Blood pressure-lowering medication prescribing, its adherence to guidelines and relationship with blood pressure control at a family medicine department.

Background: In many resource-constrained countries, control of blood pressure (BP) is low. Antihypertensive drug prescribing practices may influence BP control. However, adherence of prescribing to treatment guidelines may not be optimal in resource-constrained settings. The aim of this study was to evaluate the pattern of blood pressure-lowering medication prescribing, and how it adheres to treatment guidelines, and to identify the relationship between medication prescriptions and BP control. Methods: It was a cross-sectional study of hypertensive outpatients at the Korle Bu Teaching Hospital (KBTH) Family Medicine department (FMD)/Polyclinic. Data was collected with a validated structured form. Adherence of "prescribing" to recommendations of the 2017 Standard Treatment Guidelines of Ghana and 2018 European Society of Cardiology guidelines was assessed using a composite measure. We analyzed data with SPSS. Results: About 81% (247/304) of patients received two or more antihypertensive drugs. Most patients (41%; 267/651) received calcium channel blockers (CCB), and 21.8% (142/651), 15.7% (102/651) and 12.7% (83/651) were on diuretics, angiotensin-receptor blockers (ARBs) and angiotensin converting enzyme (ACE) inhibitors respectively. CCB plus RAS inhibitor (50%) was the most prescribed two-drug combination. Number of BP drugs per patient had a statistically significant inverse relationship with BP control (beta Coefficient = -0.402; 95% Cl: 1.252-2.470; p = 0.015). The composite adherence score was 0.73 (moderate adherence) but Single-pill combination (SPC) was poor (3.2%; n = 8). Conclusion: Most patients received multiple-pill combination treatment, and overall adherence to guidelines was suboptimal, largely owing to complex drug therapy. Number of drugs predicted BP control. Our findings suggest a need to prioritize simplified treatment, and implement other strategies to improve hypertension guideline adherence. Further research on the influence of SPC on BP control may inform future hypertension guidelines in Ghana and elsewhere in Africa.

Anti-hypertensive medication access and affordability and their association with blood pressure control at a teaching hospital in Ghana.

INTRODUCTION: many hypertensive patients require two or more anti-hypertensive drugs, but in low- and middle-income countries there may be challenges with medication access or affordability. The objective of this study was to determine accessibility and affordability of anti-hypertensive medicines and their association with blood pressure (BP) control among hypertensive patients attending the Korle-Bu teaching hospital (KBTH) polyclinic. METHODS: a cross-sectional study was conducted among 310 systematically sampled hypertensive patients attending the KBTH Polyclinic in Ghana. A structured questionnaire was used to obtain data on patient demographics and clinical characteristics, prices, availability and mode of payment of generic anti-hypertensive medicines. RESULTS: fifty-nine patients (19.4%) made out-of-pocket payments. At the private pharmacy and hospital, 123 (40.5%) and 77 patients (25.3%) respectively could not afford four anti-hypertensive medicines. Medicines availability at KBTH was 60%. Continuous access to BP drugs at KBTH was 14.8%. Overall access was 74.9% (SD ± 41.3). Out-of-pocket affordability of the medicines was positively correlated with BP control (R=0.12, p=0.037). Obtaining medicines via health insurance only was more likely to result in BP control than making any out-of-pocket payments (OR= 2.185; 95% CI, 1.215 - 3.927). Access at KBTH was more likely to result in BP control (OR=1.642; 95% C.I, 0.843 - 3.201). CONCLUSION: there were access challenges although most patients obtained BP medication free. Out-of-pocket affordability is a challenge for some hypertensive patients. Access to affordable BP medication can improve BP control. These findings provide an impetus for urgently evaluating access to affordable anti-hypertensive medicines in other hospitals in Ghana.

Point Prevalence Survey of Antimicrobial Utilization in Ghana's Premier Hospital: Implications for Antimicrobial Stewardship.

The first comprehensive point prevalence survey at the Korle Bu Teaching Hospital (KBTH) was performed as part of the 2019 Global Point Prevalence Survey (Global-PPS) on antimicrobials. The aim was to establish a PPS baseline for the whole hospital and to identify required stewardship interventions. The PPS was conducted over three days in June 2019 using the GLOBAL-PPS standardized method for surveillance of antimicrobial utilization in hospitals to evaluate antimicrobial prescribing. In all, 988 patients were admitted to 69 wards. Overall antimicrobial prevalence was 53.3%. More community-acquired infections (CAI) were treated empirically compared to health-care associated infections (94.0% vs. 86.1% respectively, p = 0.002). Main indications for prescribing antimicrobials were pneumonia (18.4%), skin and soft tissue infections (11.4%) and sepsis (11.1%). Among antimicrobials, systemic antibiotics accounted for 83.5%, of which amoxicillin with beta-lactam inhibitor (17.5%), metronidazole (11.8%) and ceftriaxone (11.5%) dominated. Guideline compliance was 89.0%. Stop/review dates were completed in 33.4% and documented reason was recorded in 53.0% of all prescriptions. If the findings in this PPS can be addressed antimicrobial stewardship at the KBTH stands to improve significantly.