PREPARED BY: FILZA NAJIHA BINTI SAMSUDIN & NUR AZIEMAH BINTI MOHD. FAUZI DIPLOMA IN PHARMACY UNIVERSITY TEKNOLOGY MARA (UiTM)

1. ‘PATIENT’S COMPLIANCE TOWARDS
ANTIHYPERTENSIVE DRUGS AT HOSPITAL SULTANAH
NORA ISMAIL
PREPARED BY: FILZA NAJIHA BINTI SAMSUDIN &
NUR AZIEMAH BINTI MOHD. FAUZI
DIPLOMA IN PHARMACY
UNIVERSITY TEKNOLOGY MARA (UiTM)
1

2. INTODUCTION
AIM &
OBJECTIVES
LITERATURE
REVIEW
METHODOLOGYRESULTSDISCUSSION
REFERENCES CONCLUSION

4. Hypertension prevalence is rising across the
region and is of growing public health
concern in both the developed and
developing countries.
The rise in Malaysia over the past 10 years
and now affects an estimated 4.8 million
Malaysians.

5. Elevation of the arterial
blood pressure above the
normal range expected
(120/80mmHg).
May be of unknown cause.
Drugs used include
diuretics, ACE inhibitors,
calcium-channel blockers,
beta blockers and alpha
blockers.
Can lead to many other
related diseases such as
stroke and kidney
malfunction.
HYPERTENSION

6. • Compliance can be defined as taking the correct
amount of the prescribed medicine at the proper
time
• Cramer et al. (2008) - refers to the act of conforming
to the recommendations made by provider with
respect to timing, dosage, and frequency of
medication taking
• Can be defined as “the extent to which a patient acts
in accordance with the prescribed interval and dose
of a dosing regimen”.
• Medicine will be effective only when taken as
prescribed by the physician
• Medication non-compliance is a failure to take drugs
on time in the dosage prescribed, is as dangerous
and costly as many other illnesses.
Cramer, J.A., Roy, A., Burrel, A. Et al. Medication Compliance And Persistence : Terminology And Definitions. Value Health [online] 2008, 11:45-46. Available
at http://www.ispor.org/workpaper/research_practices/Cramer.pdf [Accessed on July 2012]

8. • Research from Jurnal Kesihatan Negeri Johor, 2012.
• Title : The evaluation of quality of life in hypertensive
patients by using Short Form-36 in the Muar district,
Johor.
• Objective : To determine the impacts of quality of life
among hypertensive patients using Short Form-36.
• Carried out at the government clinics from 1st
November 2010 to 31st January 2011.
• Evaluation : Physical and Mental component.
• Results : Affects more on their physical component
compare to mental component.
• Conclusion: The longer the patient suffers from
hypertension, the lower will be his or her quality of life
either from the physical or mental aspect.
MohdAnuar AR, KhatijahI :. Analysis On Evaluation Of Quality Of Life In Hypertensive Patients By Using
Short Form 36 In The Muar District,Johor . JurnalKesihatanNegeri Johor,2012; 10: 13-17.

10. • To assess the level of compliance of
hypertension patients in Hospital Sultanah
Nora Ismail towards antihypertensive
drugs.
Aim
• To evaluate the percentage of
hypertension patients whom are
not comply with the
antihypertensive medications.
• To evaluate patient’s main problem
regarding non-compliance to their
medications.
• To suggest a good strategy to
increase patient’s compliance and
understanding towards the
importance of medication intake
Objectives

12. Type of study Prospective study
Settings Farmasi Pakar 1 Hospital Sultanah
Nora Ismail
Duration 4 months (20th August 2012 until 19th December
2012)
Sample size 100

13. • Subjects were enrolled to the study based on the
following inclusion and exclusion criteria:
• Subjects will be recruited using convenience
sampling.
• Subjects will be required to provide verbal
consent to participate in the study.
Inclusion criteria
• Patient who have been
diagnosed with
hypertension.
• Patient that receive the
medication from the
Outpatient Pharmacy
Department of Hospital
Sultanah Nora Ismail.
• Patient who come back
for follow up.
Exclusion criteria
• Patient who have a
normal blood pressure.
• Paediatric patients.
• Warded patients.

14. DATA COLLECTION :
Using self-administered questionnaire
containing three parts :
1. Demographics.
2. Four questions to assess their compliance.
3. Reasons why they are not compliance.
DATA ANALYSIS :
 SPSS software (version 15.0)
 Microsoft Excel 2007

16. DEMOGRAPHIC INFORMATION
Age Number of patients Percentage (%)
31-40 2 2
41-50 18 18
51-60 27 27
61-70 24 24
71-80 20 20
>80 9 9
Gender
Male 52 52
Female 48 48
Race
Malay 52 52
Chinese 36 36
Indian 12 12
Others 0 0

17. Group of medication Number of patient
(percentage (%))
Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor) 6 (6%)
β-blocker 5 (5%)
Calcium Channel Blocker 8 (8%)
Angiotensin-II Receptor Antagonist 3 (3%)
β-blocker + Angiotensin Converting Enzyme Inhibitor 9 (9%)
β-blocker + Diuretic 3 (3%)
Angiotensin Converting Enzyme Inhibitor + Diuretic 3 (3%)
Angiotensin Converting Enzyme Inhibitor + Calcium Channel Blocker 6 (6%)
Calcium Channel Blocker + Diuretic 2 (2%)
Calcium Channel Blocker + β-blocker 2 (2%)
Angiotensin-II Receptor Antagonist + β-blocker + Diuretic 3 (3%)
β-blocker + Calcium Channel Blocker + α antagonist 1 (1%)
Angiotensin Converting Enzyme Inhibitor + Calcium Channel Blocker +
Diuretic
6 (6%)
Calcium Channel Blocker + Diuretic + α antagonist 2 (2%)
Calcium Channel Blocker + Diuretic + β-blocker 5 (5%)
Angiotensin-II Receptor Antagonist + Calcium Channel Blocker + β-blocker 3 (3%)
Angiotensin-II Receptor Antagonist + Calcium Channel Blocker + Diuretic 5 (5%)
Angiotensin Converting Enzyme Inhibitor +Diuretic + β-blocker 6 (6%)
β-blocker + Calcium Channel Blocker +Angiotensin Converting Enzyme
Inhibitor
14 (14%)
Calcium Channel Blocker + Angiotensin Converting Enzyme Inhibitor + α
antagonist
2 (2%)
Angiotensin-II Receptor Antagonist + Calcium Channel Blocker + Diuretic+ β-
blocker
2 (2%)
Calcium Channel Blocker + Diuretic + β-blocker +Angiotensin Converting
Enzyme Inhibitor
4 (4%)

18. 38
17
27
9 9

19. 22.6
59.7
83.9
21
16.1
19.4
27.4
0
10
20
30
40
50
60
70
80
90
A B C D E F G
Percentage(%)
Reasons
REASONS FOR NON-COMPLIANT
Keywords :
A : Do not understand the intake of the medicine
B :Taking too much medication at same time as antihypertensive drugs
C : Forgetfulness /careless to take medicine
D : Lack of awareness on the importance of taking health
E : Preferred more to traditional medicine
F : Worry about the side effect of the medicine taken
G : Time/place constraint to get the medicine

20. 35 %
65 %
PERCENTAGE OF PATIENTS THAT KNOW THE PRICE
OF THEIR MEDICINES
yes
no

22. Reasons of noncompliance
Taking too
much of
medication
Failure to take
the
medication
Taking a drug
for the wrong
reason
Incorrect time
of
administration
Hassan NB,C I Hasanah, S B Ismail, K Foong, Li Naing,R Awang,A.Ishak . Identification of psychosocial factors of noncompliance in hypertensive
patients. Journal Of Human Hypertension [online] 2005 ;20: 23-29 . Aavailable from
http://www.nature.com/jhh/journal/v20/n1/full/1001930a.html [Accessed on 21 Disember 2012]

23. How to increase the level of
compliance?
Pharmacist Physician

24. PHARMACIST.
• Implement the system at community-based
pharmacy.
WHY??
• A DIRECT INVOLVEMENT in patient’s treatment
plan.
• The OPPORTUNITY TO PROPOSE to the physician
on the best medication regimen patients have to
take by changing or altering the patient’s medical
regimen under the supervision by the physician.
• The only member of the health care team who has
ACCESS to information about all the patient’s
drugs.

25. PHYSICIAN
• Use the SIMPLE LANGUAGE while give
the explanation to the patient regarding
on their medication.
• A consideration on PATIENT’S OPINION
because patient’s themselves are the
one who take the medication.

26. PHYSICIAN + PHARMACIST
• DISCUSS - so that the best method
can be implement to improve the
patient compliance.
• SHARES their knowledge to improve
patient’s care and compliance.

27. • Ask the patient to buy and use the
medication container, make an alarm
on their phone as well as, stick a note
so that they will not forget or careless
to take the medication at the right
time.
EXAMPLE OF MEDICATION CONTAINER

28. ALARM ON PHONE STICKY NOTE

29. Limitation
• Limited budget and number of workforce.
• Limited time
– We cannot include the warded patient (need a lot
of time to get the approval).

31. • Most or 38% of the respondents at Hospital
Sultanah Nora Ismail is compliance towards
their medications.
• Only 9% of the respondents is not
compliance.
• Among those of non-compliant patients, the
main reason for being noncompliance is
forgetfulness or careless to take the
medication.
• Compliance is important to ensure the goal
of the treatment is achieved as medicine will
be effective only when taken as prescribed
by physician.

33. 1. Cramer, J.A., Roy, A., Burrel, A. Et al. Medication Compliance And Persistence : Terminology And Definitions. Value Health [online]
2008, 11:45-46. Available at http://www.ispor.org/workpaper/research_practices/Cramer.pdf [Accessed on July 2012]
2. Hammond SL, Lambert BL: Communicating about medications .Directions for research.Health Common. [online] United States: US
Ntional Library of Medicine; 2007. Available from http://www.ncbi.nlm.nih.gov/pubmed/21690430 [Accessed November 2012]
3. Hassan NB,C I Hasanah, S B Ismail, K Foong, Li Naing,RAwang,A.Ishak .Identification of psychosocial factors of noncompliance in
hypertensive patients.Journal Of Human Hypertension [online] 2005 ;20: 23-29 . Aavailable from
http://www.nature.com/jhh/journal/v20/n1/full/1001930a.html [Accessed on 21 Disember 2012]
4. Hayes RB, Taylor DW, SackettDL :Compliancce in health care. John Hopkins University Press Baltimore MD.2010
5. Kyngas, Helvi RN, Lahdenpera. Compliance of patients with hypertension and other associated factors. Journal Of Advanced Nursing
[online] 2008; 5: 65-68. Available at http://202.186.179.7/ovidweb.cgi [Accessed November 2012].
6. Marieb EN. Essentials of Human Anatomy and Physiology. San Fransisco : Pearson Benjamin Cummings ; 2009
7. Martin J ed. Jordan B ed.British National Formulary. 61. London : BMJ Group and Pharmaceutical Press ;2011
8. MohdAnuar AR, KhatijahI :. Analysis On Evaluation Of Quality Of Life In Hypertensive Patients By Using Short Form 36 In The Muar
District,Johor . JurnalKesihatanNegeri Johor,2012; 10: 13-17.
9. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence [online].
Available at http://www.tcyh.org/medications/downloads/pfizer/MedicationMatters.pdf [Accessed July 2012]
10. Shaun H ,Hypertansion on the rise . [online] Kuala Lumpur : The Star ; 2010. Available from
http://thestar.com.my/news/story.asp?file=/2010/1/29/nation/20100129142214&sec=nation [Accessed 8th November 2012].
11. The Oxford Medical Dictionary (2010) vol.5, Oxford: Oxford University Press.
12. Wee HL, Cheung YB, Li Sc. The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life : Is the
whole greater than the sum of its parts? Pub Med Central Journal [online] 2005 ; 3:2 .Available from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC548134/ [Accessed November 2012].