Pharmacist-Led Hypertension detection and management services in the Ghanaian community pharmacy: an exploratory study

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In Ghana, as in most sub-Saharan African countries, hypertension is one common cardiovascular disease that is reported in hospitals. There is evidence that life style modifications and adequate control of blood pressure with medicines can help manage hypertension effectively and prevent complications such as stroke. The objective of the study was to evaluate a pharmacist-led hypertension detection and management service in the community pharmacy. The study was in two parts. The detection aspect of the research was an exploratory intervention study conducted from February 2012 – March 2013 in three community pharmacies. Although 250 clients were approached, 170 agreed to be screened by the Medicine Counter Assistant (MCA). Those whose blood pressure was above 140/90 were referred to the pharmacist for further assessment, who then referred them to the physician when necessary. Patient awareness and practices on some life style modification for the prevention of hypertension were also assessed; and the opinion of pharmacy staff was sought on their acceptance of the intervention. For the second part a quasi-experimental design was used to evaluate the impact of pharmacist intervention on blood pressure control and adherence among hypertensive patients. One hundred and eighty hypertensive patients were recruited for the study, 90 in the intervention group and 90 served as the control. The intervention offered by the pharmacist consisted of health education, adherence counselling and medicine use review. For hypertensive patients in the intervention group the intervention was offered at recruitment and every month for the next five months. Out of the 170 clients screened the most frequent modifiable risk factors identified were lack of exercise 107 (63%), poor diet (42%) and obesity (21%). Forty-three (25%) were pre hypertensive 42 (25%) had stage 1 hypertension and 13 (8%) had stage 2 hypertension. There was a significant relationship between BP and modifiable risk factors such as alcohol intake (P=0.045) and smoking (P<0.008). Lifestyle modification practised by respondents with prehypertension, reported on the sixth month, were weight reduction and reduced alcohol intake. Ten out of the 34 clients who were referred to the physician, were diagnosed with hypertension and an antihypertensive was prescribed. One hundred and forty-six out of the 180 hypertensive patients who were recruited for the second part of the study completed the study. At baseline there was no significant difference in demographic and clinical characteristics between Intervention Group (IG) and the Control Group (CG). Pharmaceutical care issues identified among the Intervention Group during the study period were non effectiveness of therapy (n=23), side effects (n=20) and nonadherence to therapy (n=40). Within the Intervention Group there was a reduction in systolic and diastolic blood pressure and this was statistically significant (p<0.01) at the end of the study. The mean diastolic blood pressure difference between Intervention Group and the Control group was statistically significant (f=20.250; p< 0.01; partial ղ2 =0.123). The mean adherence difference between the Intervention group and Control group was also statistically significant at the end of the study. (f=42.459; p<0.01 and partial ղ2 = 0.228). Hypertension preventative services offered in the Ghanaian community pharmacy, resulted in early detection of hypertension in 5.9 % of at risk clients screened, and promoted changes in some lifestyle practices among some patients with prehypertension. The Intervention offered by the pharmacist led to an improvement in blood pressure control and adherence among hypertensive patients.
A Thesis submitted to the Department of Clinical and Social Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences In partial fulfilment of the requirements for the degree of Doctor of Philosophy,