Patients and System Related Factors Associated With Non –Adherence to Antihypertensive Medication Among Patients at Chuka Referral Hospital, Kenya

Abstract

Non-adherence to hypertensive medication continues to become contributing factor to hypertensive complications like stroke, heart attacks, kidney disease heart failure Non-adherence prevalence to treatment with antihypertensive is not known but it’s thought to be on the rise. Associated factors of non-adherence are complex, are both internal and external to the patient but are difficult to extrapolate. Reports from Chuka referral hospital records showed that in 2016 there were 140 patients with hypertensive complications from 560 patients who attended the medical clinic that year. A descriptive study design was adopted to guide the implementation of the study. The population comprised of 575 people among them doctors, pharmacists, nurses, record officers and hypertension patients. The respondents were identified through simple random sampling for patients and a sample size of 81 was achieved, and census sampling for health care workers to include doctors, pharmacist, record officers and nurses and a sample size of 10 health care workers was also achieved. Data was collected between the month of April and May 2019. Questionnaire were used as data collection tools for the patients while the interview schedule was conducted to health care providers through an interview guide. Inferential and descriptive statistics were used for data analysis, aided by SPSS version 25. The study revealed a significant negative correlation (𝑟𝑝𝑏=−0.23,𝑝 < 0.05) between age and non-adherence, significant positive correlation with monthly income(𝑟𝑝𝑏=0.24),𝑝 0.04), non-significant relationship between non-adherence and marital status(𝑟𝑝𝑏= −0.13),𝑝=0.25 and patients’ level of education(𝑟𝑝𝑏=−0.06),𝑝=0.57 . 64% of the patients stated that they had missed medication. The overall model of patient related factors were found to be significant (p< 0.05) and these included ,cost of medication, religious beliefs, age of the patient, their education level, preference to traditional medicine, and sociocultural factors. However, it’s only age (p = 0.01), religious beliefs (p = 0.04), and cost of medication (p< .05) that were individually, significant predictors to non-adherence. The overall model of health system related factors were found to be significant (p< 0.05) and this included; quality of health service, physician patient relationship, stock out, health education, and availability of medicine,(p = 0.012) Hypertension medication nonadherence is a major problem at Chuka level five hospital. This was due to lack of funds, time, forgetfulness and patient thinking that they had healed thus continuous follow ups to improve adherence, positive reinforcement to increase motivation in order to address forgetfulness, and supply of constant and subsidized hypertensive drugs to the hospital is necessary to prevent patients from missing the drug. There is need for a continuous supply of hypertension to the hospital to prevent patients from missing the drugs especially those who cannot afford to purchase them from private chemists. There is need to reduce out of pocket payment through establishment and strengthening of the community health insurance scheme. The study recommends that the hospital should set aside some resources for making patients’ follow ups especially those treated and left to go home, discussions be made with patients on severity of non-adherence and importance of adherence, use of positive reinforcement to increase motivation and mechanism to be put in place to subsidize the cost of medication. vii