The Effectiveness of Structured Pharmaceutical Education on Medication Adherence and Blood Pressure Control Among Hypertensive Patients at The Prafi Health Center

Baiq Suryaningsih

Authors

Baiq Suryaningsih 1Program Magister Kesehatan Masyarakat,Fakultas Ilmu Kesehatan,Universitas Kadiri,Kediri

Keywords:

blood pressure, hypertension, pharmaceutical education, primary care, therapy adherence

Abstract

Hypertension is a chronic disease with a high prevalence and is at risk of causing cardiovascular complications if not optimally controlled. One of the main factors of therapy failure is the patient's low adherence to taking antihypertensive drugs. Pharmaceutical personnel have a strategic role in improving compliance through structured education. This study aims to evaluate the effectiveness of structured pharmaceutical education on therapeutic adherence and blood pressure control in hypertensive patients at the Prafi Health Center, Manokwari.The study used a quasi-experimental design with a one-group pre-test and post-test approach in 48 hypertensive patients who met the inclusion criteria. The intervention was in the form of structured individual pharmacy counseling accompanied by educational leaflets. Measurements of adherence and blood pressure were taken before the intervention and four weeks after the intervention. The analysis used a paired t-test with a significance level of p < 0.05 and an effect size calculation (Cohen's d). The study used a quasi-experimental one-group pretest–posttest design involving 48 hypertensive patients who met the inclusion criteria. The sample was selected using a purposive sampling technique from patients who were diagnosed with hypertension, had received antihypertensive therapy for at least one month, and were willing to participate in the study.Medication adherence was measured using a self-report questionnaire consisting of eight statements with a four-point Likert scale (always, often, sometimes, never). The total score ranged from 0–24, where higher scores indicated better adherence. The reliability test showed good internal consistency (Cronbach’s alpha > 0.7).The decrease in blood pressure was not statistically significant.Structured pharmaceutical education was effective in improving medication adherence but did not demonstrate a significant change in blood pressure within the four-week observation period. This intervention has the potential to serve as a supportive strategy for hypertension management in primary healthcare settings.

Downloads

Download data is not yet available.

References

Abegaz, T. M., Shehab, A., Gebreyohannes, E. A., Bhagavathula, A. S., & Elnour, A. A. (2017). Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine, 96(4), e5641. https://doi.org/10.1097/MD.0000000000005641

Alhaddad, M. S. (2019). The effect of pharmacist counseling on medication adherence and blood pressure control. Patient Preference and Adherence, 13, 187–195. https://doi.org/10.2147/PPA.S188633

Burnier, M., & Egan, B. M. (2019). Adherence in hypertension. Circulation Research, 124(7), 1124–1140. https://doi.org/10.1161/CIRCRESAHA.118.313220

Carey, R. M., et al. (2018). Prevention and control of hypertension: JACC Health Promotion Series. Journal of the American College of Cardiology, 72(11), 1278–1293. https://doi.org/10.1016/j.jacc.2018.07.008

Chisholm-Burns, M. A., et al. (2016). US pharmacists' effect as team members on patient care. Medical Care, 48(10), 923–933. https://doi.org/10.1097/MLR.0b013e3181e57962

Conn, V. S., Ruppar, T. M., & Enriquez, M. (2016). Medication adherence interventions that target subjects with adherence problems. Research in Social and Administrative Pharmacy, 12(2), 218–246. https://doi.org/10.1016/j.sapharm.2015.06.001

Cutler, R. L., Fernandez-Llimos, F., Frommer, M., Benrimoj, C., & Garcia-Cardenas, V. (2018). Economic impact of medication non-adherence. BMJ Open, 8(1), e016982. https://doi.org/10.1136/bmjopen-2017-016982

Ghembaza, M. A., et al. (2020). Impact of pharmacist-led education on adherence and blood pressure. Journal of Human Hypertension, 34(2), 123–130. https://doi.org/10.1038/s41371-019-0266-0

Hernandez-Vila, E. (2015). A review of the JNC 8 guidelines. The Ochsner Journal, 15(2), 130–136. Hypertension management guidelines have been updated in recent years (Whelton et al., 2018).

Krousel-Wood, M., et al. (2015). Medication adherence and blood pressure control. American Journal of Hypertension, 28(10), 1202–1211. https://doi.org/10.1093/ajh/hpv024

Lee, J. K., Grace, K. A., & Taylor, A. J. (2016). Effect of a pharmacy care program on medication adherence. JAMA, 296(21), 2563–2571. https://doi.org/10.1001/jama.296.21.2563

Mills, K. T., et al. (2020). Global disparities of hypertension prevalence and control. Circulation, 134(6), 441–450. https://doi.org/10.1161/CIRCULATIONAHA.115.018912

Nieuwlaat, R., et al. (2014). Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews, 11, CD000011. https://doi.org/10.1002/14651858.CD000011.pub4

Ruppar, T. M., Cooper, P. S., Mehr, D. R., Delgado, J. M., & Dunbar-Jacob, J. M. (2016). Medication adherence interventions improve blood pressure. Hypertension, 68(5), 1100–1107. https://doi.org/10.1161/HYPERTENSIONAHA.116.07994

Santschi, V., et al. (2017). Pharmacist interventions to improve blood pressure control. Journal of Hypertension, 35(1), 15–30. https://doi.org/10.1097/HJH.0000000000001137

Shrank, W. H., et al. (2016). The epidemiology of medication adherence. BMJ, 352, i600. https://doi.org/10.1136/bmj.i600

Siregar, R. N., et al. (2022). The role of pharmacist counseling in improving adherence among hypertensive patients. Pharmacy Practice, 20(1), 2614. https://doi.org/10.18549/PharmPract.2022.1.2614

Tsiantou, V., et al. (2019). Factors influencing adherence to antihypertensive therapy. Patient Preference and Adherence, 13, 1043–1050. https://doi.org/10.2147/PPA.S204606

Viswanathan, M., et al. (2017). Interventions to improve adherence to self-administered medications. Annals of Internal Medicine, 157(11), 785–795. https://doi.org/10.7326/0003-4819-157-11-201212040-00538

Whelton, P. K., et al. (2018). 2017 ACC/AHA Guideline for the prevention, detection, evaluation, and management of high blood pressure. Hypertension, 71(6), e13–e115. https://doi.org/10.1161/HYP.0000000000000065

World Health Organization. (2021). Hypertension fact sheet. Retrieved from https://www.who.int/

Yilmaz, M., et al. (2017). Effect of pharmacist intervention on medication adherence. International Journal of Clinical Pharmacy, 39(5), 1045–1052. https://doi.org/10.1007/s11096-017-0507-0

Zullig, L. L., et al. (2015). Medication adherence and blood pressure control. Journal of Clinical Hypertension, 17(8), 603–611. https://doi.org/10.1111/jch.12559

Carter, B. L., Rogers, M., Daly, J., Zheng, S., & James, P. A. (2009). The potency of team-based care interventions for hypertension: A meta-analysis. Archives of Internal Medicine, 169(19), 1748–1755. https://doi.org/10.1001/archinternmed.2009.316

Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO cares? Mayo Clinic Proceedings, 86(4), 304–314. https://doi.org/10.4065/mcp.2010.0575

Bosworth, H. B., Olsen, M. K., Grubber, J. M., et al. (2009). Two self-management interventions to improve hypertension control. Annals of Internal Medicine, 151(10), 687–695. https://doi.org/10.7326/0003-4819-151-10-200911170-00148

Poudel, A., Nissen, L., & Khanal, S. (2017). Pharmacist role in the management of hypertension: A systematic review. Integrated Pharmacy Research and Practice, 6, 97–107. https://doi.org/10.2147/IPRP.S140565

Vrijens, B., De Geest, S., Hughes, D. A., et al. (2012). A new taxonomy for describing and defining adherence to medications. British Journal of Clinical Pharmacology, 73(5), 691–705. https://doi.org/10.1111/j.1365-2125.2012.04167.x