A Cross-Sectional Survey of Fixed-Dose Combination Antihypertensive Medicine Prescribing in Twenty-Four Countries, Including Qualitative Insights.

Autor:	O'Hagan E; Westmead Applied Research Centre, The University of Sydney, Entrance K, Level 5, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia., McIntyre D; Westmead Applied Research Centre, The University of Sydney, Entrance K, Level 5, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia., Nguyen T; The George Institute for Global Health, Level 18, International Towers 3, 300 Barangaroo Ave, Sydney, NSW, 2000, Australia.; Sydney School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd Camperdown, NSW, 2050, Australia., Tan KM; Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia., Hanlon P; School of Health and Wellbeing, University of Glasgow, Clarice Pears building, Byres Road, Glasgow, UK., Siddiqui M; Westmead Applied Research Centre, The University of Sydney, Entrance K, Level 5, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia., Anastase D; Clinical Research Education, Networking and Consultancy and Department of Medicine, Douala General Hospital, Douala, Cameroon., Lim TW; National University Heart Centre, National University Hospital, 5 Lower Kent Ridge Road, 119074, Singapore., Uzendu A; Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States., Van Nguyen T; University of Medicine & Pharmacy at Ho Chi Minh City, Ho Chi Min City, Vietnam., Wong WJ; Sydney School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd Camperdown, NSW, 2050, Australia.; School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Subang Jaya, Selangor, Malaysia., Khor HM; Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia., Kumar P; All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, Ansari Nagar East, New Delhi, Delhi 110029, India., Usherwood T; Westmead Applied Research Centre, The University of Sydney, Entrance K, Level 5, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia., Chow CK; Westmead Applied Research Centre, The University of Sydney, Entrance K, Level 5, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia.
Jazyk:	angličtina
Zdroj:	Global heart [Glob Heart] 2024 Sep 12; Vol. 19 (1), pp. 73. Date of Electronic Publication: 2024 Sep 12 (Print Publication: 2024).
DOI:	10.5334/gh.1353
Abstrakt:	Background: Treatment inertia, non-adherence and non-persistence to medical treatment contribute to poor blood pressure (BP) control worldwide. Fixed dose combination (FDC) antihypertensive medicines simplify prescribing patterns and improve adherence. The aim of this study was to identify factors associated with prescribing FDC antihypertensive medicines and to understand if these factors differ among doctors worldwide. Methods: A cross-sectional survey was conducted online from June 2023 to January 2024 to recruit doctors. We collaborated with an international network of researchers and clinicians identified through institutional connections. A passive snowballing recruitment strategy was employed, where network members forwarded the survey link to their clinical colleagues. The survey instrument, developed through a literature review, interviews with academic and clinical researchers, and pilot testing, assessed participants perspectives on prescribing FDC antihypertensive medicines for hypertension. Participants rated their level of agreement (5-point Likert scale) with statements representing six barriers and four facilitators to FDC use. Findings: Data from 191 surveys were available for analysis. 25% (n = 47) of participants worked in high-income countries, 38% (n = 73) in upper-middle income, 25% (n = 48) in lower-middle income, 6% (n = 10) in low-income countries. Forty percent (n = 70) of participants were between 36-45 years of age; two thirds were male. Cost was reported as a barrier to prescribing FDC antihypertensive medicines [51% (n = 87) agreeing or strongly agreeing], followed by doctors' confidence in BP measured in clinic [40%, (n = 70)], access [37%, (n = 67)], appointment duration [35%, (n = 61)], concerns about side-effects [(21%, n = 37)], and non-adherence [12%, (n = 21)]. Facilitators to FDC antihypertensive polypills prescribing were clinician facing, such as access to educational supports [79%, (n = 143)], more BP measurement data [67%, (n = 120)], a clinical nudge in health records [61%, (n = 109)] and patient-facing including improved patient health literacy [49%, (n = 88)]. The levels of agreement and strong agreement across all barriers and facilitators were similar for participants working in higher or lower income countries. Across all countries, participants rated FDC antihypertensive medications highly valuable for managing patients with non-adherence, (82% reported high or very high value), for patients with high pill burden (80%). Interpretation: Cost and access were the most common barriers to prescribing FDCs across high- and low-income countries. While greater educational support for clinicians was perceived as the leading potential facilitator of FDC use, this seems unlikely to be effective without addressing access. Competing Interests: The authors have no competing interests to declare. (Copyright: © 2024 The Author(s).)
Databáze:	MEDLINE
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