Utilization of telepharmacy in the management of hypertension.

BACKGROUND: Deaths due to cardiovascular diseases is on the rise, with hypertension as its most important risk factor. Effective management of hypertension, however, remains a challenge. Globally, only one in five adults with hypertension have it under control. The situation is worse in sub-Saharan Africa where hypertension prevalence is highest. Telepharmacy presents a great opportunity to enhance the way we address hypertension management. OBJECTIVES: This study sought to determine the effectiveness of pharmaceutical care interventions implemented through telepharmacy on medication adherence, practice of therapeutic lifestyles and overall blood pressure control among patients with hypertension. METHODS: This was a randomized control trial conducted among individuals with hypertension recruited from two Ghanaian hospitals from May 2022 to December 2022. Patients with confirmed diagnosis of hypertension were recruited and assigned into a control or intervention group. Both groups were followed for six months with the intervention group receiving telepharmacy services in addition to standard clinical care. Outcome measures included changes in blood pressure, medication adherence, lifestyle modifications, identification and resolution of pharmaceutical care issues. RESULTS: One hundred and eighteen (118) patients with hypertension were involved in the study. There was a statistically significant reduction in mean blood pressures for the intervention group after six months (Systolic-148.1 + 23.6, to 134.8 + 13.7, Diastolic- 85.8 + 9.8, to 79.5 + 8.7) (p < 0.05). The proportion of patients with adequately controlled blood pressure increased from 39.0% to 66.1%. There was also an increase in the mean adherence score (p < 0.05). The number of participants who adopted lifestyle modifications such as reducing salt consumption (89.5%) and exercising (77.2%) increased. The majority (87%) of all pharmaceutical care issues were identified and resolved over the six-month period. CONCLUSION: Telepharmacy service provided via phone calls was effective in improving the control of blood pressure. It also promoted the practice of therapeutic lifestyle modifications, medication adherence and identification of pharmaceutical care issues among patients with hypertension.

Evaluation of workplace hypertension preventative and detection service in a Ghanaian University.

OBJECTIVES: This study sought to evaluate the effectiveness of a pharmacist-led hypertension screening, preventative and detection services at the workplace. METHODS: This was a prospective study conducted among staff at the Kwame Nkrumah University of Science and Technology from September 2019 to September 2020. Staff were screened for hypertension and interviewed via a structured questionnaire to gather data on their lifestyle practices and risk of hypertension. Prehypertensive individuals were educated and followed up for 6 months and all participants who had blood pressure consistently above 140/90 mmHg (hypertension) were referred to the University Hospital. KEY FINDINGS: Out of 162 participants screened, 19 (11.7%) were classified as stage 1 hypertensive, 5 (3.1%) as stage 2 hypertensive and 74 (45.7%) as prehypertensive. The commonest modifiable risk factor identified was body mass index > 25 kg/m2 (99, 61.1%) and physical inactivity (97, 59.9%). Eleven (61%) out of 18 participants referred to the physician were confirmed hypertensive and prescribed medications. After a 6 month follow-up, there was a reduction in the mean systolic and diastolic blood pressures (P < 0.05); and 47 (63.5%) out of 74 initially classified as prehypertensive had their blood pressures within the normal range. CONCLUSION: Workplace preventative and detection services can effectively lead to the identification of risk factors, promotion of lifestyle changes and detection of hypertension. Such services should be integrated into workplace systems to aid the prevention and detection of chronic conditions such as hypertension.

Disposal of leftover and expired medicines by community pharmacies and their clients in Ghana.

Improper and unsafe disposal of expired and unwanted medicines could cause harm to both people and the environment and therefore it is of public health importance. The objective of the study was to determine the methods employed by community pharmacist and their clients in the disposal of unwanted and expired medicines. Furthermore, the role of the pharmacists in the assessment of clients left over medicines was also explored. A cross sectional study design was employed with a sample of 120 pharmacy staff and 200 clients. Semi structured questionnaires were developed and administered to the two groups. Ethical approval was obtained. Data collected were analyzed using the Statistical Package for Social Sciences (SPSS v.24). Two hundred and eighty medicines were assessed from 131 respondents (65.5%) who brought their unused or left-over medicines to the pharmacy. These included analgesics 102(36.4%), antibiotics 50 (17.9%) and antacids 22 (7.9%). Disposal of expired and left-over medicines cited by respondents were the general-purpose bin 58(77.0%) and down the sink 11(14.3%). The majority 99(82.9%) of community pharmacies also disposed of solid dosage forms through the general-purpose bin. In addition, 90(75%) community pharmacies disposed of liquid waste in general purpose bin. Lack of enforcement of legislation was cited by community pharmacy staff as a barrier to the proper disposal of pharmaceutical waste. The predominant method of disposal of expired/unwanted medicines by community pharmacies and their clients was via the general-purpose bin. Implementation of interventions such as take back programmes that will enhance proper disposal of expired and left over medicines should be initiated.

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

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.

Exploring the extended role of the community pharmacist in improving blood pressure control among hypertensive patients in a developing setting.

BACKGROUND: In most developing countries including Ghana, there is scant literature on the involvement of the community pharmacist in the care of patients with chronic conditions such as hypertension and blood pressure control. The objective of the study was to evaluate the effect of a pharmaceutical care model on blood pressure control and adherence among hypertensive patients. METHODS: This was a quasi experimental design and the primary outcome measure was a change in systolic and diastolic blood pressure. One hundred and eighty hypertensive patients were recruited for the study: 90 in the intervention group and 90 in the control group. The intervention, consisting of health education, adherence counselling and medicine use review; was offered monthly for six months. RESULTS: At baseline there was no significant difference in demographic and clinical characteristics between the intervention and control group. Pharmaceutical care issues identified among the intervention group during the 6 months period were non effectiveness of therapy (n = 23), experience of side effects (n = 20) and nonadherence to therapy (n = 40). The mean diastolic blood pressure difference between the intervention group and the control group was statistically significant (p = 0.001). The mean adherence difference between the two groups was also statistically significant at the end of the study. (p = 0.001). CONCLUSIONS: The pharmaceutical care intervention offered by the pharmacist led to the resolution of some pharmaceutical care issues, improvement in diastolic blood pressure and adherence among hypertensive patients. Guidelines and polices to streamline these services are needed if they are to be made available in community pharmacies in developing countries.

Locus of control and anti-hypertensive medication adherence in Ghana.

INTRODUCTION: Medication non-adherence is a major public health problem in Ghana. Locus of control (LoC) may influence adherence to medication. In this study we examine the association between locus orientation and adherence to hypertensive medication among adult patients. We also take into account the role of medication side effects. METHODS: We conducted a hospital-based cross-sectional study involving two tertiary hospitals in southern and northern Ghana. Data were collected from 400 hypertensive patients using a structured questionnaire. We gathered information on patient's sociodemographic characteristics, health LoC, side effects of anti-hypertensive medication and adherence to anti-hypertensive medication. RESULTS: Participants exhibited features of mixed LoC (both internal and external) usually referred to as bi-local expectancy. However, orientation was skewed towards external LoC. Females were marginally more likely than males to have an internal LoC. Education was associated with a greater likelihood of internal LoC. While most patients (93.3%) poorly adhered to antihypertensive medications, logistic regression model revealed that non-adherence was significantly associated with low internal LoC, medication side effects and the combined effect of medication side effects and external LoC. CONCLUSION: Medication non-adherence, experiences of medication side effects and LoC are associated. Multifaceted intervention programmes highlighting personality characteristics like LoC may improve anti-hypertensive medication adherence.

Patient knowledge of medicines dispensed from Ghanaian community pharmacies.

BACKGROUND: One vital requirement for patient adherence to medicines is good patient knowledge of the medicines dispensed and this will invariably be linked to good labelling and counselling. OBJECTIVE: The aim of this study was to evaluate the quality of labelling of medicines and determine patient knowledge of the administration of medicines dispensed from a community pharmacy in Ghana. METHODS: From 6th to 29th January, 2010, dispensed prescriptions of 280 clients were purposely sampled to evaluate the quality of labelling. These clients were also interviewed about their knowledge of the last medicine received immediately after dispensing. A scoring system was employed by awarding a point for each attribute written on the package and each attribute stated by the patient. The dispensing attributes noted were name, dosage, frequency, duration, quantity and route of administration. RESULTS: Of the 280 patients interviewed, 157 (56%) were males. Thirty one (11%) had no education and 99(35%) were secondary school graduates. Antimalarials comprised 17.9% and analgesics, 15.4% of medicines dispensed. The name, quantity, dosage, frequency, duration of therapy and route of administration were written on the label in 98%, 99%, 55%, 54%, 6% and 2% respectively of the dispensed medicines. The mean labelling score was 3.096 (SD=1.05) out of 6. The corresponding patient knowledge values were 63%, 80%, 80%, 75%, 57% and 86%. The mean knowledge score was 4.375 (SD; 1.38) out of 6. The chi square test p-value for the effect of demographic characteristics (sex, educational background, location) on patient knowledge of medicines dispensed were p=0.454; p=0.000, and p=0.138 respectively. CONCLUSIONS: Patient knowledge of the administration of dispensed medicines was rated good; and this largely corresponded with the quality of labelling, except that the duration of therapy and route of administration was not frequently written and so labelling was rated just above average.

Ghanaian pharmacists' perception of people living with HIV and AIDS (PLWHIV).

To determine Ghanaian pharmacists' perception of persons living with HIV (PLWHIV), pharmacists and other health care personnel in Ghana completed self-administered questionnaires in 3 separate studies from November 2003 to January 2005. Two of the studies (studies 2 and 3) incorporated 4 simple questions that are generally administered to determine, hypothetically, the degree of discrimination against PLWHIV. Responses to these questions were also analyzed in the 2003 Ghana Demographic and Health Survey (GDHS). A nondiscriminatory response to all the indicators reflected an accepting attitude, and a discriminatory response, in at least one indicator, reflected a negative attitude. In study 1, 35% of pharmacists indicated an accepting attitude toward PLWHIV. In study 2, only 17% of the pharmacists sampled indicated an accepting attitude toward PLWHIV. In study 3, none of the 10 pharmacists sampled indicated an accepting attitude toward PLWHIV. However, 19% of the totality of health workers did so. Compared to Ghanaians of similar socioeconomic backgrounds, pharmacists tended to report a more perceived discriminatory attitude toward PLWHIV.