors' medication adherence.

2022 Renal denervation therapy for the treatment of hypertension: a statement from the Thai Hypertension Society

Hypertension remains a significant risk factor for major cardiovascular events worldwide. Poor adherence to treatment is extremely common in clinical practice, leading to uncontrolled hypertension. However, some patients with resistant hypertension still have uncontrolled blood pressure despite good medical compliance. A specific group of patients also develop adverse reactions to many blood pressure-lowering medications. These scenarios indicate that innovative strategies to lower blood pressure in challenging cases of hypertension are needed. The blood pressure-lowering efficacy of catheter-based renal denervation therapy to decrease sympathetic tone has been confirmed in many publications in recent years. Apart from both the invasiveness and the expensiveness of this technology, appropriate case selection to undergo this procedure is still developing. The utilization of renal denervation therapy for hypertension treatment in Thailand has lasted for 10 years with a good response in most cases. Currently, only certain interventionists at a few medical schools in Thailand can perform this procedure. However, more physicians are now interested in applying this technology to their patients. The Thai Hypertension Society Committee has reviewed updated information to provide principles for the appropriate utilization of renal denervation therapy. The blood pressure-lowering mechanism, efficacy, suitable patient selection, pre- and postprocedural assessment and procedural safety of renal denervation are included in this statement.

Understanding perspectives on health-promoting behaviours among older adults with hypertension

Purpose

Health-promoting behaviours (HPBs) are considered the key to determining health among older adults with hypertension. Increasing our understanding of older adults’ views on HPBs could facilitate the development of interventions aimed at improving their quality of life. This study aims to describe the perceptions of older adults with high blood pressure concerning their HPBs and associated factors.

Methods

Semi-structured interviews with 40 individuals in Thailand were used to collect the data, which were analysed using thematic analysis.

Results

The results were categorized into five main themes related to personal, social, and environmental factors. Older adults explained that their experiences with HPBs involve taking responsibility for controlling blood pressure by following a doctor’s prescription, modifying their lifestyles to be healthier, sustaining social relationships, and experiencing spiritual growth through religious practices for inner peace. Older adults also identified environmental factors that influenced their engagement in HPBs depending on their residential areas.

Conclusions

The findings of this study highlight the importance of practices in which professionals support and encourage older adults to perform HPBs to maintain health and improve their well-being.

Medication use problems among older adults at a primary care: A narrative of literature review

Appropriate medication use is one of the most significant challenges among the older population. Although medication use problems are well documented at the secondary and tertiary health care level, the evidence at the primary care level of OECD region is limited. A narrative review of existing literature was conducted through a nonsystematic search for original articles through electronic search databases, Ovid Medline, Google Scholar from 2001 to 2021, and a combination of citation references. Medication use problems are prevalent in older adults at the primary care level. The main issues of medication use identified were as follows; nonadherence, adverse drug events, accessibility, polypharmacy, inappropriate medications, belief about medications, lack of knowledge and awareness, and lack of deprescribing. In addition, the current review has identified the possibilities of the problems: many medications, forgetfulness, lack of deprescribing, lack of communication, poor understanding, and limited awareness of inappropriate medications. This review found that various medication use problems subclusters were identified to impact the health care need among older adults. Therefore, effective interventions targeting these issues need to be developed to reduce medication use problems among older adults at a primary care level.

Association of adherence measured by self-reported pill count with achieved blood pressure level in hypertension patients: a cross-sectional study

Background

Medication adherence plays an essential role in controlling blood pressure to reduce morbidity and mortality of hypertension disease. Thus, this study aimed to determine the association of medication adherence measured by self-reported pill count with blood pressure levels among patients at several community health centers in Surabaya.

Methods

Adherence was assessed using the pill count method by comparing the total number of antihypertension drugs taken with the prescribed drugs. The inclusion criteria involved hypertensive patients who received antihypertension drugs, specifically adults and elderly, except the pregnant woman. The patient blood pressure was measured by healthcare workers in the targeted community health centers. Descriptive and multivariable logistic regression analyses were performed to assess factors associated with medication adherence with blood pressure levels.

Results

A total of 264 hypertensive outpatients participating in this study, 77.65% of participants were adherent to antihypertensive drugs based on the pill count method, and 40.91% of participants had controlled blood pressure. Patients with uncontrolled blood pressure were about six times (adjusted odds ratio [AOR]: 6.15; 95% confidence interval [CI]: 2.694–14.039; P = 0.000) more likely to have non-adherent medication than patients with controlled blood pressure. Reciprocally, non-adherent participants (pill count < 80%) were about six times (AOR: 6.081; 95% CI: 2.672–13.838; P = 0.000) more likely to have uncontrolled blood pressure compared to adherent patients (pill count ≥ 80%). Age less than 40 years old (AOR: 5.814; 95% CI: 1.519–22.252; P = 0.01) and having middle school educational level (AOR: 0.387; 95% CI: 0.153–0.974; P = 0.045) were found to be independent factors associated with uncontrolled blood pressure.

Conclusions

The result showed that non-adherence to antihypertension drugs is associated with uncontrolled blood pressure. Then, age could be associated with uncontrolled blood pressure. Thus, pharmacists and other healthcare providers should pay attention to improving medication adherence and maintaining the controlled blood pressure.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40885-022-00195-5.

Preoperative predictors of poor outcomes in Thai patients with aneurysmal subarachnoid hemorrhage

Objective

A scoring system for aneurysmal subarachnoid hemorrhage (aSAH) is useful for guiding treatment decisions, especially in urgent-care limited settings. This study developed a simple algorithm of clinical conditions and grading to predict outcomes in patients treated by clipping or coiling.

Methods

Data on patients with aSAH hospitalized in a university’s neurovascular center in Thailand from 2013 to 2018 were obtained for chart review. Factors associated with poor outcomes evaluated at one year were identified using a stepwise logistic regression model. For each patient, the rounded regression coefficients of independent risk factors were linearly combined into a total score, which was assessed for its performance in predicting outcomes using receiver operating characteristic analysis. An appropriate cutoff point of the scores for poor outcomes was based on Youden’s criteria, which maximized the summation between sensitivity or true positive rate and the specificity or true negative rate.

Results

Patients (n, 121) with poor outcomes (modified Rankin Scale, mRS score, 4–6) had a significantly higher proportion of old age, underlying hypertension, diabetes and chronic kidney disease, high clinical severity grading, preoperative rebleeding, and hydrocephalus than those (n, 336) with good outcomes (mRS score, 0–3). Six variables, including age >70 years, diabetes mellitus, World Federation of Neurosurgical Societies (WFNS) scaling of IV-V, modified Fisher grading of 3–4, rebleeding, and hydrocephalus, were identified as independent risk factors and were assigned a score weight of 2, 1, 2, 1, 3 and 1, respectively. Among the total possible scores ranging from 0–10, the cut point at score 3 yielded the maximum Youden’s index (0.527), which resulted in a sensitivity of 77.7% and specificity of 75.0%.

Conclusion

A simple 0–10 scoring system on six risk factors for poor outcomes was validated for aSAH and should be advocated for use in limited resource settings.

Factors Affecting Quality of Life among Older Adults with Hypertension in Urban and Rural Areas in Thailand: A Cross-Sectional Study

This study explored factors affecting quality of life in older adults with hypertension by comparing those living in urban and rural areas. A cross-sectional study was conducted on 420 older adults living in urban and rural areas in Thailand. Data were collected using the WHOQOL-OLD and Health-Promoting Lifestyle Profile-II tools, which measured quality of life and health-promoting behaviors among the participants. Older adults in urban areas had higher quality of life scores than those in rural locations. Health-promoting behaviors significantly predicted higher quality of life for all residents. A high perceived health status predicted increase of quality of life in urban residents, whereas the presence of comorbidity effects decreased quality of life. A longer hypertension duration predicted higher quality of life in rural residents. These findings suggest that healthy behaviors and self-management interventions are critical to improve quality of life in older Thai adults with hypertension.

Transtheoretical model on the self-care behavior of hypertension patients: a systematic review

Purpose

This review aims to describe the effectiveness of education with the transtheoretical model (TTM)-based on the self-care behavior of hypertension patients.

Design/methodology/approach

A systematic literature search was carried out on four databases: PubMed, Science Direct, Cochrane and Grey literature to identify studies reported in English which were published in the last ten years. The literature search was conducted from November 13 to December 10, 2020.

Findings

Based on the six studies that have been analyzed, TTM is effective in changing the stage of change and behavior of hypertension patients. These behavioral changes have an impact on the patient's controlled blood pressure. Various types of TTM-based educational interventions can be used, but the tailored behavior intervention is the most appropriate one with a minimum intervention duration of six months. Educational intervention is carried out through combine counseling and education using electronic media.

Originality/value

This review presents the effectiveness of transtheoretical-based health education in changing the self-care behavior of hypertension patients accompanied by evidence-based on its implementation. There is a high and unclear risk of bias on several items influence this systematic outcome. Nevertheless, this review can still provide an overview of the effectiveness of education based on the TTM in hypertension patients about the quality results of the reviewed studies.

Readmission after hospitalization for heart failure in elderly patients in Chapidze Emergency Cardiology Center, Georgia

Purpose

Heart Failure (HF) is one of the leading mortality causes in elderly people. The purpose of this study is to assess readmission rates and reasons in elderly patients with HF.

Design/methodology/approach

The authors explored medical records of elderly patients with HF (75 years and more) at Chapidze Emergency Cardiology Center (Georgia) from 2015 to 2019. The authors analyzed the structure of the cardiovascular diseases and readmission rates of hospitalized patients with HF (I50, I50.0 I50.1). A multivariate logistic regression model was used to identify factors, associated with readmission for any reason during 6–9 months after the initial hospitalization for HF.

Findings

The major complication of cardiovascular diseases in elderly patients is HF (68.6%). Hospitalization rates due to HF in elderly patients have increased in recent years, which is associated with the population aging process. This trend will be most likely continue. Despite significant improvements in HF treatment, readmission rates are still high. HF is the most commonly revealed cause of readmission (48% of all readmissions). About 6–9 months after the primary hospitalization due to HF, readmission for any reason was 60%. Patients had concomitant diseases, including hypertension (43%), myocardial infarction (14%), diabetes (36%) and stroke (8%), affecting the readmission rate.

Originality/value

HF remains an important problem in public health. During HF-associated hospitalizations, both cardiac and non-cardiac conditions should be addressed, which has the potential for health problems and disease progression. Some readmissions may be prevented by the proper selection of medicines and monitoring.

Effectiveness of a Multidisciplinary Approach Intervention to Improve Blood Pressure Control Among Elderly Hypertensive Patients in Rural Thailand: A Quasi-Experimental Study

Purpose

Uncontrolled blood pressure among Thai elderly hypertensive patients is a significant public health issue in primary health care facilities under the Universal Health Coverage Scheme in Thailand. This study examines the effectiveness of a multidisciplinary approach intervention to improve blood pressure control among elderly persons in rural Thailand.

Patients and Methods

This was quasi-experimental study conducted on 200 elderly persons who receive care for hypertension at primary health care facility in rural areas of Thailand. Participants were assigned to either the intervention or control groups. The intervention group was subjected to a multidisciplinary approach intervention program. This program included community-based care for hypertension, family-supportive care for hypertension, antihypertension medication adherence education program, the use of a reminder electronic pill box, and monthly pill counts and blood pressure measurements. The intervention continued for three months. The control group received care for hypertension at the hypertension clinic of the health center. Three measurements were taken at baseline, one month, and three months after the intervention. Data analysis included descriptive statistics and independent sample t-tests. Repeated-measure analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were used to compare the differences between the two groups.

Results

At one month and three months after the intervention, the multidisciplinary approach intervention controlled blood pressure more effectively compared with the control group. Furthermore, the intervention group had lower systolic and diastolic blood pressure compared with the control group (P-value < 0.001).

Conclusion

These results suggest that the multidisciplinary approach intervention can be effective in controlling blood pressure in elderly hypertensive patients. Future studies should investigate a cost-effective means of integrating multidisciplinary approach interventions in routine hypertension care for elderly hypertensive patients.