Adherence to chronic disease management among diabetic and hypertensive patients in Trinidad

ABSTRACT

OBJECTIVES: Adherence to treatment strategies is critical for disease control and long-term clinical outcomes in patients with chronic diseases, such as diabetes and hypertension. Noncompliance is strongly correlated with lack of disease control and progression to life-threatening outcomes, including end-organ damage such as kidney failure. This study sought to determine the extent of adherence to disease management strategies, including drug compliance and lifestyle modification, among diabetic and hypertensive patients in Trinidad. DESIGN AND METHODS: A cross-sectional survey was conducted using an interviewer-administered pilot-tested de novo questionnaire during the period June to August 2013 at 22 randomly selected primary health centers throughout Trinidad. Data was analyzed using χ 2 and binary logistic regression. RESULTS: Four hundred and thirty-nine patients (439) were recruited; 179 were hypertensive only, 89 were diabetic only, and 171 had both conditions. Mean age and BMI were 61.2 + 10.7 years and 29.2 + 5.99 kg/m2 respectively. One hundred and six out of 350 hypertensive patients (or 30.1%) were controlled, whilst 108 out of 260 diabetic patients (or 41.5%) were controlled. Age (p = 0.015) and body mass index (BMI) (p = 0.028) were the only significant predictors for blood pressure control. Factors such as forgetfulness, adverse drug reactions, and symptoms negatively impacted adherence to drug therapy. CONCLUSIONS: Most hypertensive and diabetic patients attending primary healthcare facilities in Trinidad were not well controlled, which has serious implications for their long-term clinical outcomes. An approach is urgently needed to ensure higher rates of disease control to prevent progression to irreversible end-organ damage.