Medication adherence, blood pressure control: healthcare financing and associated factors among hypertensive general outpatients of a tertiary hospital in south-west Nigeria

Abstract

Background: Medication adherence refers to how effectively individuals follow their prescribed regimens. Non-adherence and uncontrolled blood pressure, particularly in chronic illnesses like hypertension, have a global impact on health outcomes and costs. This study assessed antihypertensive medication adherence and blood pressure control among hypertensive individuals. Methods: In this cross-sectional study, 350 adult hypertensive outpatients were systematically sampled from 600 patients over three months. Data on socio-demographics, health history, medication adherence, and financing were collected using a semi-structured questionnaire. Adherence was assessed using the Adherence to Refills and Medications Scale (ARMS). Data were analyzed using bivariate and multivariate methods with p-value set at 0.05. Blood pressure was measured using a mercury sphygmomanometer. Results: Respondents had mean age of 56.37 ± 9.75 years, with the majority being female (62.3%) and tertiary education (61.1%). Medication adherence was high (94.0%), and 70.6% had controlled blood pressure. Age, comfort with clinic visits, and pill burden were significantly associated with higher adherence, while blood pressure control was linked to gender, medication availability, adverse effects, pill burden comfort, and belief in drug efficacy. Older age (OR=0.162, p=0.020) and clinic comfort (OR=0.221, p=0.015) predicted adherence, whereas male gender (OR=1.72, p=0.025), drug unavailability (OR=1.827, p=0.027), and disbelief in medication effectiveness (OR=4.873, p=0.013) predicted uncontrolled blood pressure. There was no relationship between healthcare financing and adherence or blood pressure control. Conclusion: High adherence to antihypertensive medication and satisfactory blood pressure control were observed, influenced by age, medication availability, and patients' perceptions of treatment. Targeted interventions addressing these factors could further improve hypertension management outcomes.