Associations between patient factors and medication adherence: A Jordanian experience
Objective: To explore the effect of patient characteristics and health beliefs on their medication adherence.
Methods: Patients (n=167) with chronic conditions (mean age 58.9; SD=13.54, 53% males) were recruited from March 2009- to March 2010 using a cross sectional study design. Data collected included patients’ demographics, medical conditions, medications therapeutic regimen, frequency of physician visits and health beliefs. Patient self-reported adherence to medications was assessed by the researcher using a validated and published scale. Treatment related problems (TRPs) were evaluated for each patient by competent clinical pharmacists. Associations between patient characteristics/health beliefs with adherence were explored.
Results: About half of the patients (46.1%) were non-adherent. A significant association was found between lower adherence and higher number of disease states (p<0.001), higher number of medications (p=0.001), and higher number of identified TRPs (p = 0.003). Patient adherence was positively affected by older age, higher educational level, and higher number of physician visits per month, while it was negatively affected by reporting difficulties with getting prescription refills on time.
Conclusion: This study identified different factors that may negatively affect adherence, including higher number of medications and disease states, higher number of identified TRPs and inability to getting prescription refills on time. Hence, more care needs to be provided to patients with complex therapeutic regimens in order to enhance adherence.
2. Granger BB, Ekman I, Granger CB, Ostergren J, Olofsson B, Michelson E, McMurray JJV, Yusuf S, Pfeffer MA, Swedberg K. Adherence to medication according to sex and age in the CHARM programme. Eur J Heart Fail. 2009;11(11):1092-1098. doi: 10.1093/eurjhf/hfp142
3. Basheti IA, Qunaibi EA, Bulatova NR, Samara S, AbuRuz S. Treatment related problems for outpatients with chronic diseases in Jordan: the value of home medication reviews. Int J Clin Pharm. 2013;35(1):92-100. doi: 10.1007/s11096-012-9713-4
4. Lewis NJ, Bugdalski-Stutrud C, Abate MA, Blommel M, Wu CH, Gaither CA. The Medication Assessment Program: comprehensive medication assessments for persons taking multiple medications for chronic diseases. J Am Pharm Assoc (2003). 2008;48(2):171-180. doi: 10.1331/JAPhA.2008.07141
5. Horne R. Compliance, adherence, and concordance: implications for asthma treatment. Chest. 2006;130(1 Suppl):65S-72S.
6. Bassett-Clarke D, Krass I, Bajorek B. Ethnic differences of medicines-taking in older adults: a cross cultural study in New Zealand. Int J Pharm Pract. 2012;20(2):90-98. doi: 10.1111/j.2042-7174.2011.00169.x
7. Otoom S BA, Hadidi H, Hasan M, Al-Saudi K. Evaluation of drug use in Jordan using WHO prescribing indicators East Mediterr Health J. 2002;8(4-5):544-549.
8. Yousef AM, Al-Bakri AG, Bustanji Y, Wazaify M. Self-medication patterns in Amman, Jordan. Pharm World Sci. 2008;30(1):24-30.
9. Qunaibi E, Basheti IA, Hamadi SA, Bulatova NR, Shanah A, Abu-Gharbieh E. Effect of divergence in patients’ socioeconomic background on their perspective of the role of the community pharmacist in Amman, Jordan. Trop J Pharm Res. 2013;12(2):247-253.
10. Roughead EE, Barratt JD, Gilbert AL. Medication-related problems commonly occurring in an Australian community setting. Pharmacoepidemiol Drug Saf. 2004;13(2):83-87.
11. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74.
12. Svarstad BL, Chewning BA, Sleath BL, Claesson C. The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999;37(2):113-124.
13. Krass I, Taylor SJ, Smith C, Armour CL. Impact on medication use and adherence of Australian pharmacists' diabetes care services. J Am Pharm Assoc (2003). 2005;45(1):33-40.
14. World Health Organization. Adherence to long-term therapies : evidence for action. Sabaté E eGWH, Organization; 2003. http://www.who.int/chp/knowledge/publications/adherence_introduction.pdf (accessed May 1, 2015).
15. 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
16. Hong JS, Kang HC. Relationship between continuity of ambulatory care and medication adherence in adult patients with type 2 diabetes in Korea: a longitudinal analysis. Med Care. 2014;52(5):446-53. doi: 10.1097/MLR.0000000000000110
17. Alhalaiqa F, Deane KH, Nawafleh AH, Clark A, Gray R. Adherence therapy for medication non-compliant patients with hypertension: a randomised controlled trial. J Hum Hypertens. 2012;26(2):117-126. doi: 10.1038/jhh.2010.133
18. Liekens S, Hulshagen L, Dethier M, Laekeman G, Foulon V. [Adherence to chronic medication: also a frequent problem in Belgium!]. J Pharm Belg. 2013;(4):18-27.
19. Jin J, Sklar GE, Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: A review from the patient's perspective. Ther Clin Risk Manag. 2008;4(1):269-286.
20. Sweileh WM, Zyoud SH, Abu Nab'a RJ, Deleq MI, Enaia MI, Nassar SM, Al-Jabi SW. Influence of patients' disease knowledge and beliefs about medicines on medication adherence: findings from a cross-sectional survey among patients with type 2 diabetes mellitus in Palestine. BMC Public Health. 2014;14:94. doi: 10.1186/1471-2458-14-94
21. Danladi J, Falang K, Barde R, Jimam N, Dangiwa D, Jimoh H. Pharmaceutical care and medication adherence in management of psychosis in a Nigerian tertiary hospital. J Res Pharm Pract. 2013;2(2):83-87. doi: 10.4103/2279-042X.117388
22. Weinman J, Petrie KJ, Moss-Morris R, Horne R. The illness perception questionnaire: A new method for assessing the cognitive representation of illness. Psychol Health. 1996;11(3):431-445.
23. Horne R, Chapman SC, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One. 2013;8(12):e80633. doi: 10.1371/journal.pone.0080633