Date of Award

2001

Degree Type

Thesis

Degree Name

Master of Science (MS)

Department

Pharmaceutical Sciences

Abstract

Objective: Using a self-administered questionnaire, the objectives of this study were: (1) to identify the predictors that discriminate between the patients who consider returning to antihypertensive therapy and those who indicate that they will not return to drug therapy; (2) to compare the predictors of returning to antihypertensive drug therapy in a North American population (United States, and Canada) with a European (France, Germany, and Italy) population. Design: Cross-sectional study. Data Collection: An existing dataset was obtained from Bristol Myers Squibb (BMS), New Jersey. BMS recruited patients with a diagnosis of hypertension from five different countries (USA, Canada, France, Germany, and Italy) (n=731). Trained interviewers administered the questionnaire in one-on-one interview sessions at a research facility, interviewer's home, or patient's home. Methodology: Required variables were extracted from the dataset using SAS (Statistical Analysis System). The patients who said that they were already taking their antihypertensive medication as directed were deleted from the study. Therefore the final sample of 439 patients was used for the analyses. Independent variables were divided into four groups and logistic regression analyses were carried out separately for each sets of variables. The significant variables from each set of variables were identified and combined to develop a final logistic regression model. Finally, the study sample was divided into North American population and European population. A final logistic regression model was developed separately for these two populations. Results: The number of physician visits for blood pressure problems, number of medication additions to the ones that patients were already taking for their blood pressure, patients' satisfaction towards the assistance they received from their health care provider in managing high blood pressure, and patients' satisfaction with the medications that were available to use to manage their blood pressure were identified as significant predictors in the final model. The European population showed two significant predictors that include number of physician visits for blood pressure problems and patients' satisfaction with the medications that were available to use in manage their blood pressure. However, North American population showed only one significant predictor that is number of medication additions to the ones that patients were already taking to manage their blood pressure. No interaction terms were found to be significant. The model worked best for the set of psychological variables. Conclusion: The treatment of hypertension remains a difficult task. A frequent reason is poor adherence to the drug regimen. The results indicate that an increase in the number of physician visits for blood pressure problems may improve the odds of reinitiating drug therapy. The increase in number of physician visits for blood pressure problems may help patients to consider reinitiating antihypertensive drug therapy The difference of predictors in North American and European population necessitates further investigation in separate geographical areas. The identification of predictors in each location may help in customizing the compliance improvement strategy. Continued research in this area is vital because once the predictors of adherence to drug therapy are identified, effective interventions can be implemented to improve it. The interventions could be followed by its assessment. The feedback from assessment will help in modifying the interventions.

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