4.3.1 Factors related to drug adherence
We included the BMA analysis to determine the factors that influence drug compliance to make recommendations for intervening.
According to our results, individuals with a longer hypertension duration were more likely to be less adherent to medication, and participants with chronic comorbidities had a compliance rate 2.21 times those without other chronic diseases. It can be reasoned that the longer the patients had the disease, the more neglectful they were to not take medication or voluntarily stop medication when they felt that their BP had stabilized. Prolonged treatment also affected the patients psychologically and they did not maintain compliance at the time of diagnosis. Because patients with additional comorbidities require other medications, this may help maintain medication compliance. Moreover, anxiety and fear of disease risks from not taking medication may increase patient compliance.
When compared with other studies in Vietnam, our study results coincided with those of the study by Nguyen Thi My Hanh on associated diabetes, but the time factor of treating hypertension was different.
- My Hanh Nguyen Thi
- Duyen Nguyen Thi My
- Khanh Ly Huy
- et al.
Investigation of the relationship between medication adherence and blood pressure control in hypertensive patients on outpatient treatment.
My Hanh's study showed age as a factor, which may be because subjects aged ≥18 years were evaluated. Young patients may have different compliance behaviors than the elderly, thereby leading to discrepancies in results. According to a Hanoi study conducted by Vu Xuan Phu, after incorporating variables into the multivariate model, only gender and knowledge of hypertension were the variables related to treatment adherence.
Study on some factors related to hypertension treatment adherence in 25-60 year old patients in 4 wards of Hanoi city.
Although this study controlled for confounding factors, it is reasonable for the subjects to have different ages than those of ours.
4.3.2 Factors related to non-pharmacological adherence
Our research identified factors that were related to the variables of patient non-drug adherence by using BMA. In previous studies, authors mainly focused on identifying factors related to drug adherence but did not consider factors affecting patients’ recommended behaviors.
In this study, the results showed that for salt reduction compliance, people with chronic comorbidities had poorer adherence rates than those without other chronic diseases. This may be due to behaviors that do not reduce daily salt intake as recommended, which can lead to other chronic diseases. Moreover, our study only measured salt consumption through high-salt foods; hence, the percentage of patients who adhered to salt reduction may actually be higher than the reality. The rate of salt reduction adherence in hypertensive patients has also been reported worldwide, ranging from 57% to 80%.
- Buda E.S.
- Hanfore L.K.
- Fite R.O.
- Buda A.S.
Lifestyle modification practice and associated factors among diagnosed hypertensive patients in selected hospitals, South Ethiopia.
Having comorbidities is considered one of the factors that reduces the patient's adherence to lifestyle modification. Thus, salt reduction has not been given much attention in elderly patients with hypertension, which is likely to increase the risk of complications as well as other chronic diseases. Conversely, in patients with multiple comorbidities, salt reduction adherence may be more difficult to achieve. Therefore, clinicians should pay more attention to salt consumption when implementing treatment guidelines in these patients.
Our study also found an association between higher follow-up compliance and having health insurance, diabetes, or obesity. This is because health insurance will pay for a doctor's consultation, diagnostic tests, medicine cost, and hospitalization expenses; therefore, the patient may return to the hospital more frequently and have regular check-ups. Moreover, when there are several comorbidities, the patient will need close monitoring and periodic tests; thus, a higher compliance rate is influenced. Frequent follow-up visits help doctors assess treatment effectiveness, detect adverse drug reactions, or detect early complications.
- Whelton P.K.
- Carey R.M.
- Aronow W.S.
- et al.
ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.
However, in Vietnam, the cost of hypertension examination and treatment is still a burden. In a recent study, the total cost of one treatment for hypertension was 199,019 VND.
- Chung Nguyen Thanh
- Ha Ta Ngoc
- Le Van Hieu
Analysis of the cost of treatment for hypertension at the grassroots health level in Ha Nam province in 2019 and some related factors.
Although not too expensive, hypertension is a disease that requires lifelong treatment, plus monthly follow-up visits or other costs, making the total cost incalculable. Therefore, health insurance is considered a solution to help patients not only financially, but also to better adhere to treatment to achieve high efficiency.
Non-adherence to medication is prevalent in patients with hypertension. Therefore, interventions to improve adherence in both pharmacological and non-pharmacological treatments are necessary. A program which includes continuous monitoring of regular medication use, salt intake reduction, physical activity enhancement, weight loss, ideal weight maintenance, and regular follow-up visit attendance is needed. In particular, the intervention program should pay attention to patients who do not have health insurance and those with additional long-term illnesses.