The impact of pharmacist-led intervention on medication and lifestyle non-adherence among patients with uncontrolled blood pressure in Southwestern Nigeria

Abstract

Non-adherence to recommended therapy remains a challenge to achieving optimal clinical outcomes. The study aimed to evaluate the impact of a pharmacist-led intervention on treatment non-adherence among patients with poorly-controlled blood pressure (BP) in two tertiary healthcare facilities in Nigeria. This is a quasi-randomised study among 200 hypertensive patients enrolled from two tertiary healthcare facilities using a questionnaire-guided interview. Patients were allocated to control (BP < 140/90mmHg) and intervention (BP ≥ 140/90mmHg) groups. The baseline questionnaire comprising of different scales to assess patients’ adherence to medications, diet and physical activity. Patients were followed up for 6 months. During this period, patients in the intervention group received patient-specific educational intervention to resolve discrepancies identified in the intervention group only, while the control group continued to receive usual care. Data was analysed using descriptive and inferential statistics with p < 0.05 considered significant. Mean age was 63.3 ± 11.2 years. After 6-month follow-up, the mean systolic and diastolic blood pressure decreased insignificantly from 121.3 ± 11.5/74.4 ± 7.9mmHg to 120.2 ± 13.5/74.4 ± 8.3mmHg (control group) and significantly from 150.4 ± 14.5/89.7 ± 10.0mmHg to 142.9 ± 13.8/85.5 ± 9.0mmHg in the intervention group (p < 0.001). While medication adherence and dietary adherence improved significantly in the intervention group. Dietary adherence score increased significantly from 49.0 ± 7.7 at baseline to 55.5 ± 4.0 at 6-month (intervention), p < 0.001, and insignificantly from 52.3 ± 7.2 to 53.1 ± 7.2 (p = 0.061) in the control group. Although physical activity scores increased slightly, the change was not statistically significant. There was an improved adherence to medications, diet and physical activity in the intervention group, with a corresponding significant reduction of BP. These findings highlight the essential role of pharmacists in improving adherence and blood pressure control in hypertensive patients. ClinicalTrials.gov identifier NCT04712916. Retrospectivelyregistered.