Projecting prescribing issues and patient patterns on the way to therapeutic appropriateness at the community level through elderly hypertensives

Abstract

Introduction: Despite treatment, up to 50% of older hypertensives have poorly controlled blood pressure in the community. Possibly, the management advice does not reach the intended. Who stands responsible; the prescriber, the system (social dynamics) or the patients themselves? The study aims to showcase various prescribing practices and patient behaviours that influence therapeutic delivery and thus patient care. Appropriate redressals to such practices and behaviours as and when required during health planning/practice could result in the percolation of the best possible care unto all socioeconomic strata within a community. Materials and Methods: Older patients on antihypertensives (n = 143) were interviewed by visits to various urban slums of a district in Western Maharashtra, India, between December 2018 and October 2020 for this cross-sectional, descriptive study. Demographic and clinical data were recorded on a predesigned pro forma with reasons for the patient's behavior concerning disease/treatment. Finally, available prescriptions and the latest blood/urine evaluations were recorded. Prescribing practices were recorded with available tools and data was analysed. Results: The mean age of the study population was 68 ± 7.39 years. Optimal control of the blood pressure was not achieved in 72.03% of patients (P < 0.0001%; 95% confidence interval [CI]: 32.94–53.54%), whereas adverse drug reactions (ADRs) occurred in 35.66% of patients. Physician's prescription was available in 101 patients for prescription quality assessment; however, 12 patients had never been prescribed and 30 lost their prescriptions. Even patients under regular follow-up with a physician failed to achieve the blood pressure targets or prevent an ADR. Finally, the patients' behavior was studied, wherein 41.22% became lost to follow-up and 64.13% of patients had old prescriptions. Forty-two patients could explain such behaviors. Conclusions: Both physicians and patients were responsible for poor blood pressure control. The means of assisting a physician on physician-patient communication would reduce physician workload (thus increasing efficiency) and reduce confusion/misconception (about drug/disease etc) that patient upholds (thus addressing counterproductive patient behaviours).

Keywords

• health behaviors
• patient behavior
• prescribing practices
• prescription quality