Patients' attitudes towards medication have a major impact on disease management, but this is often neglected. A large body of literature has been published from developed nations on the evaluation of non-adherence in chronic disease management and in patients with hypertension in particular.1–2 However, there is a paucity of data in the context of hypertensive patients' perspective from developing countries, to gather in-depth information towards hypertension management.
In the context of developing nations like Pakistan, health-seeking behaviour always occurs in the context of medical pluralism, where the patient uses different systems of healing. Patients make independent assessments regarding the use of modern medicines. Orthodox medications do not have such dominance over the population as seen in the western world.3–4 In addition, indigenous healing systems, particularly hikmat (treatment with herbs) and spiritual healing, are quite prominent in these populations. There is no legal or official acknowledgment as far as the spiritual healing is concerned; but it is still the treatment of choice for the majority of the population. Insufficient information and understanding emerges as major barriers associated with all aspects of medicine use. Knowledge about the disease and drugs used for its treatment is apparently poor and in return produces a great impact on patients' adherence to medication. Another issue that lies ahead for health practitioners is that discussions of the advantages and disadvantages of drugs in ways that are relevant for individual patients is rarely seen in practice.
What is needed at this point is a complete revision of the practices that are currently being employed in the healthcare system. Individuals must be educated not only on the risk factors, presenting features, and complications of hypertension, but also about the benefits of medications on treatment outcomes and quality of life. Patients may need to be educated about the differences between curing hypertension and treating it with medications. Efforts to educate the public about lifestyle modifications in the prevention of hypertension and other cardiovascular diseases may also be of great importance. Advancement in preventive and curative health responses needs to be reconsidered. Development of immediate health strategies, policies, and interventions are the most important of the present day and this development has to move ahead from promises to practices. The gap between healthcare professionals and the patients must be narrowed if optimal results are to be achieved. This may result in the change of perception and the development of trust in medication that will lead to ideal pharmaceutical care.
- © British Journal of General Practice, 2010.