Blood pressure—lowering medication prescribing, its adherence to guidelines and relationship with blood pressure control at a family medicine department

Background

In many resource‐constrained countries, control of blood pressure (BP) is low. Antihypertensive drug prescribing practices may influence BP control. However, adherence of prescribing to treatment guidelines may not be optimal in resource‐constrained settings. The aim of this study was to evaluate the pattern of blood pressure‐lowering medication prescribing, and how it adheres to treatment guidelines, and to identify the relationship between medication prescriptions and BP control.

Methods

It was a cross‐sectional study of hypertensive outpatients at the Korle Bu Teaching Hospital (KBTH) Family Medicine department (FMD)/Polyclinic. Data was collected with a validated structured form. Adherence of “prescribing” to recommendations of the 2017 Standard Treatment Guidelines of Ghana and 2018 European Society of Cardiology guidelines was assessed using a composite measure. We analyzed data with SPSS.

Results

About 81% (247/304) of patients received two or more antihypertensive drugs. Most patients (41%; 267/651) received calcium channel blockers (CCB), and 21.8% (142/651), 15.7% (102/651) and 12.7% (83/651) were on diuretics, angiotensin‐receptor blockers (ARBs) and angiotensin converting enzyme (ACE) inhibitors respectively. CCB plus RAS inhibitor (50%) was the most prescribed two‐drug combination. Number of BP drugs per patient had a statistically significant inverse relationship with BP control (beta Coefficient = –0.402; 95% Cl: 1.252–2.470; p = 0.015). The composite adherence score was 0.73 (moderate adherence) but Single‐pill combination (SPC) was poor (3.2%; n = 8).

Conclusion

Most patients received multiple‐pill combination treatment, and overall adherence to guidelines was suboptimal, largely owing to complex drug therapy. Number of drugs predicted BP control. Our findings suggest a need to prioritize simplified treatment, and implement other strategies to improve hypertension guideline adherence. Further research on the influence of SPC on BP control may inform future hypertension guidelines in Ghana and elsewhere in Africa.

Drug‐related problems among hospitalized hypertensive and heart failure patients and physician acceptance of pharmacists' interventions at a teaching hospital in Ghana

Background

Hypertensive and heart failure patients frequently require multiple drug therapy which may be associated with drug‐related problems (DRPs).

Aim

To determine the frequency, types, and predictors of DRPs, and acceptance of pharmacists' interventions among hospitalized hypertensive and heart failure patients.

Method

It was a prospective cross‐sectional study at the internal medicine department wards of Korle Bu Teaching Hospital (KBTH) between January and June 2019 using a validated form (the pharmaceutical care form used by clinical pharmacists at the medical department). DRPs were classified based on the Pharmaceutical Care Network Europe (PCNE) Classification scheme for DRPs V8.02. Descriptive and inferential statistics were used for data analysis.

Results

A total of 247 DRPs were identified in 134 patients. The mean number of DRPs was 1.84 (SD: 1.039) per patient. Most DRPs occurred during the prescribing process (40.5%; n(DRPs) = 100), and the highest prescribing problem was untreated indication (11.7%; n = 29). Other frequent DRPs were medication counseling need (25.1%; n = 62), administration errors 10.1%(n = 25), drug interaction (10.5%; n = 26), and “no” or inappropriate monitoring (10.5%; n = 26). The number of drugs received significantly predicted the number of DRPs (adjusted odds ratio [AOR]: 9.85; 95% CI: 2.04–47.50; p < 0.001). Clinical variables were significant predictors of number of DRPs (diabetic status: AOR: 0.41, 95% CI: 0.18–0.98, p < 0.05; statin use: AOR: 0.34, 95% CI: 0.14–0.81, p < 0.05; antiplatelet use: AOR: 5.95, 95% CI: 2.03–17.48, p < 0.01). Average acceptance of interventions by physicians was 71.6% (SD: 11.7). Most (70.6%; n = 48) accepted interventions were implemented by physicians (resolved).

Conclusion

DRPs frequently occur, with most problems identified in the prescribing process. Medication counseling was frequently needed. Patients' number of drugs and clinical factors predicted the occurrence of DRPs. Physicians accepted and implemented most interventions. Our findings suggest that clinical pharmacists have an important role in cardiovascular patient care, but this study should be replicated in other hospitals in Ghana to corroborate these findings.

Evaluation of a pharmacist-led hypertension preventative and detection service in the Ghanaian community pharmacy: an exploratory study

OBJECTIVES

The objective of the study was to explore the feasibility and acceptability of a pharmacist-led hypertension preventative service in the community pharmacy.

METHODS

This was an exploratory uncontrolled pre-post intervention study conducted from February 2012 - March 2013 in three community pharmacies in Ghana. Clients at risk for hypertension were identified and screened by the Medicine Counter Assistant (MCA). Those whose blood pressure was above 140/90 (stage 1 and 2 hypertension) were referred to the pharmacist for further assessment and referral to the physician as necessary. Participant awareness of risk and changes in the lifestyle was assessed at baseline and 6-month follow-up respectively.

KEY FINDINGS

Out of 250 clients approached, 170 agreed to be screened. Forty three (25%) were pre-hypertensive, 42 (25%) had stage 1 hypertension and 13 (8%) had stage 2 hypertension. The most frequent modifiable risk factors identified were lack of exercise 107 (63%), poor diet (42%) and obesity (21%). Lifestyle changes reported at 6 months by participants with pre-hypertension were weight reduction and reduced alcohol intake. Of the 34 participants who were referred to the physician, 10 (29%) were diagnosed with hypertension and an antihypertensive was prescribed.

CONCLUSIONS

Hypertension preventative services offered in the Ghanaian community pharmacy are acceptable to clients. The findings suggest that pharmacists can detect hypertension and promote some lifestyle changes among clients with pre-hypertension. A larger controlled study is needed to confirm these findings. Ultimately guidelines and polices to streamline these services would be needed if such services were made routinely available in community pharmacies in Ghana.