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Studer CM, Linder M, Pazzagli L. A global systematic overview of socioeconomic factors associated with antidiabetic medication adherence in individuals with type 2 diabetes. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:122. [PMID: 37936205 PMCID: PMC10631092 DOI: 10.1186/s41043-023-00459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Antidiabetic medication adherence is a key aspect for successful control of type 2 diabetes mellitus (T2DM). This systematic review aims to provide an overview of the associations between socioeconomic factors and antidiabetic medication adherence in individuals with T2DM. METHODS A study protocol was established using the PRISMA checklist. A primary literature search was conducted during March 2022, searching PubMed, Embase, Web of Science, as well as WorldCat and the Bielefeld Academic Search Engine. Studies were included if published between 1990 and 2022 and included individuals with T2DM. During primary screening, one reviewer screened titles and abstracts for eligibility, while in the secondary screening, two reviewers worked independently to extract the relevant data from the full-text articles. RESULTS A total of 15,128 studies were found in the primary search, and 102 were finally included in the review. Most studies found were cross-sectional (72) and many investigated multiple socioeconomic factors. Four subcategories of socioeconomic factors were identified: economic (70), social (74), ethnical/racial (19) and geographical (18). The majority of studies found an association with antidiabetic medication adherence for two specific factors, namely individuals' insurance status (10) and ethnicity or race (18). Other important factors were income and education. CONCLUSIONS A large heterogeneity between studies was observed, with many studies relying on subjective data from interviewed individuals with a potential for recall bias. Several socioeconomic groups influencing medication adherence were identified, suggesting potential areas of intervention for the improvement of diabetes treatment adherence and individuals' long-term well-being.
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Affiliation(s)
- Christian Ming Studer
- Department of Chemistry and Applied Biosciences, Institute for Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Marie Linder
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Laura Pazzagli
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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Udupa H, Viswanath A, Umesh Shenoy P, Antao KJ, Das R. Medication Adherence in Elderly Diabetic Patients: A Cross-Sectional Study From Dakshina Kannada, India. Cureus 2023; 15:e43098. [PMID: 37692709 PMCID: PMC10483026 DOI: 10.7759/cureus.43098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Diabetes Mellitus (DM) has emerged as a major global healthcare problem. The risk of diabetes can be reduced by maintaining blood glycaemic levels, which can be achieved by stringent adherence to the treatment regime. Therefore, there is a continuing need to assess the level of adherence to medication/self-care activities and the factors that are related to non-adherence to medication and self-care. This would facilitate healthcare professionals to identify subjects with low medication adherence and thereby aid them in planning interventions to improve medication and self-care adherence. In this study, we aimed to estimate the proportion of medication adherence among diabetic patients above 60 years of age attending a tertiary care hospital in Southern India. We found that 72% of type 2 diabetes patients were adherent to the medications prescribed to them and there was a discernible effect of gender and literacy on medication adherence. However, more such regional studies need to be conducted with a larger sample size from diverse hospital setups to obtain a clear and unbiased picture of the drug adherence scenario in India.
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Affiliation(s)
- Hrushikesh Udupa
- Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, IND
| | - Anusree Viswanath
- Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, IND
| | - Pooja Umesh Shenoy
- Data Analytics, Bioinformatics and Structural Biology (DABS), Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, IND
| | - Karen Jennifer Antao
- Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, IND
| | - Ranajit Das
- Data Analytics, Bioinformatics and Structural Biology (DABS), Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, IND
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Paudel G, Vandelanotte C, Dahal PK, Biswas T, Yadav UN, Sugishita T, Rawal L. Self-care behaviours among people with type 2 diabetes mellitus in South Asia: A systematic review and meta-analysis. J Glob Health 2022; 12:04056. [PMID: 35916498 PMCID: PMC9346342 DOI: 10.7189/jogh.12.04056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The burden of Type 2 Diabetes Mellitus (T2DM) in South Asian countries is increasing rapidly. Self-care behaviour plays a vital role in managing T2DM and preventing complications. Research on self-care behaviours among people with T2DM has been widely conducted in South Asian countries, but there are no systematic reviews that assess self-care behaviour among people with T2DM in South Asia. This study systematically assessed the studies reporting self-care behaviours among people with T2DM in South-Asia. Methods Adhering to the PRISMA guidelines, we searched six bibliographic databases (Scopus, PubMed, CINAHL, Embase, Web of Science, and PsychInfo) to identify the relevant articles published between January 2000 through March 2022. Eligibility criteria included all observational and cross-sectional studies reporting on the prevalence of self-care behaviours (ie, diet, physical activity, medication adherence, blood glucose monitoring, and foot care) conducted in South Asian countries among people with T2DM. Results The database search returned 1567 articles. After deduplication (n = 758) and review of full-text articles (n = 192), 92 studies met inclusion criteria and were included. Forward and backward reference checks were performed on included studies, which resulted in an additional 18 articles. The pooled prevalence of adherence to blood glucose monitoring was 65% (95% CI = 49-80); 64% for medication adherence (95% CI = 53-74); 53% for physical activity (95% CI = 39-66); 48% for diet (95% CI = 38-58); 42% for foot care (95% CI = 30-54). About a quarter of people with T2DM consumed alcohol (25.2%, IQR = 13.8%-38.1%) and were using tobacco products (18.6%, IQR = 10.6%-23.8%). Conclusions Our findings suggest that the prevalence of self-care behaviours among people with T2DM in South Asia is low. This shows an urgent need to thoroughly investigate the barriers to the practising of self-care and design and implement interventions to improve diabetes self-care behaviour among people with T2DM in South Asia.
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Affiliation(s)
- Grish Paudel
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia
| | - Corneel Vandelanotte
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, Australia
| | - Padam K Dahal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia
| | - Tuhin Biswas
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Uday N Yadav
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Tomohiko Sugishita
- Section of Global Health, Division of Public Health, Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia.,Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, Australia.,Translational Health Research Institute (THRI), Western Sydney University, Sydney Australia
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Habib MK, Khan MN, Sadiq A, Iqbal Q, Raziq A, Ahmad N, Iqbal Z, Haider S, Anwar M, Khilji FUR, Saleem F, Khan AH. Medication Errors and Type 2 Diabetes Management: A Qualitative Exploration of Physicians' Perceptions, Experiences and Expectations From Quetta City, Pakistan. Front Med (Lausanne) 2022; 9:846530. [PMID: 35419370 PMCID: PMC8995793 DOI: 10.3389/fmed.2022.846530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background Type 2 Diabetes-related medication errors are frequently reported from the hospitals and consequently are of major concern. However, such reports are insufficient when developing healthcare settings are pursued in literature. Keeping this inadequacy in mind, we therefore aimed to explore physicians' perceptions, experiences and expectations of medication errors when managing patients with Type 2 Diabetes Mellitus. Methods A qualitative design was adopted. By using a semi-structured interview guide through the phenomenology-based approach, in-depth, face-to-face interviews were conducted. Physicians practicing at the medicine ward of Sandeman Provincial Hospital, Quetta, were purposively approached for the study. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Results Although the saturation was reached at the 13th interview, we conducted additional two interviews to ensure the saturation. Fifteen physicians were interviewed, and thematic content analysis revealed six themes and nine subthemes. Mixed conceptualization and characterization of medication errors were identified. Medication errors were encountered by all physicians however poor understanding of the system, deficiency of logistics and materials were rated as barriers in reporting medication errors. Among contributors of medication errors, physicians themselves as well as dispensing and patient-related factors were identified. Physicians suggested targeted training sessions on medication error-related guidelines and reporting system. Parallel, establishment of an independent unit, involving the pharmacists, and strict supervision of paramedics to minimize medication errors was also acknowledged during data analysis. Conclusion With a longer life expectancy and a trend of growing population, the incidences of medication errors are also expected to increase. Our study highlighted prescribing, dispensing and administration phases as contributing factors of medication errors. Although, physicians had poor understanding of medication errors and reporting system, they believed getting insights on guidelines and reporting system is essential. A review of admission and discharge reconciliation must be prioritized and a culture of teamwork, communication and learning from mistakes is needed.
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Affiliation(s)
| | - Muhammad Naeem Khan
- Post Graduate Medical Institute, Bolan Medical Complex Hospital, Quetta, Pakistan
| | - Abdul Sadiq
- Department of Biochemistry, Jhalawan Medical College Khuzdar, Khuzdar, Pakistan
| | - Qaiser Iqbal
- Faculty of Pharmacy & Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Abdul Raziq
- Department of Statistics, University of Baluchistan, Quetta, Pakistan
| | - Nafees Ahmad
- Faculty of Pharmacy & Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Zaffar Iqbal
- Health Department, Government of Balochistan, Quetta, Pakistan
| | - Sajjad Haider
- Faculty of Pharmacy & Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Muhammad Anwar
- Faculty of Pharmacy & Health Sciences, University of Baluchistan, Quetta, Pakistan
| | | | - Fahad Saleem
- Faculty of Pharmacy & Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Amer Hayat Khan
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Malaysia
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Mardare I, Campbell SM, Meyer JC, Sefah IA, Massele A, Godman B. Enhancing Choices Regarding the Administration of Insulin Among Patients With Diabetes Requiring Insulin Across Countries and Implications for Future Care. Front Pharmacol 2022; 12:794363. [PMID: 35095504 PMCID: PMC8795368 DOI: 10.3389/fphar.2021.794363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
There are a number of ongoing developments to improve the care of patients with diabetes across countries given its growing burden. Recent developments include new oral medicines to reduce cardiovascular events and death. They also include new modes to improve insulin administration to enhance adherence and subsequent patient management thereby reducing hypoglycaemia and improving long-term outcomes. In the case of insulins, this includes long-acting insulin analogues as well as continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion systems, combined with sensor-augmented pump therapy and potentially hybrid closed-loops. The benefits of such systems have been endorsed by endocrine societies and governments in patients with Type 1 diabetes whose HbA1c levels are not currently being optimised. However, there are concerns with the low use of such systems across higher-income countries, exacerbated by their higher costs, despite studies suggesting their cost-effectiveness ratios are within accepted limits. This is inconsistent in higher-income countries when compared with reimbursement and funding decisions for new high-priced medicines for cancer and orphan diseases, with often limited benefits, given the burden of multiple daily insulin injections coupled with the need for constant monitoring. This situation is different among patients and governments in low- and low-middle income countries struggling to fund standard insulins and the routine monitoring of HbA1c levels. The first priority in these countries is to address these priority issues before funding more expensive forms of insulin and associated devices. Greater patient involvement in treatment decisions, transparency in decision making, and evidence-based investment decisions should help to address such concerns in the future.
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Affiliation(s)
- Ileana Mardare
- Public Health and Management Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Stephen M. Campbell
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Johanna C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Israel Abebrese Sefah
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Amos Massele
- Pharmacology and Therapeutics Department, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
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6
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Azharuddin M, Adil M, Sharma M, Gyawali B. A systematic review and meta-analysis of non-adherence to anti-diabetic medication: Evidence from low- and middle-income countries. Int J Clin Pract 2021; 75:e14717. [PMID: 34378293 DOI: 10.1111/ijcp.14717] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/17/2021] [Accepted: 08/08/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Non-adherence to anti-diabetic medication is an important cause of uncontrolled blood glucose that leads to complications of diabetes. However, there is a lack of evidence on the burden of and factors associated with non-adherence to anti-diabetic medication among individuals living with diabetes in low-and middle-income countries (LMICs). OBJECTIVES This systematic literature review and meta-analytic synthesis aims to estimate non-adherence to anti-diabetic medication reported among individuals in LMICs and explores factors affecting non-adherence. METHODS We systematically searched MEDLINE and Embase to identify studies investigating non-adherence to anti-diabetic medications published from January 2000 to May 2020. Two authors carried out study selection, screening, and data extraction independently. Cross-sectional studies that had been conducted among individuals with diabetes in LMICs were eligible for the selection process. Critical appraisal of the included studies was carried out using the Newcastle Ottawa Scale. Meta-analysis was carried out using Stata 14.2. Random effects model was used to compute the pooled proportion at a 95% confidence interval (CI). RESULTS Forty-three studies met the inclusion criteria, of which 13 studies were used in meta-analysis. The pooled proportion of non-adherence to anti-diabetic medications using the eight-item Morisky Medication Adherence Scale (MMAS-8) was 43.4% (95% CI: 17.5-69.4; P < 0.001) and 29.1% (95% CI: 19.8-38.4; P < 0.001) when using the cut-off at 80 or 90%. The pooled proportion of non-adherence was 29.5% (95% CI: 25.5-33.5; P = .098) when using the four-item Morisky Medication Adherence Scale (MMAS-4). Using the World Health Organization (WHO) five dimensions of medication adherence framework, the factors contributing to non-adherence were varied, including disease factors, therapy-related factors, healthcare system factor, patient-centred factors, and socio-economic factors. CONCLUSIONS Non-adherence to anti-diabetic medication remains an ongoing challenge in LMICs and several factors operating at different levels were cited as reasons. Comprehensive intervention strategies are urgently needed to address these factors in effectively tackling medication non-adherence in LMICs.
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Affiliation(s)
- Md Azharuddin
- Division of Pharmacology, Department of Pharmaceutical Medicine, School of Pharmaceutical Education and Research, New Delhi, India
| | - Mohammad Adil
- Department of Pharmacology, School of Pharmaceutical Education and Research, New Delhi, India
| | - Manju Sharma
- Division of Pharmacology, Department of Pharmaceutical Medicine, School of Pharmaceutical Education and Research, New Delhi, India
- Department of Pharmacology, School of Pharmaceutical Education and Research, New Delhi, India
| | - Bishal Gyawali
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Maiguma T, Komoto A, Shiraga E, Hagiwara S, Onishi J, Li M, Teshima D. Influence of Pharmacist Intervention on Re-Elevation of Glycated Hemoglobin for Diabetic Outpatients. Hosp Pharm 2021; 56:191-197. [PMID: 34024928 DOI: 10.1177/0018578719883806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: The effect of pharmacist intervention on blood sugar control in diabetic outpatients in a pharmacist-managed clinic was studied by focusing on the re-elevation of the glycated hemoglobin (A1c) level defined as a continuous variable. Methods: A retrospective chart review was performed at the Mizushima Kyodo Hospital from April 2014 to March 2016. Of the 221 diabetic outpatients who were provided guidance by nurses and nutritional managers, 62 further consulted the pharmacist-managed clinic. The remaining 159 patients were enrolled in a nonintervention group. Finally, the data of 115 patients with A1c level of ≥7.5% and A1c re-elevation were extracted. Intergroup comparison was performed between the pharmacist intervention (n = 26) and nonintervention (n = 89) groups. In both the groups, the starting point (baseline) was the time when the A1c level of ≥7.5% was observed. Subsequent monitoring was performed once in every 3 months. The average cumulative level of A1c re-elevation (CARE) was compared between groups. Patients with A1c level of ≥8.0% and A1c level between 7.5% and 8.0%, and male and female patients were also compared. Furthermore, the number of days until the re-elevation of the A1c level from the baseline was also compared. Results: The CARE values were 0.89 ± 0.86% and 1.51 ± 1.25% in the pharmacist intervention and nonintervention groups, respectively, showing a significant difference (P = .0195). There were no significant differences between patients with A1c level of ≥8.0% and A1c level between 7.5% and 8.0%, or between males and females. The number of days until the re-elevation of A1c level from the baseline also showed no significant difference. Conclusion: Pharmacist intervention for diabetic outpatients in pharmacist-managed clinics significantly suppressed CARE when compared with effects of no intervention, and this could be useful for preventing the exacerbation of diabetes.
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Affiliation(s)
| | | | | | | | | | - Miyoshi Li
- Mizushima Kyodo Hospital, Okayama, Japan
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8
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Masyuko S, Ngongo CJ, Smith C, Nugent R. Patient-reported outcomes for diabetes and hypertension care in low- and middle-income countries: A scoping review. PLoS One 2021; 16:e0245269. [PMID: 33449968 PMCID: PMC7810280 DOI: 10.1371/journal.pone.0245269] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 12/26/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Patient-reported outcome measures (PROMs) assess patients' perspectives on their health status, providing opportunities to improve the quality of care. While PROMs are increasingly used in high-income settings, limited data are available on PROMs use for diabetes and hypertension in low-and middle-income countries (LMICs). This scoping review aimed to determine how PROMs are employed for diabetes and hypertension care in LMICs. METHODS We searched PubMed, EMBASE, and ClinicalTrials.gov for English-language studies published between August 2009 and August 2019 that measured at least one PROM related to diabetes or hypertension in LMICs. Full texts of included studies were examined to assess study characteristics, target population, outcome focus, PROMs used, and methods for data collection and reporting. RESULTS Sixty-eight studies met the inclusion criteria and reported on PROMs for people diagnosed with hypertension and/or diabetes and receiving care in health facilities. Thirty-nine (57%) reported on upper-middle-income countries, 19 (28%) reported on lower-middle-income countries, 4 (6%) reported on low-income countries, and 6 (9%) were multi-country. Most focused on diabetes (60/68, 88%), while 4 studies focused on hypertension and 4 focused on diabetes/hypertension comorbidity. Outcomes of interest varied; most common were glycemic or blood pressure control (38), health literacy and treatment adherence (27), and acute complications (22). Collectively the studies deployed 55 unique tools to measure patient outcomes. Most common were the Morisky Medication Adherence Scale (7) and EuroQoL-5D-3L (7). CONCLUSION PROMs are deployed in LMICs around the world, with greatest reported use in LMICs with an upper-middle-income classification. Diabetes PROMs were more widely deployed in LMICs than hypertension PROMs, suggesting an opportunity to adapt PROMs for hypertension. Future research focusing on standardization and simplification could improve future comparability and adaptability across LMIC contexts. Incorporation into national health information systems would best establish PROMs as a means to reveal the effectiveness of person-centered diabetes and hypertension care.
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Affiliation(s)
- Sarah Masyuko
- RTI International, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Ministry of Health, Nairobi, Kenya
| | - Carrie J. Ngongo
- RTI International, Seattle, Washington, United States of America
- * E-mail:
| | - Carole Smith
- RTI International, Seattle, Washington, United States of America
- Department of Neurology, University of Washington, Seattle, Washington, United States of America
| | - Rachel Nugent
- RTI International, Seattle, Washington, United States of America
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9
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Beliefs about medicines among type 2 diabetes mellitus patients in Quetta city, Pakistan: a cross-sectional assessment. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01046-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Khan TA, Hussain S, Ikram A, Mahmood S, Riaz H, Jamil A, Amin A, Haider YG, Sandhu M, Mushtaq A, Barbui C, Johnson CF, Godman B. Prevalence and treatment of neurological and psychiatric disorders among tertiary hospitals in Pakistan; findings and implications. Hosp Pract (1995) 2020; 48:145-160. [PMID: 32343632 DOI: 10.1080/21548331.2020.1762366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mental health and neurological disorders are prevalent in Pakistan. However, there are considerable concerns with their management due to issues of access, availability of trained personnel and stigma alongside paucity of such data. Consequently, there is a need to document current treatment approaches starting with tertiary hospitals in Pakistan where patients with more severe mental and neurological disorders are typically treated. Subsequently, use the findings to help direct future policies and initiatives. METHODS Multi-centered, cross-sectional, prospective study principally evaluating current medicine usage among patients attending tertiary hospitals in Pakistan with psychiatric and neurological disorders. In addition, possible factors contributing to the prevalence of these disorders in this population to help with future care. All 23 tertiary care hospitals in the ten major Districts in Pakistan were included, which cover 75% of the population. RESULTS 57,664 patients were evaluated of which 35.3% were females. Both females and males had multiple brain disorders and multiple co-morbidities. Schizophrenia was the most prevalent disorder overall among both females (25.2%) and males (30.4%). A median of six medicines were prescribed per patient, with antipsychotics and antidepressants the most prescribed medicines. Clozapine was the most prescribed medicine in males (12.25%) and females (11.83%) including for psychiatric disorders, with sodium valproate the most prescribed medicine in epilepsy in males (42.44% of all anti-epileptic medicines) as well as females (46.38%). There was a greater prevalence of both disorders among the lower classes. A greater prevalence of schizophrenia was seen in patients abusing alcohol and smokers. The divorce rate was higher among the studied patients and the prevalence of depression was higher among the widowed population. CONCLUSIONS There were concerns with the quality of prescribing including the extent of polypharmacy as well as possible overuse of clozapine especially in patients with epilepsy, both of which need addressing.
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Affiliation(s)
- Tanveer Ahmed Khan
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Shahzad Hussain
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Aamer Ikram
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Sidra Mahmood
- Department of Pharmacy, Quaid-e-Azam University , Islamabad, Pakistan
| | - Humayun Riaz
- Department of Pharmaceutics, Rashid Latif College of Pharmacy , Lahore, Pakistan
| | - Ayesha Jamil
- Faculty of Pharmacy, Hajvery University , Lahore, Pakistan
| | - Amina Amin
- Faculty of Pharmacy, Hajvery University , Lahore, Pakistan
| | | | - Marva Sandhu
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Atifa Mushtaq
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona , Verona, Italy
| | - Chris F Johnson
- Pharmacy Services, National Health Service Greater Glasgow and Clyde (NHS GGC) , Glasgow, UK
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm, Sweden.,Department of Pharmacoepidemiolgy, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University , Glasgow, UK.,Health Economics Centre, Liverpool University , Liverpool, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University , Pretoria, South Africa
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Sefah IA, Okotah A, Afriyie DK, Amponsah SK. Adherence to Oral Hypoglycemic Drugs among Type 2 Diabetic Patients in a Resource-Poor Setting. Int J Appl Basic Med Res 2020; 10:102-109. [PMID: 32566526 PMCID: PMC7289204 DOI: 10.4103/ijabmr.ijabmr_270_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/02/2019] [Accepted: 01/10/2020] [Indexed: 01/09/2023] Open
Abstract
Objective: Diabetes mellitus is a growing public health problem in many countries including Ghana. Adherence to drugs, especially among patients with type 2 diabetes mellitus (T2DM) is often poor is some resource-poor settings. The objective of this study was to assess adherence to oral hypoglycemic drugs and factors that affect adherence among patients with T2DM in the Volta Region of Ghana. Methods: The study was cross-sectional and conducted among 400 patients with T2DM attending diabetic clinics at 4 randomly selected hospitals in the Volta Region of Ghana between January 10 and March 30, 2015. Patients were interviewed using a structured questionnaire and other data collection tools to determine the commonest self-reported reason(s) for nonadherence. Adherence was assessed using the 8-item Morisky Medication Adherence Scale. Multivariate analysis was performed between adherence and statistically significant patient variables. Results: Adherence to oral hypoglycemic drugs among T2DM patients was 47.75%. The odds of adherence with fasting blood glucose between 1 and 6 mmol/L was approximately two-fold (adjusted odd ratio [aOR] =1.92, confidence interval [CI]: 1.11–3.32) versus the odds of having fasting blood glucose of above 10 mmol/L. The odds of adherence among patients with tertiary education was approximately three-fold (aOR = 3.01 CI: 1.44–6.269) versus patients with no formal education. The commonest self-reported reason for nonadherence was forgetfulness. Conclusion: Adherence to oral hypoglycemic drugs among T2DM patients in the current study was sub-optimal. Therefore, in such settings, management of T2DM must include strategies to identify nonadherent patients, and regular patient education and counseling.
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Affiliation(s)
| | - Archibald Okotah
- Department of Pharmacy, Ho Municipal Hospital, Ghana Health Service, Ho, Accra, Ghana
| | | | - Seth Kwabena Amponsah
- Department of Pharmacology and Toxicology, School of Pharmacy, University of Ghana, Accra, Ghana
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Hussain N, Said ASA, Khan Z. Influence of Health Literacy on Medication Adherence Among Elderly Females With Type 2 Diabetes in Pakistan. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 41:35-44. [PMID: 31886737 DOI: 10.1177/0272684x19896724] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Health literacy is how well the patients are able to attain, deal with, and understand basic health information. This is particularly important when it comes to comprehending prescribed medication instructions. To improve the communication strategies for health-care professionals during patient counseling, our study aimed to assess the influence of health literacy and medication adherence in older patients. The objectives of the study were to evaluate associations that occur between the level of health literacy and medication adherence. This study used a convenience sampling method of females (older than 60 years) attending the diabetic clinic in two hospital settings (N = 524). All study participants filled three validated questionnaires: these were the Literacy Assessment for Diabetes, the Diabetes Numeracy Test, and a modified Brief Adherence Rating Scale. To assess the spectrum of health literacy differences, we used χ2 analysis and linear regression analysis. Individuals with adequate health literacy were more likely to remember to take their medications compared with those with inadequate health literacy, χ2(4) = 11.6, p = .04. Adequate literacy level study participants were more likely to not change the dose of their medications without medical advice (12.3%) compared with those individuals with inadequate health literacy (2.8%), χ2(4) = 11.13, p = .03. The results in our study suggest that health-care professionals should focus on appropriate communication attuned to the assessment of health literacy levels particularly in older female patients when discussing medication instructions.
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Affiliation(s)
- Nadia Hussain
- Department of Pharmaceutical Sciences, College of Pharmacy, Al Ain University of Science and Technology, UAE
| | - Amira S A Said
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University of Science and Technology, UAE
| | - Zainab Khan
- Department of Internal Medicine, Punjab Care hospital, Lahore, Pakistan
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Rwegerera GM, Masaka A, Pina-Rivera Y, Moshomo T, Gaenamong M, Godman B, Oyewo TA, Massele A, Habte D. Determinants of glycemic control among diabetes mellitus patients in a tertiary clinic in Gaborone, Botswana: findings and implications. Hosp Pract (1995) 2019; 47:34-41. [PMID: 30311819 DOI: 10.1080/21548331.2018.1535977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/09/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND AIMS Glycemic control among patients with diabetes mellitus is associated with a marked reduction of both macrovascular and microvascular complications; however, glycemic control remains an elusive goal worldwide. The aim of this study was to determine factors associated with glycemic control among patients attending a tertiary clinic in Botswana as limited information to date. METHODS Cross-sectional study in a tertiary clinic in Gaborone, Botswana. Patients were recruited between 21 July 2015 and 21 September 2015. The majority of the randomly recruited patients (368/380-96.8%) had documentation of glycemic control (HbA1c) within three months of study recruitment and were subsequently included in the analysis. Glycemic control was categorized as desirable, suboptimal and poor if HbA1c was <7%, 7-9% and >9%, respectively. Data were analyzed using SPSS for descriptive statistics including both bivariate and multinomial logistic regression. A value of p < 0.05 was considered statistically significant. RESULTS The analyzed study population consisted of 258/368 (70.1%) females with a mean age (SD) of 56.7 ± 13.6 years. Means (SDs) for diabetes duration and glycated hemoglobin were 7.2 ± 7.1 years and 7.97 ± 2.02%, respectively. Of the 368 patients, 136 (36.95%) and 132/368 (35.86%) had desirable and suboptimal glycemic control, respectively. Older age, attending the clinic for more or equal to 3 years and not being on insulin were associated with both desirable and suboptimal glycemic control whereas duration of diabetes between 5 and 10 years was associated with poor glycemic control. CONCLUSIONS The majority of patients had poor glycemic control. Older age and not being on insulin were associated with better glycemic control. The fact that patients on insulin had poor glycemic control calls for more research to determine the timing of insulin initiations and dosing schedule factors as these will help to improve overall glycemic control in Botswana and elsewhere.
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Affiliation(s)
- Godfrey M Rwegerera
- a Department of Internal Medicine , University of Botswana , Gaborone , Botswana
- b Department of Medicine , Princess Marina Hospital , Gaborone , Botswana
| | - Anthony Masaka
- c Department of Public Health Management , Botho University , Gaborone , Botswana
| | - Yordanka Pina-Rivera
- a Department of Internal Medicine , University of Botswana , Gaborone , Botswana
- b Department of Medicine , Princess Marina Hospital , Gaborone , Botswana
| | - Thato Moshomo
- a Department of Internal Medicine , University of Botswana , Gaborone , Botswana
| | - Marea Gaenamong
- d Department of Emergency Medicine , Princess Marina Hospital , Gaborone , Botswana
| | - Brian Godman
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , Strathclyde University , Glasgow , UK
- f Division of Clinical Pharmacology , Karolinska Institutet , Stockholm , Sweden
- g Health Economics Centre , University of Liverpool Management School , Liverpool , UK
- h Department of Public Health and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Pretoria , South Africa
| | | | - Amos Massele
- i Department of Biomedical Sciences , University of Botswana , Gaborone , Botswana
| | - Dereje Habte
- j Consultant Public Health Specialist , Addis Ababa , Ethiopia
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Moosa A, Bezuidenhout S, Meyer JC, Godman B. Knowledge regarding medicines management of type 2 diabetes amongst patients attending a Community Health Centre in South Africa. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract
Objective
The prevalence of type 2 diabetes mellitus (T2DM) is growing in Sub-Saharan countries including South Africa. This is a concern given its appreciable impact on morbidity, mortality and costs with the recent introduction of universal health care in South Africa. The purpose of the study was to assess the knowledge of patients with T2DM attending a typical community health centre (CHC) regarding the management of their disease including risk factors and prevention to guide future initiatives. Typically, patients with T2DM in South Africa are managed in ambulatory care including CHCs.
Method
A quantitative, descriptive study in a CHC. The sample included 217 adults with T2DM who have visited a physician as well as the pharmacy. Face-to-face patient exit interviews were conducted using a structured questionnaire.
Key findings
Females predominated (65%), with the majority of patients >60 years (38.2%) and more than half from the Indian racial category. Most patients did not know how their medication controls their diabetes (79.3%) or did not know any of the side effects (83.9%) from their medication. Less than half of the patients knew how to take their medication, and more than a third of patients indicated that they were not practicing any form of self-care.
Conclusion
The results indicate that these T2DM patients lacked sufficient knowledge regarding the management of their disease. Healthcare managers should consider instigating programmes to improve patients’ knowledge about the management of their disease as part of general initiatives within South Africa to improve the management of patients with chronic diseases in the public sector.
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Affiliation(s)
- Afsana Moosa
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Selente Bezuidenhout
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Health Economics Centre, Liverpool University Management School, Liverpool, UK
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Aziz MM, Masood I, Yousaf M, Saleem H, Ye D, Fang Y. Pattern of medication selling and self-medication practices: A study from Punjab, Pakistan. PLoS One 2018; 13:e0194240. [PMID: 29566014 PMCID: PMC5863987 DOI: 10.1371/journal.pone.0194240] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 02/14/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Access to medicines without prescription is a major contributing factor for self-medication practices. This study was designed to examine the ratio of non-prescribed medicines sales and self-medication practices in Punjab, Pakistan. This study also evaluates the reasons for self-medication within its communities. METHODS An observational study was conducted in 272 systemically selected pharmacies to analyze medicines-related sales, with or without prescription. A cross-sectional survey was performed between June 2015 and November 2016. Consumers were interviewed about their self-medication practices. RESULTS Of the pharmacies surveyed, 65.3% participated in the study. A total of 4348 medicines were purchased for self-medication by 3037 consumers (15.2% of all study participants), of which 873 (28.7%) participated in an interview. Majority (81.2%) medicine purchaser, (90.9%) interview participants, and (59.4%) drug users were male. On average, each community pharmacy sold 7.9 medicines without prescription each day, to an average of 5.5 customers. Many participants (28.9%) had matriculation in their formal education. The medicines most often sold for self-medication were analgesics and antipyretics(39.4%). More than 25% of participants reported fever symptoms and 47.8% assumed their illness was too trivial to consult a doctor. Media advertisements were the most common source of information for participants (46.7%). CONCLUSION Many types of medicines were often sold without prescription from community pharmacies. Self-medication was common practice for a wide range of illnesses. Pakistan also needs effective implementation of policies to monitor medication sales. Public education about rational medication and limits to advertising medicine are very necessary.
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Affiliation(s)
- Muhammad Majid Aziz
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’anJiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- The Global Health Institute, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
| | - Imran Masood
- Faculty of Pharmacy and Alternative Medicine, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Mahreen Yousaf
- Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Hammad Saleem
- Institute of Pharmaceutical Sciences, University of Veterinary & Animal Sciences, Lahore, Pakistan
| | - Dan Ye
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’anJiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- The Global Health Institute, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’anJiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- The Global Health Institute, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- * E-mail:
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