Blood Pressure Control, Accessibility, and Adherence to Antihypertensive Medications: Patients Seeking Care in Two Hospitals in the Ashanti Region of Ghana

Abstract

Hypertension is the second leading cause of death in Ghana, partly accounting for two-thirds of all medical admissions and more than 50% of deaths. This study aimed to comparatively evaluate adherence and accessibility to antihypertensive medications at two different levels of healthcare facilities in Kumasi, Ghana, and determine factors associated with medicine accessibility and adherence. A cross-sectional study involving outpatient department (OPD) hypertensive patients, 143 at KNUST Hospital (UHS) and 342 at Komfo Anokye Teaching Hospital (KATH), was conducted using a semistructured questionnaire. Correlations were drawn to evaluate the effect of accessibility and adherence on blood pressure control. A face-to-face interview was also conducted with relevant stakeholders involved in procurement of medicines. Blood pressure was uncontrolled in 50.4% (n = 72) of participants at UHS and 52.9% (n = 181) at KATH. With respect to medicine accessibility, 98.8% (n = 338) and 42.9% (n = 61) received at least one medication from the hospital pharmacy of KATH and UHS, respectively. Using MARS-10, 49.2% (n = 70) and 52.9% (n = 181) were nonadherent in UHS and KATH, respectively. There was a significant association between adherence and BP control at both UHS ( p = 0.038 ) and KATH ( p = 0.043 ). At UHS, there was a significant association between accessibility to medicines at the hospital and BP control ( p = 0.031 ), whilst at KATH, no significant association was observed ( p = 0.198 ). Supply chain practices and delays in payment by the NHIA affected accessibility to antihypertensive medications. Blood pressure control was inadequate among participants in both facilities. Accessibility to medicines was better at the tertiary facility compared to the secondary facility. Increased accessibility and adherence to antihypertensives were related to blood pressure control in both facilities. Good supply chain practices and prompt payment by the National Health Insurance Authority would enhance accessibility to antihypertensive medications.

Health System Determinants of Hypertension Care and Outcomes in Sub-Saharan Africa: A Systematic Review

“…The effect of patients’ access to hypertension care on hypertension outcomes was explored in 38% (15/39) of the included studies within seven SSA countries [34, 35, 37, 38, 47, 48, 50–52, 54, 58, 63, 64, 66, 67]. The general trend was that the lower cost of care was significantly associated with better hypertension outcomes.…”

“…A quarter (10/39) of the studies [36, 39–41, 48, 49, 55, 66, 67, 69] across eight countries explored the availability of equipment and consumables involved in hypertension management and impact on BP outcomes. The procurement of drugs and consumables and improvement in the supply chain implemented in the experimental studies and quality improvement project was in combination with other interventions such as providers’ training in Cameroon, Kenya, and Zambia [36, 39, 40], and better data management in Botswana [69].…”

“…While the decentralization of care might address geographic barriers to hypertension care access, other factors of accessibility such as cost of care and time of services require additional and potentially different interventions. Extensively, the current and previous literature have shown that the high direct and indirect costs of care hamper patients’ use of health services and lead to poor health outcomes and among patients with hypertension, poor blood pressure control [54, 66, 90]. The time of operation of clinics, though limited evidence exists, has an impact on the staffing hence the long queues of patients at the in- and outpatient departments which discourages patients’ attendance to their appointments and encourages loss to follow-up [67, 91, 92].…”

“…It is crucial to ensure that the detachment of hypertension care from the general outpatient department or from the well-equipped hospital does not hamper the patients' initiation on hypertension treatment through the internal transfer processes and that patients with hypertension continue to receive holistic care for other health problems they might have in addition to hypertension. poor health outcomes and among patients with hypertension, poor blood pressure control [54,66,90]. The time of operation of clinics, though limited evidence exists, has an impact on the staffing hence the long queues of patients at the in-and outpatient departments which discourages patients' attendance to their appointments and encourages loss to follow-up [67,91,92].…”

“…Nineteen cross-sectional studies were conducted in Ethiopia (n=3) [50][51][52], Nigeria (n=2) [53,54], Botswana (n=1) [55], Democratic Republic of Congo (n=1) [56], Swaziland now called Eswatini (n=2) [57,58], Namibia (1) [59], South Africa (n=3) [60][61][62], Ghana (n=4) [63][64][65][66] , Kenya (n=2) [67,68]. We additionally identified one quality improvement report from Botswana [69].…”