A retrospective study of physician-managed hypertension in a tertiary hospital in Southwestern Nigeria
Main Article Content
Abstract
Background: Hypertension is a cardiovascular disease of public health concern that has caused severe mortality and morbidity. Information on costs of managing hypertension is very essential. Data on factors that influence physicians' choice of antihypertensive drugs are scarce.
Objectives: To determine costs and classes of antihypertensive drugs used by physicians and assess factors that influence physicians' choice of such drugs in a tertiary hospital in Southwestern Nigeria.
Methods: Six hundred and eighty-four case notes of hypertensive patients were retrospectively reviewed within a three-month period. A prospective interaction with 85 randomly selected physicians was undertaken using a pretested questionnaire to obtain their demographic characteristics and their views on the class of drugs used in managing hypertension. Data were summarized using descriptive statistics. Inferential statistics was used to determine the associations between variables.
Results: Physicians and patients mean ages were 45.74±10.63 and 65±11.12 years respectively. Average monthly costs of antihypertensive drugs in patients without and with comorbidities were $9.11±0.15 USD and $12.56±0.06 USD, respectively. These different costs were significant at p=0.001. Classes of antihypertensive drug used were thiazides (60.8%), calcium channel blockers (57.6%), angiotensin converting enzymes inhibitors (50.7%), α-blockers 15.2%), and β-blockers ( (6.1%). Physicians' choice of anti-hypertensive medications was significantly influenced by cost of medication (p=0.003), patients' economic status (p=0.004), presence of comorbidities (p=0.026), among others.
Conclusion: Cost of managing hypertension was high compared to average monthly income of patients. Classes of drugs used were in line with JNC 7 guidelines. Physicians' choice of medications was mostly influenced by costs of medication, patients' physical and economic status. The implications of these findings in clinical practice are that physicians should continue to focus more on generic prescribing and substitution as cost-reduction strategies.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Venkata C, Ram S (2018). Latest guidelines for hypertension. Adopt and Adapt. Journal of American Society of Hypertension 12(2): 67-68.
Available at: https://doi.org/10.1016/j.jash.2017.11.002 Accessed July 18, 2019.
Amira CO, Okubadejo NU (2006). Antihypertensive pharmacotherapy in a developing economy. Pattern, acquisitions, costs and conformity to international guideline in a tertiary care setting. Journal of Human Hypertension 20:894-897.
Onikeze OO, Ige O, Osungbade KO, Olumide EA, Asuzu MC (2010). An Overview of the national health insurance scheme in Nigeria. Dokita 1:15-21.
Ilesanmi OS, Ige OK, Adebiyi AO (2012). The managed hypertensive: the costs of blood pressure control in a Nigerian town. The Pan African Medical Journal 12: 96.
Rachana PR, Anuradha HV, Shivamurthy MC (2014). Antihypertensive prescribing patterns and cost analysis for primary hypertension. Journal of Clinical Diagnosis and Research 8:19-21.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB (2013). On behalf of American heart association statistics committee and stroke statistics subcommittee. Heart disease and stroke-2013 update: A report from the American heart association. Circulation p. 127-245.
Bakare OQ, Akinyinka MR, Goodman O, Kuyinu YA, Wright OK, Adeniran A, Odusanya OO, Osibogun A (2016). Antihypertensive use, prescription patterns, and cost of medications in a teaching hospital in Lagos, Nigeria. Nigerian Journal of Clinical Practice 19: 668-672.
Cooper R, Rotimi C, Ataman S. McGee D, Osotimehin B, Kadiri S, Muna W, Kingue S, Fraser H, Forrester T, Bennett F Wilks R (1997). The prevalence of hypertension in seven populations of West African origin. American Journal of Public Health 87:160-168.
Erhun WO, Olayiwola G, Agbani EO, Omotosho NS (2005). Prevalence of hypertension in a university community in South West Nigeria. African Journal of Microbial Research 8:15-19.
Tee SR, Toeh XY, Aiman WA, Aiful A, Har CS, Tan ZF (2010). The prevalence of hypertension and its associated risk factors in two rural communities in Penang, Malaysia. International E-Journal of Science Medicine and Education 4: 27-40.
Reichert S, Simon T, Helm E (2000). Physicians' attitude about prescribing and knowledge of the cost of common medication. Achieves of Internal Medicine 160:2799-2803.
Goldman DP, Joyce GF, Zheng Y (2007). Prescription Drug Cost shaving; associations with medication and medical utilization and spending in health. The Journal of the American Medical Association 298:61-69.
Ugwuja EI, Ezenkwa US, Nwibo AN, Ogbanshi M, Idoko O, Nnabu R (2015). Prevalence and determinants of hypertension in an agrarian rural community in Southeast Nigeria. Annals of Medical Health Science and Research 5: 45-49.
Sayed HAS, Mehdi M, Gelarah A, Jamshid S, Sayed AA, Alireza Z (2018). Main Factors Affecting Physicians Prescribing Decision: The Iranian
Experience. Iranian Journal of Pharmaceutical Research 17: 1105-1115.
Olatunbosun ST, Kaufman JS, Cooper RS, Bella AF (2000). Hypertension in a black population: Prevalence and biosocial determinant of high blood pressure in a group of urban Nigerians. Journal of Human Hypertension 14:249-57
Adedoyin RA, Mbada CE, Balogun MO, Martins T, Adebayo RA, Akintomide A, Akinwusi PO (2008). Prevalence and pattern of hypertension in a semiurban community in Nigeria. European Journal of Cardiovascular Prevention and Rehabilitation 15: 683-687.
Ekwunife OI, Udeogaranya PO, Nwatu IL (2010). Prevalence, awareness, treatment and control of hypertension in Nigeria population. Health 2:731-735.
Ulasi II, Ijoma CK, Onwubere BJ, Arodiwe E, Onodugo O, Okafor C (2011). High prevalence and low awareness of hypertension in a market population in Enugu, Nigeria. International Journal of Hypertension: 869675.
Ogah OS, Okpechi I, Chukwuonye II. Akinyemi JO,Onwubere BJ, Falase AO, Stewart S, Sliwa K (2012). Blood pressure, prevalence of hypertension related complications in Nigeria Africans: A review. World Journal of Cardiology 20:327-40.
Adigun AQ, Ishola DA, Akintomide AO, Ajayi AAL (2003). Shifting trends in the pharmacological treatment of hypertension in a Nigerian tertiary hospital: a real-world evaluation of the efficacy, rationality and pharmaco-economics old and newer antihypertensive drugs. Journal of Human Hypertension 17: 277-285.
Yusuff KB, Balogun O (2005). Physicians' prescribing of anti-hypertensive combinations in a tertiary care setting in southwestern Nigeria. Journal of Pharmacy and Pharmaceutical Sciences 8:235-42.
Etuk E, Isezuo SA, Chika A, Akuche J, Ali M (2008). Prescribing pattern of anti-hypertensive drugs in a tertiary health institution in Nigeria. Annals of African Medicine 7:128-132.
Ekwunife OI, Ubaka CM (2011). Drug utilization of antihypertensive therapy among patients with compelling indications in two hospitals in SouthEastern Nigeria. Journal of Pharmacy and Pharmacology 2:25-28.
Busari OA, Oluyombo R, Fasae AJ, Gabriel OE, Ayodele LM, Agboola SM, Olatayo Adeoti A. (2014). Prescribing pattern and utilization of antihypertensive drugs and blood pressure control in adult patients with systemic hypertension in a rural tertiary hospital in Nigeria. American Journal of Medicine 2: 144-149.
OYSG (2016). Oyo State Government Handbook, Government House, Ibadan, Nigeria.
Bernard HR (2000): Social Research Methods. Sage Publications, Inc. London. p 161.
Mooi E, Sarstedt M, Mooi-Reci I (2018): Market Research. The Process, Data, and Methods using Strata. Springer. p 43.
Osemene KP, Afolabi MO (2017): An Evaluation of the Knowledge and Perceptions of Pharmacy Students on Pharmacovigilance Activities in Nigeria. BMC Research Notes 10, 273 DOI https://doi.org/10.1186/. s13104-017-2586-9 Accessed May 14, 2020.
Bhatia T, Hansen K, Krishnamurthi L (2006). Modeling key drivers of physician choice of prescription drugs: An integrated view incorporating patient and physician heterogeneity. ISBM Report.
Abratt R, Lanteigne J (2000). Factors influencing general practitioners in the prescription of homeopathic medicines. African Journal of Business Management 1:91-98.
Ogunbameru O A (2003). Research Methods in Social Sciences, 2nd edn. Norway: D-Net Communications E-Books Press, 2003.
Cunningham CT, Quan H, Hemmelgan B (2015). Exploring Physicians Specialist Response Rate to Web-based Surveys. BMC Medical Research Methodology15, 32. https://doi.org/10.1186/s/2874-015-0016-Z Accessed June 22, 2019.
Brtnikeva M, Crane LA, Allison MA, Hurley LP, Beaty BL, Kempe A (2018). A Method of Achieving a High Response Rate in National Surveys of US Primary Care Physicians. Public Library of Science (PLOS ONE) 13 (18): e 0202755. Doi: 10.1371/journal.pone.0202755. Accessed January
, 2020.
Soremekun R, Omitiran B (2014). Factors affecting physicians' prescription and patterns of prescription in the management of secondary infertility. African Journal of Pharmacy and Pharmacology 8: 1205-1212.
FMOH (2004). Federal Ministry of Health. Health Sector Reform Programme: Strategic Trusts with a Logical Framework and Plans of Action, 2004-2007; Abuja. Nigeria.
The World Bank (2014). Out-of-pocket expenditure (Percentage total expenditure on health) Internet. A v a i l a b l e a t :
http//data.worldbank.org/indicator/SHXPD.OOPC.TO.ZS/countries/1W-C9-ZG-NG-ZF-A4?Display=default. Accessed November 10, 2019.
Keetile M, Navaneethan K, Letamo G (2015). Patterns and determinants of hypertension in Botswana. Z. Gesundt Wiss 23(5): 311-318. Doi: 10.1007/s10389-015-0682-7. Accessed January 9, 2020.
Chobanian AV, Bakris JL, Black HR, Cushman WC, Green LA (2003). Seventh Report of the Joint national committee on prevention, detection, evaluation and treatment of high blood pressure. Hypertension 42:749-763.
Geraldine M. (2019). Cardiology-First line in Hypertension. https://w.w.w.nice.org.uk Accessed on January 6, 2020.
Ganiyu KA, Suleiman IA (2012). Assessment of antihypertensive utilisation in a private teaching hospital in Nigeria. International Journal of Pharmacy and Pharmaceutical Sciences 4(Suppl 5): 480-483.
Massele AY, Ofori-Adjei D, Laing RO (1993). A study of prescribing patterns with special reference to drug use medication in Dar es Salaam region. Tanzania. Tropical Doctor 23:104-107.
Watkins C, Harvey I, Carthy P, Moore L, Robinson E, Brown R (2003). Attitude and Behavour of General Practitioners and their prescribing costs: A national cross-sectional survey. Quality and Safety in Health Care 12:29-34.
Schumock GT, Walton SM, Park HY, Nutesu EA, Blackburn JC, Finley JM (2004). Factors that influence prescription decisions. Annals of
Pharmacotherapy 38: 557-5562.
Holdford DA (2003). Marketing for Pharmacists. 2nd ed., Chapter 6. Landis NT and Cannon SJ (eds.) American Pharmacists Association, Washington DC. p103.