Barriers and Challenges in Managing Hypertension in Belitung, Indonesia: A Qualitative Study

Background: The Government of Indonesia has provided a Chronic Disease Management Program, better known as PROLANIS, to reduce the incidence of hypertension; however, the prevalence of hypertension remains high in the community, especially in Belitung, Indonesia, which warrants further investigation. One of the strategies to decrease the number of hypertensions is by addressing barriers and challenges in hypertension management according to patients’ points of view, which has become a lack of focus in previous studies.Purpose: This study aimed to explore the barriers and challenges of patients in managing hypertension in Belitung, Indonesia.Methods: This research employed a qualitative descriptive study design with 20 hypertensive patients who had access to the PROLANIS program in public health centers. Focus group discussions were conducted for data collection. The content analysis was used for data analysis.Results: Six themes were developed from the data, including (1) Dietary habits: the role of salt, (2) Nonadherence to medication due to the use of traditional medicine, (3) Shopping habit on nonprescription medication, (4) Confusion of anti-hypertensive drugs, (5) Barriers to physical exercise, and (6) Health monitoring and education.Conclusion: This study serves as an input for nurses and healthcare providers to improve the PROLANIS program, especially in hypertension management, as well as to develop new nursing interventions according to the barriers and challenges.

Nonprescription Medication Use in Hospice Patients

Objective: Patients admitted to hospice are more vulnerable to age-related physiologic changes, polypharmacy, and inappropriate medication use and monitoring. The objective of this study was to characterize the utilization of nonprescription medications in a hospice population. Methods: This was a retrospective study designed to characterize nonprescription or over-the-counter medication use in hospice patients. Data for this study were provided by Seasons Hospice & Palliative Care, a national hospice organization with licenses to operate in 19 states and collected from January 1 to December 31, 2016. The most frequently utilized nonprescription medications, therapeutic classes, and the frequency of patients with at least 1 claim within a therapeutic class were summarized. Results: The final study population included 62 639 orders representing 15 164 patients. The average age was 79.31 years with a standard deviation of 13.31 years. The average length of stay was 26.80 days with a standard deviation of 44.14 days. The top 5 most common medications were as follows: acetaminophen (25.15%), bisacodyl (21.69%), senna (8.35%), omeprazole (4.51%), and docusate (4.46%). Approximately 13 714 (29.67%) of patients were exposed to analgesics, 13 469 (29.14%) to laxatives, and 3535 (7.65%) to antacids or antigas medications. Conclusion: This study highlights numerous opportunities for improvement in the use of nonprescription medications among hospice patients. Reducing the use of nonprescription medications that are ineffective or produce unwanted side effects can contribute to improving the quality of care that patients receive.