O'hagan, Edel and Mcintyre, Daniel and Nguyen, Tu and Tan, Kit Mun and Hanlon, Peter and Siddiqui, Maha and Anastase, Dzudie and Lim, Toon Wei and Uzendu, Anezi and Nguyen, Tan Van and Wong, Wei Jin and Khor, Hui Min and Kumar, Pramod and Usherwood, Timothy and Chow, Clara K. (2024) A Cross-Sectional Survey of Fixed-Dose Combination Antihypertensive Medicine Prescribing in Twenty- Four Countries, Including Qualitative Insights. Global Heart, 19 (1). p. 73. ISSN 2211-8160, DOI https://doi.org/10.5334/gh.1353.
Full text not available from this repository.Abstract
Background: Treatment inertia, non-adherence and non-persistence to medical treatment contribute to poor blood pressure (BP) control worldwide. Fixed dose combination (FDC) antihypertensive medicines simplify prescribing patterns and improve adherence. The aim of this study was to identify factors associated with prescribing FDC antihypertensive medicines and to understand if these factors differ among doctors worldwide. Methods: A cross-sectional survey was conducted online from June 2023 to January 2024 to recruit doctors. We collaborated with an international network of researchers and clinicians identified through institutional connections. A passive snowballing recruitment strategy was employed, where network members forwarded the survey link to their clinical colleagues. The survey instrument, developed through a literature review, interviews with academic and clinical researchers, and pilot testing, assessed participants perspectives on prescribing FDC antihypertensive medicines for hypertension. Participants rated their level of agreement (5-point Likert scale) with statements representing six barriers and four facilitators to FDC use. Findings: Data from 191 surveys were available for analysis. 25% (n = 47) of participants worked in high-income countries, 38% (n = 73) in upper-middle income, 25% (n = 48) in lower-middle income, 6% (n = 10) in low-income countries. Forty percent (n = 70) of participants were between 36-45 years of age; two thirds were male. Cost was reported as a barrier to prescribing FDC antihypertensive medicines 51% (n = 87) agreeing or strongly agreeing], followed by doctors' confidence in BP measured in clinic 40%, (n = 70)], access 37%, (n = 67)], appointment duration 35%, (n = 61)], concerns about side-effects (21%, n = 37)], and non-adherence 12%, (n = 21)]. Facilitators to FDC antihypertensive polypills prescribing were clinician facing, such as access to educational supports 79%, (n = 143)], more BP measurement data 67%, (n = 120)], a clinical nudge in health records 61%, (n = 109)] and patient-facing including improved patient health literacy 49%, (n = 88)]. The levels of agreement and strong agreement across all barriers and facilitators were similar for participants working in higher or lower income countries. Across all countries, participants rated FDC antihypertensive medications highly valuable for managing patients with non-adherence, (82% reported high or very high value), for patients with high pill burden (80%). Interpretation: Cost and access were the most common barriers to prescribing FDCs across high- and low-income countries. While greater educational support for clinicians was perceived as the leading potential facilitator of FDC use, this seems unlikely to be effective without addressing access.
| Item Type: | Article |
|---|---|
| Funders: | UNSPECIFIED |
| Uncontrolled Keywords: | hypertension; antihypertensive medications; fixed dose combinations; global healthcare survey; polypills |
| Subjects: | R Medicine > R Medicine (General) |
| Divisions: | Faculty of Medicine |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 22 Nov 2024 05:23 |
| Last Modified: | 22 Nov 2024 05:23 |
| URI: | http://eprints.um.edu.my/id/eprint/47103 |
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