Prevalence and quality of antihypertensive therapy among hypertension patients enrolled in the Ghana National Health Insurance Scheme.
Africa
Ghana National Health Insurance Scheme
antihypertensive
hypertension treatment
pharmacoepidemiology
Journal
Pharmacoepidemiology and drug safety
ISSN: 1099-1557
Titre abrégé: Pharmacoepidemiol Drug Saf
Pays: England
ID NLM: 9208369
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
revised:
26
03
2021
received:
10
12
2020
accepted:
24
05
2021
pubmed:
27
5
2021
medline:
25
12
2021
entrez:
26
5
2021
Statut:
ppublish
Résumé
Hypertension is a leading cause of morbidity in Ghana. However, there is insufficient data on the prevalence and quality of antihypertensive therapy. To describe the prevalence of use and quality of antihypertensive therapy. A cross-sectional study design was used to analyze the 2015 Ghana National Health Insurance Scheme (NHIS) electronic claims data. Hypertension diagnosis was defined using ICD-10 codes. The primary outcomes assessed were the prevalence of use and quality of antihypertensive therapy. Quality of antihypertensive therapy was defined as the use of antihypertensive agents recommended for treating hypertension patients with comorbid heart failure, myocardial Infarction/Coronary Artery Disease, diabetes, chronic kidney disease or stroke. We used multivariable logistic regression models to identify predictors of antihypertensive use and quality of therapy. Antihypertensive medication use was very high (86%) among the 161 873 hypertension patients covered under the Ghana NHIS. Only a third (32%) of hypertension patients received guideline-concordant therapy. Angiotensin receptor blockers were consumed at the highest dosages of 120 (Interquartile Range [IQR]: 60, 180) daily defined doses over a year. Males (odds ratio [OR] = 0.60; 95% Confidence Interval [CI]:0.58, 0.61) and those with comorbid stroke (OR = 0.91, 95% CI:0.84, 0.99), diabetes (OR = 0.72; 95% CI:0.69, 0.74) and stroke (OR = 0.74, 95%CI:0.68, 0.80) were less likely to use antihypertensives, all other predictors were associated with higher use. Antihypertensive medication use was very high among hypertension patients covered under the Ghana NHIS. However, there was indication of suboptimal quality of the antihypertensive therapy provided.
Sections du résumé
BACKGROUND
Hypertension is a leading cause of morbidity in Ghana. However, there is insufficient data on the prevalence and quality of antihypertensive therapy.
OBJECTIVES
To describe the prevalence of use and quality of antihypertensive therapy.
METHODS
A cross-sectional study design was used to analyze the 2015 Ghana National Health Insurance Scheme (NHIS) electronic claims data. Hypertension diagnosis was defined using ICD-10 codes. The primary outcomes assessed were the prevalence of use and quality of antihypertensive therapy. Quality of antihypertensive therapy was defined as the use of antihypertensive agents recommended for treating hypertension patients with comorbid heart failure, myocardial Infarction/Coronary Artery Disease, diabetes, chronic kidney disease or stroke. We used multivariable logistic regression models to identify predictors of antihypertensive use and quality of therapy.
RESULTS
Antihypertensive medication use was very high (86%) among the 161 873 hypertension patients covered under the Ghana NHIS. Only a third (32%) of hypertension patients received guideline-concordant therapy. Angiotensin receptor blockers were consumed at the highest dosages of 120 (Interquartile Range [IQR]: 60, 180) daily defined doses over a year. Males (odds ratio [OR] = 0.60; 95% Confidence Interval [CI]:0.58, 0.61) and those with comorbid stroke (OR = 0.91, 95% CI:0.84, 0.99), diabetes (OR = 0.72; 95% CI:0.69, 0.74) and stroke (OR = 0.74, 95%CI:0.68, 0.80) were less likely to use antihypertensives, all other predictors were associated with higher use.
CONCLUSION
Antihypertensive medication use was very high among hypertension patients covered under the Ghana NHIS. However, there was indication of suboptimal quality of the antihypertensive therapy provided.
Substances chimiques
Antihypertensive Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1566-1575Informations de copyright
© 2021 John Wiley & Sons Ltd.
Références
Ministry of Health RoG. Dietary and Physical Activity Guidelines for Ghana; 2010.
Sanuade OA, Boatemaa S, Kushitor MK. Hypertension prevalence, awareness, treatment and control in Ghanaian population: Evidence from the Ghana demographic and health survey. PLoS One. 2018;13(11):e0205985.
Bosu WK. Epidemic of hypertension in Ghana: a systematic review. BMC Public Health. 2010;10:418.
Kushitor MK, Boatemaa S. The double burden of disease and the challenge of health access: Evidence from Access, Bottlenecks, Cost and Equity facility survey in Ghana. PLoS One. 2018;13(3):e0194677.
Agyemang C, Bruijnzeels MA, Owusu-Dabo E. Factors associated with hypertension awareness, treatment, and control in Ghana, West Africa. J Hum Hypertens. 2006;20(1):67-71.
Cappuccio FP, Micah FB, Emmett L, et al. Prevalence, detection, management, and control of hypertension in Ashanti, West Africa. Hypertension. 2004;43(5):1017-1022.
Addo J, Smeeth L, Leon DA. Prevalence, detection, management, and control of hypertension in Ghanaian civil servants. Ethn Dis. 2008;18(4):505-511.
Addo J, Amoah AG, Koram KA. The changing patterns of hypertension in Ghana: a study of four rural communities in the Ga District. Ethn Dis. 2006;16(4):894-899.
Amoah AG. Hypertension in Ghana: a cross-sectional community prevalence study in greater Accra. Ethn Dis. 2003;13(3):310-315.
Ankrah D, Hallas J, Odei J, Asenso-Boadi F, Dsane-Selby L, Donneyong M. A review of the Ghana National Health Insurance Scheme claims database: possibilities and limits for drug utilization research. Basic Clin Pharmacol Toxicol. 2019;124(1):18-27.
Authority GNHI. NHIS Medicines List 2021; 2021. http://www.nhis.gov.gh/files/Main%20Medicines%20List%202021%20March%20Version%20(003).pdf. Accessed March 23, 2021.
Dsane-Selby HWNOL. Ghana National Health Insurance Scheme: Improving Financial Sustainability Based on Expenditure Review.
Ministry of Health RoG. Standard Treatment Guidelines. 7th ed; 2017.
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520.
Methodology WCCfDS. Definition and general considerations; 2021. https://www.whocc.no/ddd/definition_and_general_considera/. Accessed March 19, 2021.
Ford B. Incomplete data in sample surveys. New York Academic Pr. 1983;185:207.
Little RJ. Survey nonresponse adjustments for estimates of means. Int Stat Rev. 1986;54(2):139-157.