Knowledge of the hypertensive-only and the hypertensive-HIV patients on Hypertension and the role of pharmacists in the pharmaceutical care of these patients in Dar-es-salaam city

Abstract

SETTINGS: The study was conducted in public hypertension and HIV clinics, hospital and community pharmacies in Dar es Salaam. OBJECTIVE: To assess the knowledge of the hypertensive-only and the hypertensive-HIV patients on hypertension; and the role of pharmacists in the pharmaceutical care of these patients in Dar- es-Salaam city. DESIGN: Cross sectional descriptive study. METHODOLOGY: Face to face interviews were conducted with the hypertensive-only, hypertensive-HIV patients and pharmacists working in hospital and community pharmacies. Convenience sampling method was used to select the patients and pharmacists. Sample sizes were chosen depending on the available time and resources. Hypertensive-only patients on anti- hypertensive medicines and hypertensive-HIV patients on both anti-hypertensive medicines and ARVs attending the clinics during the period of the study who consented to participate in the study were recruited. Pharmacists in hospital pharmacies where the clinics were situated and pharmacists in community pharmacies who consented to participate in the study were recruited. RESULTS A total of 200 hypertensive-only and 200 hypertensive-HIV patients were interviewed at the three district hospitals Temeke, Mwananyamala, Amana and one referral hospital Muhimbili. All of the hypertensive patients in both the groups knew the name of the disease they were suffering from. The hypertensive-only group knew more about symptoms of hypertension than the hypertensive-HIV group. More than a half of the patients in both groups were not aware of the consequences of uncontrolled hypertension. Neither of the hypertensive-only nor the hypertensive-HIV patients knew the names of the anti-hypertensive medicines taken by them. However, they both reported to know about the types of lifestyle changes. CAM users were found to be a minority who did not know the types of CAM they were using. Majority of the hypertensive-HIV patients reported rmssmg out several doses of anti- hypertensive medicines in comparison to ARVs. Adverse drug reactions were reported significantly more when a combination of both ARVs and anti-hypertensive medicines were used together in comparison to when they were used alone. Fatigue and headache were reported significantly more in the hypertensive-HIV patients in comparison to the hypertensive-only patients. Fatigue and GIT disturbances were reported significantly more in the hypertensive-HIV patients who were using anti-hypertensive medicines before and now are using both ARVs and anti-hypertensive medicines in comparison to those who had been using ARV s before. Drowsiness, rash and nightmares were reported significantly more in patients who were on ARVs before and now are using a combination of both. Majority (86.5%) of the nifedipine users were using nevirapine as one of the ARVs combination therapy. About three quarters (78.13%) of these nifedipine and nevirapine combination users had their blood pressure readings not controlled. Majority of the pharmacists (85%) could not correctly define hypertension nor classify the types of hypertension (91 %) and they could also not mention more than three symptoms of hypertension. Around 90% of the pharmacists were not aware of the anti-hypertensive medicines contraindicated and useful in heart failure. 65% of the pharmacists were not aware of any drug interactions between anti-hypertensive medicines and other medicines. However, they were well versed with the goals of hypertension treatment (95%), complications of untreated hypertension (98%), causes of secondary hypertension (67%), risk factors of hypertension (90%), drugs which induce hypertension (73%) and anti-hypertensive medicines contraindicated in diabetes (59%) and asthma (75%). Most of them (90%) were not aware of any HIV associated hypertensive problems due to ARVs and of any drug interactions with the ARVs and anti-hypertensive medicines (81 %). It was also observed that pharmacists did not practice what they reported i.e they did not give any advice to the patients regarding the drug drug interactions or food drug interactions. They also did not give precautions on the side effects of the medicines. No pharmacist was found to work in any of the hypertension clinics that were visited. Most of the counseling was done by the doctors and nurses. The pharmacist was not involved except in the HIV clinic where the pharmacist was involved in explaining the use and storage of the medicines to the HIV patients and very few of the patients found the pharmacists to be of any help to them. CONCLUSION There is a need to improve the patients' knowledge and awareness of hypertension so as to reduce the morbidity and mortality. An opportunity exists to focus patient education programs and interventions on the cardiovascular risks associated with uncontrolled hypertension. Monitoring of adverse drug reactions especially in the hypertensive-HIV patients is a matter of importance since these patients are usually using a lot of medications. The pharmacy profession is moving from purely product supply to a clinical and information supply role. At present, pharmacists are not fully integrated into the primary health care team. This is in part the fault of the profession and general practices for not making the most of the pharmacist's potential. Pharmacists' skills could be better used to help patients with their long term medicines. Thus, it is essential that pharmacists' knowledge should be updated regularly as they can playa major role in the society to improve the quality of life of the patients and thus reduce the morbidity and mortality of the disease.