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.

Diabetes is one of the most pressing health issues in the Southeast Asian region, and hypertension has been commonly reported as a comorbidity in adults with diabetes. This systematic review aimed to synthesize evidence on the prevalence and management of hypertension in adults with diabetes in Southeast Asian countries. A literature search was conducted in Ovid MEDLINE and Embase Classic + Embase from database inception until March 15, 2024. Studies were included if (1) they were conducted in Southeast Asian countries, (2) the study populations were adults with diabetes, and (3) there was information related to hypertension or blood pressure (BP) in the study results. Of the 7486 abstracts found, 90 studies qualified for this review. Most studies reported a hypertension prevalence of 70% or higher (ranging from 29.4% to 93.4%). Despite this high prevalence, a substantial proportion of these populations did not receive adequate BP control, with most studies indicating a control rate of less than 40%. There was limited evidence on the prescription of antihypertensive therapies and medication adherence. There was a lack of studies from 4 of the 11 countries in the region. This review highlights that BP control in adults with diabetes remains a significant challenge in Southeast Asia. Given the ongoing epidemiological transition, and the increasing older population in this region who are likely to accumulate multiple chronic conditions complicating medication strategies, this review highlights the urgent need to improve BP management in those with diabetes.

Purpose: This study aimed to explore pharmacy students’ perceptions of remote flipped classrooms in Malaysia, focusing on their learning experiences and identifying areas for potential improvement to inform future educational strategies.Methods: A qualitative approach was employed, utilizing inductive thematic analysis. Twenty Bachelor of Pharmacy students (18 women, 2 men; age range, 19–24 years) from Monash University participated in 8 focus group discussions over 2 rounds during the coronavirus disease 2019 pandemic. Participants were recruited via convenience sampling. The focus group discussions, led by experienced academics, were conducted in English via Zoom, recorded, and transcribed for analysis using NVivo. Themes were identified through emergent coding and iterative discussions to ensure thematic saturation.Results: Five major themes emerged: flexibility, communication, technological challenges, skill-based learning challenges, and time-based effects. Students appreciated the flexibility of accessing and reviewing pre-class materials at their convenience. Increased engagement through anonymous question submission was noted, yet communication difficulties and lack of non-verbal cues in remote workshops were significant drawbacks. Technological issues, such as internet connectivity problems, hindered learning, especially during assessments. Skill-based learning faced challenges in remote settings, including lab activities and clinical examinations. Additionally, prolonged remote learning led to feelings of isolation, fatigue, and a desire to return to in-person interactions.Conclusion: Remote flipped classrooms offer flexibility and engagement benefits but present notable challenges related to communication, technology, and skill-based learning. To improve remote education, institutions should integrate robust technological support, enhance communication strategies, and incorporate virtual simulations for practical skills. Balancing asynchronous and synchronous methods while addressing academic success and socioemotional wellness is essential for effective remote learning environments.

Objective: The aim of this study was to identify the prevalence and patterns of comorbidity in community‐dwelling older people with type 2 diabetes mellitus (T2DM) attending general practice settings in Australia.Methods: This study involved a cross‐sectional analysis using the Bettering the Evaluation and Care of Health (BEACH) sub‐study data. In a series of sub‐studies, a representative sample of general practitioners was asked to record all diagnosed chronic conditions for patients at 40 consecutive encounters using structured paper‐based recording forms. The dataset was analysed with descriptive analyses, and exploratory factor analyses were applied to examine comorbidity patterns.Results: Of the 14,042 patients aged 65 years or older, 2688 had a diagnosis of T2DM (19%). Of the 2688 patients with T2DM, hypertension was present in 67% (95% CI: 64.6–70.0), followed by arthritis 52% (95% CI: 48.8–54.8), hyperlipidaemia 45% (95% CI: 41.8–47.9), ischemic heart disease, 23% (95% CI: 20.7–24.9), depression 16% (95% CI: 48.8–54.8), atrial fibrillation 10% (95% CI: 8.9–11.6), congestive heart failure 7% (95% CI: 6.0–8.1), stroke/cerebrovascular accident 7% (95% CI: 5.4–8.2) and peripheral vascular disease 5% (95% CI: 4.4–6.2). We identified two comorbidity patterns among older people with T2DM. The first were psychological and musculoskeletal conditions and the second were cardiovascular conditions and chronic renal failure.Conclusions: The prevalence of cardiovascular and non‐cardiovascular comorbidities in community‐dwelling older people with T2DM was high. Adequate primary care strategies should be in place to support the long‐term care for this population.

Aims: This study aimed to assess medication adherence among older people with coronary heart disease and its relationship with hospitalizations. Methods: This is a prospective cohort study conducted at the outpatient clinics of a major hospital in Vietnam from November 2022 to June 2023. Consecutive older patients with coronary heart disease were recruited and followed for 6 months. Medication adherence was defined using the five‐item Medication Adherence Report Scale (MARS‐5). Multivariable logistic regression models were applied to examine the impact of medication adherence on hospitalization due to cardiovascular disease (CVD) and all‐cause hospitalization. Results: There were 643 participants, mean age 73 ± 8 years, 74.3% were male. Overall, 76.4% (491/643) were classified as ‘adherent’. Over 6 months follow‐up, 23.3% of the participants were admitted to hospital and of these hospitalizations, 9.2% were due to CVD. The CVD‐related hospitalization rate was significantly higher in the non‐adherent group compared to the adherent group (13.8% vs . 7.7%, P = 0.023, respectively). In logistic regression models, medication adherence was associated with significantly reduced odds of CVD‐related hospitalization (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI] 0.27–0.86). Medication adherence was also associated with a trend of reduced all‐cause hospitalization (adjusted OR 0.75, 95% CI 0.49–1.15). Conclusions: This study showed a positive relationship between medication adherence and reduced risk of CVD‐related hospitalization in older people with coronary heart disease. Healthcare providers should consider incorporating adherence assessment into the long‐term care for older patients with coronary heart disease.

One of the leading causes of poor adherence to antihypertensive medications is forgetfulness. A better understanding of the impact of forgetfulness can help in developing targeted interventions to improve blood pressure (BP) control. This study aimed to (1) examine the prevalence of forgetfulness to take antihypertensive medications and its associated factors in older adults with type 2 diabetes and hypertension, and (2) investigate the relationship between forgetfulness to take antihypertensive medications and poor BP control in this population. This observational study was conducted at the outpatient clinics of two hospitals in Vietnam from June 2023 to June 2024. Forgetfulness was assessed using the question: “Do you sometimes forget to take your prescribed antihypertensive medications?”. Poor BP control was defined as a mean systolic BP ≥140 mm Hg or a mean diastolic BP ≥90 mm Hg. There were 448 participants. They had a mean age of 73.5 years (SD 7.2), 32.1% were female. The prevalence of forgetfulness to take antihypertensives was 29.5%, highest among participants in the first 5 years of hypertension (43.8%), followed by those with >15 years (28.0%), 11–15 years (25.2%), and 6–10 years (23.9%) (p = 0.009). Logistic regression analysis revealed that hypertension duration and disability in activities of daily living were significantly associated with forgetfulness. Forgetfulness increased the odds of poor BP control, with an adjusted OR of 1.64 (95% CI 1.03–2.56). These findings suggest the need for future studies focusing on interventions on forgetfulness to improve medication adherence for this population.