Factors affecting medication adherence in Lebanese patients with chronic diseases

  • Amal Al-Hajje
  • Sanaa Awada
  • Samar Rachidi
  • Salam Zein
  • Wafa Bawab
  • Zeinab El-Hajj
  • Mayssam Bou Zeid
  • Mohammad Yassine
  • Pascale Salameh
Keywords: Medication Adherence, Prevalence, Causality, Multivariate Analysis, Lebanon

Abstract

Background: Non-adherence to prescribed medications represents an obstacle toward achieving treatment goals. This problem is more pronounced in patients with chronic illness.

Objective: To identify the extent of adherence in Lebanese outpatients with chronic diseases, and to suggest possible predictors of non-adherence in this population. The secondary objective was to assess if medication adherence affects patients' quality of life.

Methods: A questionnaire was administered face-to-face to a sample of Lebanese adults visiting the external clinics at two Tertiary Care Hospitals in Beirut. The level of adherence was assessed using the 8-item Morisky Medication Adherence Scale which was first validated. The health-related quality of life (HRQoL) of patients was measured using the EQ-5D. Linear regression and logistic regression analyses examined possible predictors of adherence.

Results: Out of the 148 patients included in this study, 42.6% were classified as adherent. In the univariate analyses, statistically significant predictors of high adherence included good physician-patient relationship (p=0.029) and counseling (p=0.037), a high level of HRQoL (p<0.001), and a high level of perceived health (p<0.001). Predictors of low adherence included a declining memory (p<0.001), anxiety/depression (p=0.002), little drug knowledge (p<0.001), and postponing physician appointments (p<0.001). The multivariate analyses revealed similar results. In the linear regression, the most powerful predictor of non-adherence was the disbelief that the drug is ameliorating the disease (beta=0.279), however, in logistic regression, patient who were willing to skip or double doses in case of amelioration/deterioration were found to be 7.35 times more likely to be non-adherent than those who were not (aOR=0.136, 95%CI: 0.037-0.503).

Conclusion: The findings of this study reassure the view that patients should be regarded as active decision makers. Patient education should be regarded as a cornerstone for treatment success. Additional studies as well are needed to test the practicability and effectiveness of interventions suggested to enhance adherence.

Downloads

Download data is not yet available.

References

1. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;(2):CD000011. doi: 10.1002/14651858.CD000011.pub3

2. Hovstadius B, Petersson G. Non-adherence to drug therapy and drug acquisition costs in a national population - a patient-based register study. BMC Health Serv Res. 2011;11:326. doi: 10.1186/1472-6963-11-326

3. Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44-47. doi: 10.1111/j.1524-4733.2007.00213.x

4. Laufs U, Rettig-Ewen V, Böhm M. Strategies to improve drug adherence. Eur Heart J. 2011;32(3):264-268. doi: 10.1093/eurheartj/ehq297

5. Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005;43(6):521-530.

6. Atella V, Peracchi F, Depalo D, Rossetti C. Drug compliance, co-payment and health outcomes: Evidence from a panel of Italian patients. Health Econ. 2006;15(9):875-892.

7. Martin LR, Williams SL, Haskard KB, DiMatteo MR. The challenge of patient adherence. Ther Clin Risk Manag. 2005;1(3):189-199.

8. Moore T, Neher J. Safranke S. FPIN’s clinical inquiries: improving medication adherence in patients with comorbidities. Am Fam Physician. 2011;84(7):1-2.

9. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23(8):1296-1310.

10. Coleman CI, Limone B, Sobieraj DM, Lee S, Roberts MS, Kaur R, Alam T. Dosing frequency and medication adherence in chronic disease. J Manag Care Pharm. 2012;18(7):527-539.

11. Bangalore S, Kamalakkannan G, Parkar S, Messerli FH. Fixed-dose combinations improve medication compliance: A meta-analysis. Am J Med. 2007;120(8):713-719.

12. Shrank WH, Hoang T, Ettner SL, Glassman PA, Nair K, DeLapp D, Dirstine J, Avorn J, Asch SM. The implications of choice: Prescribing generic or preferred pharmaceuticals improves medication adherence for chronic conditions. Arch Intern Med. 2006;166(3):332-337.

13. Briesacher BA, Andrade SE, Fouayzi H, Chan KA. Medication adherence and the use of generic drug therapies. Am J Manag Care. 2009;15(7):450-456.

14. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348-354.

15. EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990; 16(3):199-208.

16. Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999;47(6):555-567.

17. Rolnick SJ, Pawloski PA, Hedblom BD, Asche SE, Bruzek RJ. Patient characteristics associated with medication adherence. Clin Med Res. 2013;11(2):54-65. doi: 10.3121/cmr.2013.1113

18. Gold D, McClung B. Approaches to patient education: Emphasizing the long- term value of compliance and persistence. Am J Med. 2006;119(4 Suppl 1):S32-S37.

19. DiMatteo M, Reiter R. Gambone J. Enhancing medication adherence through communication and informed collaborative choice. Health Communication. 1994;6(4):253-265.

20. Balkrishnan R. Predictors of Medication Adherence in the Elderly. Clin Ther. 1998;20(4):764-771.

21. Lau HS, Beuning KS, Postma-Lim E, Klein-Beernink L, de Boer A, Porsius AJ. Non-compliance in elderly people: Evaluation of risk factors by longitudinal data analysis. Pharm World Sci. 1996;18(2):63-68.

22. Fincke BG, Miller DR, Spiro A 3rd. The interaction of patient perception of overmedication with drug compliance and side effects. J Gen Intern Med. 1998;13(3):182-185.

23. Gadkari AS, McHorney CA. Unintentional non-adherence to chronic prescription medications: How unintentional is it really? BMC Health Serv Res. 2012;12:98. doi: 10.1186/1472-6963-12-98

24. Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, Johnson JA. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006;333(7557):15.

25. Saleem F, Hassali MA, Shafie AA, Awad GA, Atif M, ul Haq N, Aljadhey H, Farooqui M. Does treatment adherence correlates with health related quality of life? Findings from a cross sectional study. BMC Public Health. 2012;12:318. doi: 10.1186/1471-2458-12-318

26. Côté I, Farris K, Feeny D. Is adherence to drug treatment correlated with health-related quality of life? Qual Life Res. 2003;12(6):621-633.

27. Saleem F, Hassali MA, Shafie AA, Awad AG, Bashir S. Association between Knowledge and Drug Adherence in Patients with Hypertension in Quetta, Pakistan. Trop J Pharm Res. 2011;10(2):125-132.

28. Garber MC, Nau DP, Erickson SR, Aikens JE, Lawrence JB. The Concordance of Self-Report With Other Measures of Medication Adherence: A Summary of the Literature. Med Care. 2004 Jul;42(7):649-652.

29. Voils CI, Hoyle RH, Thorpe CT, Maciejewski ML, Yancy WS Jr. Improving the measurement of self-reported medication nonadherence. J Clin Epidemiol. 2011;64(3):250-254. doi: 10.1016/j.jclinepi.2010.07.014

30. Grymonpre RE, Didur CD, Montgomery PR, Sitar DS. Pill count, self-report, and pharmacy claims data to measure medication adherence in the elderly. Ann Pharmacother. 1998;32(7-8):749-754.

31. Briesacher BA, Andrade SE, Fouayzi H, Chan KA. Comparison of drug adherence rates among patients with seven different medical conditions. Pharmacotherapy. 2008;28(4):437-443. doi: 10.1592/phco.28.4.437

32. Glombiewski JA, Nestoriuc Y, Rief W, Glaesmer H, Braehler E. Medication adherence in the general population. PLoS One. 2012;7(12):e50537. doi: 10.1371/journal.pone.0050537
Published
2015-08-19
How to Cite
1.
Al-Hajje A, Awada S, Rachidi S, Zein S, Bawab W, El-Hajj Z, Bou Zeid M, Yassine M, Salameh P. Factors affecting medication adherence in Lebanese patients with chronic diseases. Pharm Pract (Granada) [Internet]. 2015Aug.19 [cited 2019Sep.22];13(3). Available from: https://pharmacypractice.org/journal/index.php/pp/article/view/590
Section
Original Research

Most read articles by the same author(s)