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Boonpattharatthiti K, Saensook T, Neelapaijit N, Sakunrag I, Krass I, Dhippayom T. The prevalence of adherence to insulin therapy in patients with diabetes: A systematic review and meta-analysis. Res Social Adm Pharm 2024; 20:255-295. [PMID: 38104019 DOI: 10.1016/j.sapharm.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Adherence to insulin therapy is crucial to achieving good glycemic control for patients with type 1 diabetes (T1D) or type 2 diabetes (T2D). A comprehensive estimation of adherence to insulin therapy in patients with diabetes is currently lacking. OBJECTIVE To explore the prevalence of adherence to insulin therapy in patients with both T1D and T2D. METHODS A systematic search was performed using the following databases: PubMed, EMBASE, Cochrane CENTRAL, and ProQuest Dissertation and Theses from the inception of each database to August 2023. Cross-sectional studies were included if they met the following criteria: (1) conducted in patients with T1D or T2D; (2) reported adherence to insulin therapy. The Joanna Briggs Institute (JBI) critical appraisal checklist for studies reporting prevalence data was used to assess the quality of included studies. Pooled estimates of the prevalence of adherence to insulin were calculated as a percentage together with a 95 % confidence interval (95%CI) using a random-effect model. All analyses were conducted using STATA 15 (College Station, Texas, United States); PROSPERO (CRD42022322323). RESULTS Search results yielded 14,914 articles, of these 57 studies with a total of 125,241 patients met the inclusion criteria. The overall estimated prevalence of adherence to insulin therapy in both types of diabetes was 55.37 % (95%CI: 48.55 %-62.19 %). The adherence for T1D was 52.63 % (95 % CI: 37.37 %-67.87 %), whereas the adherence for T2D was 52.55 % (95 % CI: 43.08 %-62.01 %). The prevalence of adherence in lower middle-income countries was 56.79 % (95 % CI: 27.85 %-85.74 %). CONCLUSIONS The overall prevalence of adherence to insulin therapy was remarkably low. This requires attention from healthcare practitioners and policymakers to implement appropriate strategic approaches to improve adherence to insulin therapy.
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Affiliation(s)
- Kansak Boonpattharatthiti
- Faculty of Pharmaceutical Sciences, Burapha University, Chon Buri, Thailand; The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
| | - Thitinan Saensook
- The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Department of Pharmacy, Navamin 9 Hospital, Bangkok, Thailand.
| | - Nipaporn Neelapaijit
- The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Department of Pharmacy, Navamin 9 Hospital, Bangkok, Thailand.
| | - Itsarawan Sakunrag
- The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
| | - Ines Krass
- School of Pharmacy, University of Sydney, Sydney, NSW, Australia.
| | - Teerapon Dhippayom
- The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
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Suprapti B, Izzah Z, Anjani AG, Andarsari MR, Nilamsari WP, Nugroho CW. Prevalence of medication adherence and glycemic control among patients with type 2 diabetes and influencing factors: A cross-sectional study. GLOBAL EPIDEMIOLOGY 2023; 5:100113. [PMID: 37638377 PMCID: PMC10446000 DOI: 10.1016/j.gloepi.2023.100113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 08/29/2023] Open
Abstract
Background This study aimed to assess medication adherence, glycemic control, and their influencing factors among outpatients at an Indonesian clinic with type 2 diabetes. Methods A cross-sectional study was conducted among patients with type 2 diabetes at a hospital-based clinic in Surabaya, Indonesia, from September to December 2018. A purposive sampling was used; patients aged 18 years and older, had diabetes and any comorbidity, received hypoglycemic agents, and provided written informed consent were included. The previously validated Brief Medication Questionnaire was used to measure medication adherence, while glycosylated hemoglobin (A1C) levels were used to evaluate glycemic control. Binary logistic regression was used to identify factors associated with medication adherence and glycemic control. Results Of 321 patients enrolled in the study, 268 (83.5%) patients were medication nonadherent. Patients who did not engage regularly in physical activity (aOR: 0.49, 95% CI: 0.26-0.93) was more likely to be medication adherent. Poor glycemic control (A1C: >7%) was observed in 106 (33.0%) of the patients. Patients who used a combination of oral hypoglycemic agents and insulin (aOR: 2.74, 95% CI: 1.09-6.86), did not take biguanide (aOR: 2.73, 95% CI: 1.16-6.43), reported hyperglycemia (aOR: 4.24, 95% CI: 1.53-11.81), and had comorbid diseases (aOR: 4.33, 95% CI: 1.08-17.34) increased the risk of having poor glycemic control. Patients who were more likely to achieve good glycemic control were male (aOR: 0.39, 95% CI: 0.20-0.74) and aged older (aOR: 0.95, 95% CI: 0.92-0.99). Conclusions The proportion of patients who were medication nonadherent was much higher than those with poor glycemic control. Whereas regular exercise was a predictor of nonadherence, age, sex, diabetes medication, not taking biguanide, acute complications, and comorbidity were predictors of poor glycemic control. Therefore, strategies are needed to improve medication adherence and glycemic control.
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Affiliation(s)
- Budi Suprapti
- Department of Pharmacy Practice, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
- Department of Pharmacy, Universitas Airlangga Hospital, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
| | - Zamrotul Izzah
- Department of Pharmacy Practice, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
- Department of Pharmacy, Universitas Airlangga Hospital, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, Netherlands
| | - Ade Giriayu Anjani
- Master of Clinical Pharmacy Program, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
| | - Mareta Rindang Andarsari
- Department of Pharmacy Practice, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
- Department of Pharmacy, Universitas Airlangga Hospital, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
| | - Wenny Putri Nilamsari
- Department of Pharmacy Practice, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
| | - Cahyo Wibisono Nugroho
- Department of Internal Medicine, Faculty of Medicine Universitas Airlangga, Mayjen Prof. Dr. Moestopo 47, Surabaya 60131, Indonesia
- Department of Internal Medicine, Universitas Airlangga Hospital, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
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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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McClintock HF, Edmonds SE, Bogner HR. Depression and Cost-Related Health Care Utilization Among Persons with Diabetes. Popul Health Manag 2023; 26:232-238. [PMID: 37590079 DOI: 10.1089/pop.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
The presence of depression among people with diabetes can substantially increase health care costs and reduce health care utilization. This study aimed at further elucidating the factors underlying the relationship between depressive disorders and health care utilization among people with diabetes. Data were obtained from the 2019 Behavioral Risk Factor Surveillance System, and the sample was limited to people with diabetes (n = 22,642). The independent variable was assessed by a lifetime diagnosis of depressive disorder, including depression, major depression, dysthymia, or minor depression. The dependent variable was cost-related health care utilization assessed as a response (yes/no) to whether participants had not seen a doctor due to costs in the past year. Logistic regression models examined the association between depressive disorders and health care utilization, adjusting for covariates incorporating weighting to account for study design. Overall, 25.2% of the people with diabetes reported having had a depressive disorder in their lifetime. People with diabetes who had ever been diagnosed with a depressive disorder were more likely to have reported not seeing a doctor due to costs in the past year (adjusted odds ratio: 1.82 [1.49, 2.28]). Findings from this study suggest a need for further research regarding the relationship between depression and cost-related health care utilization among people with diabetes.
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Affiliation(s)
- Heather F McClintock
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, Pennsylvania, USA
| | - Sarah E Edmonds
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, Pennsylvania, USA
| | - Hillary R Bogner
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Shahabi N, Fakhri Y, Aghamolaei T, Hosseini Z, Homayuni A. Socio-personal factors affecting adherence to treatment in patients with type 2 diabetes: A systematic review and meta-analysis. Prim Care Diabetes 2023; 17:205-220. [PMID: 37012162 DOI: 10.1016/j.pcd.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE The purpose of study was to identify the socio-personal factors affecting adherence to the treatment of patients with type 2 diabetes. METHODS Cross-sectional articles were extracted from databases such as Web of Science, PubMed, Elsevier. A meta-analysis was performed using integrated odds ratios (OR) and 95% confidence interval (CIs) for age, BMI, depression, educational level, gender, employment status, marital status, smoking status. STATA 12.0 was used to estimate pooled RR in definite subgroups. The quality of the studies included was evaluated using the STROBE checklist. RESULTS Thirty-one studies out of 7407 extracted articles were finally selected for the meta-analysis. The results showed that younger people had a 17% higher risk than older people, smokers had a 22% higher risk than non-smokers, and the employed had a 15% higher risk of non-adherence to treatment. CONCLUSION In conclusion, older age, smoking and employment can lead to non-adherence to T2D treatment. Interventions are suggested to be made besides common health care considering the socio-personal features on type 2 diabetes patients' treatment adherence.
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Affiliation(s)
- Nahid Shahabi
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Yadolah Fakhri
- Food Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Zahra Hosseini
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Atefeh Homayuni
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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McClintock HF, Edmonds SE, Bogner HR. Adherence patterns to oral hypoglycemic agents among primary care patients with type 2 diabetes. Prim Care Diabetes 2023; 17:180-184. [PMID: 36803970 DOI: 10.1016/j.pcd.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 07/18/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023]
Abstract
AIMS To examine patterns of adherence to oral hypoglycemic agents among primary care patients with type 2 diabetes mellitus and to assess whether these patterns were associated with baseline intervention allocation, sociodemographic characteristics, and clinical indicators. METHODS Adherence patterns were examined by Medication Event Monitoring System (MEMS) caps at baseline and 12 weeks. Participants (n = 72) were randomly allocated to a Patient Prioritized Planning (PPP) intervention or a control group. The PPP intervention employed a card-sort task to identify health-related priorities that included social determinants of health to address medication nonadherence. Next, a problem-solving process was used to address unmet needs involving referral to resources. Multinomial logistic regression examined patterns of adherence in relation to baseline intervention allocation, sociodemographic characteristics, and clinical indicators. RESULTS Three patterns of adherence were found: adherent, increasing adherence, and nonadherent. Participants assigned to the PPP intervention were significantly more likely to have a pattern of improving adherence (Adjusted Odds Ratio (AOR)= 11.28, 95% confidence interval (CI)= 1.78, 71.60) and adherence (AOR=4.68, 95% CI=1.15, 19.02) than participants assigned to the control group. CONCLUSION Primary care PPP interventions incorporating social determinants may be effective in fostering and improving patient adherence.
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Affiliation(s)
- Heather F McClintock
- Department of Public Health, College of Health Sciences, Arcadia University, 450 S. Easton Road, Glenside, PA 19038, USA.
| | - Sarah E Edmonds
- Department of Public Health, College of Health Sciences, Arcadia University, 450 S. Easton Road, Glenside, PA 19038, USA
| | - Hillary R Bogner
- Family Medicine and Community Health, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA, USA
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Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12051981. [PMID: 36902770 PMCID: PMC10004070 DOI: 10.3390/jcm12051981] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Poor adherence to oral antidiabetic drugs (OADs) in patients with type 2 diabetes (T2D) can lead to therapy failure and risk of complications. The aim of this study was to produce an adherence proportion to OADs and estimate the association between good adherence and good glycemic control in patients with T2D. We searched in MEDLINE, Scopus, and CENTRAL databases to find observational studies on therapeutic adherence in OAD users. We calculated the proportion of adherent patients to the total number of participants for each study and pooled study-specific adherence proportions using random effect models with Freeman-Tukey transformation. We also calculated the odds ratio (OR) of having good glycemic control and good adherence and pooled study-specific OR with the generic inverse variance method. A total of 156 studies (10,041,928 patients) were included in the systematic review and meta-analysis. The pooled proportion of adherent patients was 54% (95% confidence interval, CI: 51-58%). We observed a significant association between good glycemic control and good adherence (OR: 1.33; 95% CI: 1.17-1.51). This study demonstrated that adherence to OADs in patients with T2D is sub-optimal. Improving therapeutic adherence through health-promoting programs and prescription of personalized therapies could be an effective strategy to reduce the risk of complications.
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Bekalu YE, Wudu MA, Gashu AW. Adherence to Chemotherapy and Associated Factors Among Patients With Cancer in Amhara Region, Northeastern Ethiopia, 2022. A Cross-Sectional Study. Cancer Control 2023; 30:10732748231185010. [PMID: 37795961 PMCID: PMC10557419 DOI: 10.1177/10732748231185010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Cancer is the leading cause of death worldwide, and poor adherence to chemotherapy has become a public health issue in developing countries, including Ethiopia. OBJECTIVE To assess chemotherapy adherence and associated factors among patients with cancer in the Amhara Region, Northeast Ethiopia. METHODS A hospital-based prospective cross-sectional study design was employed, and a total of 460 cancer patients were enrolled using a systematic random sampling method at Felege Hiwot and Dessie comprehensive specialized hospitals from May 15, 2022, to July 15, 2022, in the Amhara region. The data was gathered through a review of medical records and a face-to-face interview and entered into Epi-Data version 4.6 before being exported to SPSS version 26 for analysis. Furthermore, at 95% confident interval (CI), multivariable binary logistic regression was used, and variables with P-values of <.05 were found to be significant. RESULT The overall response rate in this study was 94.1% (433), with 42.3% of patients adhering to chemotherapy. Moreover, having a family history of cancer [AOR = 3.58, 95% CI (2.22, 5.76)], being female [Adjusted Odds ratio (AOR) = 2.17, 95% CI: (1.31, 3.60)], having no history of comorbidity [AOR = 2.74, 95% CI (1.56, 4.81)], having side effects from chemotherapy [AOR = 3.50, 95% CI (1.55, 7.90)], and having social support [AOR = 1.52, 95% CI (1.21, 1.95)] were important predictors of chemotherapy adherence. CONCLUSION and recommendations: Patients' understanding of illness characteristics and treatment should be improved through health education. Involving family members in the treatment plan will also improve adherence to chemotherapy in this context.
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Affiliation(s)
- Yemane Eshetu Bekalu
- Department of Public Health, ALKAN Health Sciences Business and Technology College, Dessie, Ethiopia
| | - Muluken Amare Wudu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Amare Workie Gashu
- Department of Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Abdullah NF, Khuan L, Theng CA, Sowtali SN. Prevalence and reasons influenced medication non-adherence among diabetes patients: A mixed-method study. J Diabetes Metab Disord 2022; 21:1669-1678. [PMID: 36404839 PMCID: PMC9672180 DOI: 10.1007/s40200-022-01118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
Abstract
Objectives This study aimed to identify the prevalence of medication non-adherence (MNA) and to explore the reasons that influenced MNA among diabetes patients. Design This study used the explanatory mixed-method design. Phase one comprised of a cross-sectional study followed by phase two of a qualitative study. Setting This study took place at two public hospitals in the Klang Valley, Malaysia. Participants About 427 diabetes patients were recruited and 399 of them completed the study. The inclusion criteria were those with age more than 18 years and above, Malaysian citizen, able to understand Malay or English, and were diagnosed with diabetes mellitus for more than one year. The exclusion criteria were those with an intellectual disability and pregnant women. Phase two involved 12 participants recruited from non-adherent patients in phase one of the study. Results About 46.6% of the patients failed to adhere to the medication. Malays (OR: 1.66, 95%CI: 1.09 to 2.51, p = 0.017), single/widow or divorced (OR: 1.79, 95%CI: 1.05 to 3.05, p = 0.031) and poor HbA1c (OR: 2.57, 95% CI: 1.61 to 4.10, p = < 0.01) were associated with medication non-adherence. Five main categories emerged as the reasons for medication non-adherence, including perceived benefit of Complementary and Alternative medicine, attitude towards drawback of western medication, poor healthcare providers and patients' relationship, undesirable emotional response towards medication intake, as well as restraints in daily routine and cognitive function. Conclusions There are many reasons for patients' non-adherence to their anti-diabetes medication. These findings are important in identifying the factors that influenced non-adherence to recommend reliable patient-centred care strategies in improving medication non-adherence among patients with diabetes.
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Affiliation(s)
- Nor Fadhilah Abdullah
- Centre for Science of Nursing Studies, Faculty of Medicine, Universiti Sultan Zainal Abidin, 21300 Kuala Nerus, Terengganu Malaysia
- Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Lee Khuan
- Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Cheong Ai Theng
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Siti Noorkhairina Sowtali
- Department of Professional Nursing Studies, Kulliyyah of Nursing, International Islamic University Malaysia, Jalan Hospital Campus, 25100 Kuantan, Pahang, Malaysia
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Dima SA, Shibeshi MS. Antiepileptic drug adherence in children in southern Ethiopia: A cross sectional study. PLoS One 2022; 17:e0263821. [PMID: 35176045 PMCID: PMC8853530 DOI: 10.1371/journal.pone.0263821] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 01/27/2022] [Indexed: 12/01/2022] Open
Abstract
Background Epilepsy is one of the commonest chronic neurological disorders with serious health consequences. Treatment adherence is one of the determinants of seizure control. This study was designed to determine factors affecting antiepileptic drug adherence among children with epilepsy. Methods A cross sectional study was conducted on 192 children with epilepsy (≤14 years of age) on follow-up at a pediatric neurology clinic in Southern Ethiopia from January 1st to August 30th, 2019. Medication Adherence was measured using the eight-item Morisky’s medication adherence scale. Logistic regression analysis was done to determine factors associated with antiepileptic drug adherence. Result One hundred twenty-five (65%) of the study subjects were adherent to their medication. On multivariable analysis, factors predictive of good adherence included family size of ≤5 [AOR = 2.34, (95% CI: 1.07, 5.10); P = 0.03] and duration of epilepsy (<1year [AOR = 5.83, (95% CI: 1.48, 22.92); P = 0.012] and 1-2year [AOR = 4.58, (95% CI: 1.12, 18.77); P = 0.035]). Monthly family income of <1000 Ethiopian Birr [AOR = 0.18, (95% CI: 0.06, 0.61); P = 0.005] and presence of seizure attack in the past 3months [AOR = 0.23, 95% (CI: 0.10, 0.55); P = 0.001] predicted poor antiepileptic drug adherence. Conclusion Adherence to antiepileptic drugs in children is low in our setting; low family income and occurrence of seizures while on treatment predicted poor adherence. Supplying free antiepileptic drugs to poor children and regular provision of information about expected treatment response to children with epilepsy and their caretakers may help improve adherence.
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Affiliation(s)
- Shamil Ahmed Dima
- Department of Pediatrics and Child Health, Madda Walabu University, Gobba, Ethiopia
- * E-mail:
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Wibowo MINA, Yasin NM, Kristina SA, Prabandari YS. Exploring of Determinants Factors of Anti-Diabetic Medication Adherence in Several Regions of Asia - A Systematic Review. Patient Prefer Adherence 2022; 16:197-215. [PMID: 35115768 PMCID: PMC8803611 DOI: 10.2147/ppa.s347079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/31/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The determinants of medication adherence in people with diabetes may differ between populations of an area due to social environment, cultural beliefs, socioeconomic conditions, education, and many other factors differences. OBJECTIVE Therefore, this study aims to explore, identify and classify the determinants of medication adherence in several Asian regions. METHODS A systematic literature review was conducted to gain insight into the determinants of medication adherence. Seven relevant databases (EBSCO, ProQuest, PubMed, ScienceDirect, Scopus, Wiley, dan Taylor and Francis) and hand searching methods were conducted from January 2011 to December 2020. Keywords were compiled based on the PICO method. The selection process used the PRISMA guidelines based on inclusion, and the quality was assessed using Crowe's critical assessment tool. Textual summaries and a conceptual framework model of medication adherence were proposed to aid in the understanding of the factors influencing medication adherence. RESULTS Twenty-six articles from countries in several Asian regions were further analyzed. Most studies on type 2 diabetes patients in India used the MMAS-8 scale, and cross-sectional study is the most frequently used research design. The medication adherence rate among diabetic patients was low to moderate. Fifty-one specific factors identified were further categorized into twenty-three subdomains and six domains. Furthermore, the determinants were classified into four categories: inconsistent factors, positively related factors, negatively related factors, and non-associated factors. In most studies, patient-related factors dominate the association with medication adherence. This domain relates to patient-specific demographics, physiological feelings, knowledge, perceptions and beliefs, comorbidities, and other factors related to the patient. Several limitations in this review need to be considered for further research. CONCLUSION Medication adherence to diabetic therapy is a complex phenomenon. Most determinants produced disparate findings in terms of statistical significance. The identified factors can serve various goals related to medication adherence. Policymakers and health care providers should consider patient-related factors.
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Affiliation(s)
- Much Ilham Novalisa Aji Wibowo
- Doctoral Program in Pharmaceutical Science, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Pharmacy, Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Nanang Munif Yasin
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susi Ari Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yayi Suryo Prabandari
- Department of Public Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Medication Adherence of Persons with Type 2 Diabetes in Malaysia: A Scoping Review and Meta-Analysis. J ASEAN Fed Endocr Soc 2022; 37:75-82. [PMID: 35800597 PMCID: PMC9242658 DOI: 10.15605/jafes.037.01.14] [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: 09/26/2021] [Accepted: 02/04/2022] [Indexed: 12/25/2022] Open
Abstract
Objective This is a scoping review of Malaysian scientific studies on medication adherence among persons with type 2 diabetes mellitus (T2DM). Methodology We conducted a bibliographic search of PubMed, Scopus and Google Scholar using the following keywords: "medication adherence," "drug compliance," "DMTAC" and "Malaysia." The search covered all publications up to 31 December 2021. Eligible articles were original studies conducted in Malaysia that measured or quantified medication adherence among persons with T2DM. Results We identified 64 eligible studies published between 2008 to 2021. Most studies included patients with T2DM in ambulatory facilities. Five studies were qualitative research. The quantitative research publications included clinical trials, and cross-sectional, validation, retrospective and prospective cohort studies. Thirty-eight studies used medication adherence scales. The Morisky Medication Adherence Scale (MMAS-8, used in 20 studies) and Malaysian Medication Adherence Scale (MALMAS, used in 6 studies) were the most commonly used tools. There were 6 validation studies with 4 medication adherence scales. A meta-analysis of 10 studies using MMAS-8 or MALMAS revealed that the pooled prevalence of low medication adherence is 34.2% (95% CI: 27.4 to 41.2, random effects model). Eighteen publications evaluated various aspects of the Diabetes Medication Therapy Adherence Clinics (DMTAC). Conclusion This scoping review documented extensive research on medication adherence among persons with diabetes in Malaysia. The quantitative meta-analysis showed a pooled low medication adherence rate.
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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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Olagbemide OJ, Omosanya OE, Ayodapo AO, Agboola SM, Adeagbo AO, Olukokun TA. Family support and medication adherence among adult type 2 diabetes: Any meeting point? Ann Afr Med 2021; 20:282-287. [PMID: 34893566 PMCID: PMC8693738 DOI: 10.4103/aam.aam_62_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/18/2020] [Accepted: 10/05/2020] [Indexed: 11/05/2022] Open
Abstract
Background Serious disability diabetes mellitus (DM) cause for patients and their support system-family and friends are enormous. It remains an important public health challenge, despite effective medical therapies for its management; patients' poor adherence remains a global problem. Objective The study assessed the relationship between family support and medication adherence among adult Type 2 DM (T2DM) attending family medicine clinic of a rural tertiary hospital. Methodology This was an analytic cross-sectional hospital-based study carried out among 367 patients selected by systematic random sampling method. Relevant data collected through a semi-structured questionnaire and clinical data recorded and fasting plasma glucose (FPG) were utilized for the study. Data were analyzed using SPSS version 16. Results The mean (standard deviation) age of respondents was 61.7 ± 11.4 years. Those with strong family support that achieved medium/high (Morisky Medication Adherence Scale-8 > 6) level of medication adherence (odds ratio [OR] [95% confidence interval (CI)] = 1 6.4 [9.1-29.6], P < 0.001) constituted 69.5% of respondents. Family support was also found to have a direct relationship to glycemic control (FPG < 7.1 mmol/l), 65.7% of those with strong family support achieved good glycemic control, P < 0.001, OR (95% CI) = 17.4 (9.2-37.2). The level of medication adherence was noted to be directly related to glycemic control, 79.4% of those with medium/high medication adherence had good glycemic control, OR (95% CI) = 25.0 (14.4-43.6), P < 0.001. Strong family support leads to higher medication adherence level which resulted into better glycemic control. Conclusion Family support improves medication adherence and glycemic control. Physicians should explore patients' family support system to improve medication adherence level and better management outcome of chronic diseases especially T2DM.
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Affiliation(s)
| | | | | | - Segun Matthew Agboola
- Department of Family Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | | | - Taiwo Adebayo Olukokun
- Department of Family Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
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Boshe BD, Yimar GN, Dadhi AE, Bededa WK. The magnitude of non-adherence and contributing factors among adult outpatient with Diabetes Mellitus in Dilla University Referral Hospital, Gedio, Ethiopia. PLoS One 2021; 16:e0247952. [PMID: 33661976 PMCID: PMC7932062 DOI: 10.1371/journal.pone.0247952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/17/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The global prevalence of Diabetes Mellitus (DM) has increased alarmingly over the last two decades. On top of this, the issues of non-adherence to the prescribed medicines further fuel the DM- related complications to become one of the top causes of mortality and morbidity. Despite the considerable efforts in addressing the poor adherence issues, there are still plenty of problems ahead of us yet to be addressed. The objective of this study was to determine the extent of non-adherence and its contributing factors among diabetic patients attending the medical Referral clinic of Dilla University Referral Hospital. METHODS The institutional-based descriptive cross-sectional study was carried out among patients with diabetes mellitus attending the medical referral clinic of Dilla University Referral Hospital. A systematic random sampling method was used to recruit study participants, and tool was adopted to assess for adherence. A pretested semi-structured questionnaire was used to collect information on factors influencing non-adherence to the diabetic medications, and in-depth interview questionnaire was used for key informant interviews for the qualitative part. Data analysis was carried out using SPSS-20. RESULTS The overall prevalence of non-adherence to diabetic treatment regimen among the study participants was 34.0%. The study revealed that cost of transport to the hospital and taking alcohol were significantly associated with non-adherence to the diabetic treatment regimen with the (AOR = 6.252(13.56, 28.822); p < 0.000) and (AOR = 13.12(8.06, 44.73); p<0.002) respectively. CONCLUSIONS The study revealed that significant numbers of participants were non-adherent to the Diabetes Mellitus treatment regimens. Intensive counseling, and health education on the importance of good adherence and negative consequences of poor adherence need to be discussed with the patients before starting the medications, and amidst follow up.
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Affiliation(s)
| | - Getachew Nenko Yimar
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Aberash Eifa Dadhi
- Department of Midwifery, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Worku Ketema Bededa
- Department of Pediatrics and Child Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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16
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Chia YC, Devaraj NK, Ching SM, Ooi PB, Chew MT, Chew BN, Mohamed M, Lim HM, Beh HC, Othman AS, Husin HS, Mohamad Gani AH, Hamid D, Kang PS, Tay CL, Wong PF, Hassan H. Relationship of an adherence score with blood pressure control status among patients with hypertension and their determinants: Findings from a nationwide blood pressure screening program. J Clin Hypertens (Greenwich) 2021; 23:638-645. [PMID: 33586334 PMCID: PMC8029568 DOI: 10.1111/jch.14212] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 12/01/2022]
Abstract
This study aimed to examine the relationship of adherence with blood pressure (BP) control and its associated factors in hypertensive patients. This cross-sectional nationwide BP screening study was conducted in Malaysia from May to October 2018. Participants with self-declared hypertension completed the Hill-Bone Compliance to High Blood Pressure Therapy Scale (Hill-Bone CHBPTS) which assesses three important domains of patient behavior to hypertension management namely medication taking, appointment keeping and reduced salt intake. Lower scores indicate better compliance while higher scores indicate otherwise. Participant's body mass index and seated BP were measured based on standard measurement protocol. Determinants of adherence to treatment were analyzed using multiple linear regression. Out of 5167 screened subjects, 1705 were known hypertensives. Of these, 927 (54.4%) answered the Hill-Bone CHBPTS and were entered into analysis. The mean age was 59.0 ± 13.2 years, 55.6% were female and 42.2% were Malays. The mean Hill-Bone CHBPTS score was 20.4 ± 4.4 (range 14-47), and 52.1% had good adherence. The mean systolic BP and diastolic BP were 136.4 ± 17.9 and 80.6 ± 11.6 mmHg, respectively. BP was controlled in 58.3% of those with good adherence compared to 50.2% in those with poor adherence (p = .014). Based on multiple linear regression analysis, female gender (β = -0.72, 95% confidence interval [CI] -1.30, -0.15, p = .014), older age (β = -0.05, 95% CI -0.07, -0.03, p < .001), and individuals with primary or lower educational level (β = -0.91, 95% CI -1.59, -0.23, p = .009) had better adherence to BP management. Interventional programs targeted at the less adherent groups are needed in order to improve their adherence and BP control.
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Affiliation(s)
- Yook Chin Chia
- Department of Medical Sciences, School of Medical and Live Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Navin Kumar Devaraj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.,Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.,Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Pei Boon Ooi
- Department of Medical Sciences, School of Medical and Live Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Ming Tsuey Chew
- Department of Medical Sciences, School of Medical and Live Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Bee Nah Chew
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohazmi Mohamed
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Student Health Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Hooi Min Lim
- Department of Primary Care Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Hooi Chin Beh
- Department of Primary Care Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | - Hanis Saadah Husin
- International Medical School, Management and Science University, Shah Alam, Malaysia
| | | | - Dalyana Hamid
- AU2 Keramat Government Health Clinic, Kuala Lumpur, Malaysia
| | - Pei San Kang
- Gopeng Government Health Clinic, Perak, Malaysia
| | - Chai Li Tay
- Simpang Government Health Clinic, Perak, Malaysia
| | - Ping Foo Wong
- Cheras Baru Government Health Clinic, Kuala Lumpur, Malaysia
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17
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Maruan K, Md Isa KA, Sulaiman N, Karuppannan M. Adherence of patients with type 2 diabetes to refills and medications: a comparison between ‘telephone and collect’ and conventional counter services in a health clinic. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-020-00776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Yong SY, Goh GM, Loh HH. Insulin adherence and the associated factors among patients with type 2 diabetes mellitus at the Hospital Queen Elizabeth II, Sabah. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-020-01409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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19
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Tan CS, Hassali MAA, Neoh CF, Ming LC. Beliefs about medicine and medication adherence among hypertensive patients in the community setting. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-020-00744-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Trevisan DD, São-João T, Cornélio M, Jannuzzi F, de Sousa MR, Rodrigues R, Lima MH. Effect of an 'implementation intention' intervention on adherence to oral anti-diabetic medication in Brazilians with type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2020; 103:582-588. [PMID: 31630899 DOI: 10.1016/j.pec.2019.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the effects of an implementation intention intervention on adherence to an oral anti-diabetic medication regime, diabetes-related distress and on glycemic control in patients with type 2 diabetes mellitus. METHODS A randomized, parallel-group, single-center controlled trial was conducted among adults with type 2 diabetes being managed at the primary care level. The intervention group (IG, n = 45) received an 'implementation intention' intervention; the control group (CG, n = 45) received standard care. Primary outcomes were the taking of oral anti-diabetic medication, global adherence and level of glycated hemoglobin. The secondary outcome was diabetes-related distress. Data were gathered at baseline and after 15 weeks. RESULTS The IG showed improvements in adherence to an oral anti-diabetic medication regime (p < 0.0001), glycemic control (p < 0.0001) and diabetes-related distress (p < 0.0001) relative to the CG. CONCLUSIONS The implementation intention intervention enhanced adherence to an oral anti-diabetic medication regime, which had positive effects on blood glucose levels and diabetes-related distress. PRACTICE IMPLICATIONS Adherence to an oral anti-diabetic medication regime can decrease blood glucose levels and diabetes-related distress and thus reduce complications of type 2 diabetes.
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Affiliation(s)
| | - Thaís São-João
- School of Nursing - University of Campinas, Campinas, Brazil
| | | | - Fernanda Jannuzzi
- Technical School of Campinas - University of Campinas, Campinas, Brazil
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Mirahmadizadeh A, Khorshidsavar H, Seif M, Sharifi MH. Adherence to Medication, Diet and Physical Activity and the Associated Factors Amongst Patients with Type 2 Diabetes. Diabetes Ther 2020; 11:479-494. [PMID: 31916213 PMCID: PMC6995790 DOI: 10.1007/s13300-019-00750-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The prevalence of type 2 diabetes mellitus (T2D) has increased considerably while the outcome of diabetic management is suboptimal. In order to promote diabetic management, associated factors for adherence to medications, diet, and physical activity (PA) need to be more clearly identified amongst patients with T2D. METHODS This cross-sectional study was conducted on 206 men and 294 women amongst patients with diabetes who were registered in ten special diabetic clinics in Shiraz, Iran from November 2018 to April 2019. Levels of adherence to medication, Mediterranean diet (MD), and physical activity were measured with validated and appropriate questionnaires. RESULTS Mean age (± SD) was 56.92 ± 0.52 years and 294 (58.8%) were female. Data showed that reduced adherence to medication, MD, and PA increased glycated hemoblobin (HbA1c). Adherence to medication among low, moderate, and high levels was 27.2%, 59.2%, and 13.6%, respectively. Associated factors such as 50-64 years of age, at least 65 years of age, overweight, obese, divorced widow, smoker, and ex-smoker had a significant influence on adherence to medication, P = 0.017, P = 0.018, P = 0.008. P = 0.045, P = 0.026, P < 0.004, and P = 0.001, respectively. In addition, adherence to MD among low, moderate, and high levels was 5.4%, 77.2%, and 17.4%, respectively. Associated factors such as 50-64 years of age, at least 65 years of age, overweight, obese, and smoker had a significant influence on adherence to MD, P = 0.011, P = 0.046, P = 0.002, P < 0.001, and P = 0.032, respectively. Furthermore, adherence to PA among low, moderate, and high levels was 21%, 68.6%, and 10.4%, respectively. Only the non-smoker factor played a significant role in PA adherence, P = 0.010. CONCLUSION Levels of adherence to medications, diet, and PA amongst patients with T2D are not within the acceptable range. Recognized associated factors that contribute to adherence might improve diabetes management and allow one to tailor the appropriate message to improve glycemic indices.
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Affiliation(s)
- Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mozhgan Seif
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Sharifi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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22
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Vluggen S, Hoving C, Schaper NC, De Vries H. Psychological predictors of adherence to oral hypoglycaemic agents: an application of the ProMAS questionnaire. Psychol Health 2019; 35:387-404. [PMID: 31588778 DOI: 10.1080/08870446.2019.1672873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: This study aimed to identify psychological predictors of oral hypoglycaemic agent (OHA) adherence and to compare adherence rates between a novel and well-known instrument, i.e. the Probabilistic Medication Adherence Scale (ProMAS) and Medication Adherence Report Scale (MARS-5).Design and main outcome measures: A longitudinal study design was applied with surveys at baseline and 6-month follow-up. At baseline, OHA adherence using the ProMAS and MARS-5, socio-cognitive determinants and demographics were assessed. At follow-up, the ProMAS was applied as outcome measure, on which socio-cognitive determinants and demographics were regressed using linear regression analysis.Results: The baseline and follow-up sample included 304 and 231 participants, respectively. When applying cut-off points of ≥15 for the ProMAS and ≥23 for the MARS-5, 47.4 and 89.5% adhered to their OHAs. Consistent predictors of better adherence comprised a low education, lower severity perceptions, and higher self-efficacy and intention. After correcting for baseline adherence, a low education and higher self-efficacy remained significant adherence predictors.Conclusions: Compared to the MARS-5, ProMAS data was less skewed, similar to objectively collected data, and yielded insights in a broader spectrum of (non)-adherence behaviours. Results stress the need for adherence improving interventions which particularly should target higher educated patients and patients with low self-efficacy, low intention and high severity perceptions.
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Affiliation(s)
- Stan Vluggen
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Ciska Hoving
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Endocrinology and Internal Medicine, School CAPHRI, University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Hein De Vries
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands
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Dhillon H, Nordin RB, Ramadas A. Quality of Life and Associated Factors among Primary Care Asian Patients with Type 2 Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193561. [PMID: 31547629 PMCID: PMC6801549 DOI: 10.3390/ijerph16193561] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/14/2022]
Abstract
Diabetes complications, medication adherence, and psychosocial well-being have been associated with quality of life (QOL) among several Western and Asian populations with diabetes, however, there is little evidence substantiating these relationships among Malaysia’s unique and diverse population. Therefore, a cross-sectional study was conducted in a Malaysian public primary care clinic among 150 patients diagnosed with type 2 diabetes mellitus (T2DM). Structured and validated questionnaires were used to investigate the associations between demographic, clinical, and psychological factors with QOL of the study participants. Approximately three-quarters of patients had a good-excellent QOL. Diabetes-related variables that were significantly associated with poor QOL scores included insulin containing treatment regimens, poor glycemic control, inactive lifestyle, retinopathy, neuropathy, abnormal psychosocial well-being, higher diabetes complication severity, and nonadherence (p < 0.05). The main predictors of a good-excellent QOL were HbA1c ≤ 6.5% (aOR = 20.78, 95% CI = 2.5175.9, p = 0.005), normal anxiety levels (aOR = 5.73, 95% CI = 1.8–18.5, p = 0.004), medication adherence (aOR = 3.35, 95% CI = 1.3–8.7, p = 0.012), and an aDCSI score of one and two as compared to those greater than or equal to four (aOR = 7.78, 95% CI = 1.5–39.2, p = 0.013 and aOR = 8.23, 95% CI = 2.1–32.8, p = 0.003), respectively. Medication adherence has also been found to be an effect modifier of relationships between HbA1c, depression, anxiety, disease severity, and QOL. These predictors of QOL are important factors to consider when managing patients with T2DM.
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Affiliation(s)
- Hardesh Dhillon
- Barwon Health, University Hospital Geelong, Geelong, Victoria 3220, Australia.
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor 47500, Malaysia.
| | - Rusli Bin Nordin
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor 47500, Malaysia.
| | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor 47500, Malaysia.
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Tan C, Abdin E, Liang W, Poon LY, Poon NY, Verma S. Medication adherence in first-episode psychosis patients in Singapore. Early Interv Psychiatry 2019. [PMID: 29521010 DOI: 10.1111/eip.12559] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Early intervention programmes for first episode psychosis (FEP) aim to reduce the duration of untreated psychosis (DUP) and improve functional outcomes. The sustained maintenance of improved outcomes depends largely on patients' adherence to prescribed treatment. This paper examines the prevalence of non-adherence in a cohort of patients with FEP and the sociodemographic and clinical factors associated with non-adherent behaviour. METHODS The sample included consecutive patients accepted from 2007 to 2012 into the Early Psychosis Intervention Programme (EPIP) in Singapore. Sociodemographic variables as well as DUP, insight, severity of psychopathology and clinical diagnoses were collected. Patients were assessed at baseline and 1 year with the PANSS and Global Assessment of Functioning Scale (GAF). Medication adherence was grouped into 3 categories: no-adherence, partial adherence and regular adherence. RESULTS Of the 445 patients included, 51% were male with a mean age of 26.3 years, 74.6% had schizophrenia spectrum and delusional disorders, 14% had affective psychosis and 11.3% had brief psychotic disorder or psychotic disorder not otherwise specified. At 1 year follow up, 65.5% reported regular adherence, 18.7% were partially adherent and 15.8% were non-adherent. Non-adherence was correlated with male gender, living alone and having poorer judgement and insight. Partial adherence was associated with Malay ethnicity and having undergone national service. CONCLUSION Medication adherence is prevalent in FEP and associated with a variety of factors. This study supports the use of culturally appropriate interventions in addressing barriers to adherence. Further studies would need to be done to address specific factors affecting adherence outcomes.
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Affiliation(s)
- Chunzhen Tan
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | | | - Wilfred Liang
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | - Lye Yin Poon
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | - Ngar Yee Poon
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | - Swapna Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
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Lee S, Jiang L, Dowdy D, Hong YA, Ory MG. Effects of the Chronic Disease Self-Management Program on medication adherence among older adults. Transl Behav Med 2019; 9:380-388. [PMID: 29878214 DOI: 10.1093/tbm/iby057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Despite many interventions to promote medication adherence in older adults, we know little about how medication adherence has improved as a result of such interventions. The purpose of this study was to examine the long-term program impacts on medication adherence from participating in the Chronic Disease Self-Management Program (CDSMP). Secondary data used for this study included the CDSMP participants' sociodemographic characteristics and their baseline and 6- and 12-month follow-up assessments on health-related indicators, including medication adherence, self-rated health, depression, and patient communication skills. This study included those who were 65 years or older, had one or more chronic conditions, and attended at least the first or second session. Linear mixed models were used to analyze the impacts of short-term (6 months) changes in health-related indicators on long-term (12 months) changes in medication nonadherence. The subset analyses were performed among participants with self-rated major depression at baseline. This study included 687 participants. Self-reported medication adherence did not improve significantly at 6-month follow-up assessment but significantly improved at 12-month follow-up assessment. Among those with self-reported major depression at baseline assessment, the short-term improvements in depression and self-rated health were associated with long-term changes in medication adherence. The long-term impacts of the CDSMP on medication adherence were influenced by the short-term program impacts on health-related indicators. More targeted interventions are needed for patients with major depression, and programs such as the CDSMP can be particularly helpful among the population.
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Affiliation(s)
- Shinduk Lee
- Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, USA.,Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Luohua Jiang
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA, USA
| | - Diane Dowdy
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Y Alicia Hong
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Marcia G Ory
- Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, USA.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
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Abdullah NF, Khuan L, Theng CA, Sowtali SN, Juni MH. Effect of patient characteristics on medication adherence among patients with type 2 diabetes mellitus: a cross-sectional survey. Contemp Nurse 2019; 55:27-37. [PMID: 30764733 DOI: 10.1080/10376178.2019.1583067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The prevalence of diabetes mellitus (DM) is steadily increasing worldwide, with a significant DM population in Asian countries. Adherence to medications is important to achieve good glycaemic control among patients with DM. Thus, patients' adherence to their medication regimen should be determined to optimise DM management. Aims: To determine medication adherence and the relationship between patient profile and medication adherence among patients with type 2 DM (T2DM). Design: Cross-sectional survey. Methods: This study was conducted in a public hospital in Selangor, Malaysia, from December 2016 to June 2017. Data was obtained through administration of the Medication Compliance Questionnaire and an electronic medical records database. Multivariate logistic regression analysis was used to determine the predictors of medication adherence. Results: A total of 232 (95.9% response rate) patients participated in this study. The overall percentage of medication adherence among patients with DM was 55.2%. The majority of participants were female (53.4%), Malay (47.0%), aged 41-64 years (55.2%; mean age, 56.69 years), married (84.5%), unemployed (60.8%) and attended secondary school (53.9%). The factors independently associated with adherence were ethnicity (odds ratio [OR], 1.43; 95% confidence interval [CI]: 1.03-1.99) and haemoglobin A1c (HbA1c) level (OR, 2.71; 95% CI: 1.56-4.72). Conclusions: The medication adherence among patients with DM in a public hospital in Selangor, Malaysia was low. A health intervention emphasising patient-centred care is warranted to improve DM patients' adherence to prescribed medication. Considering that Malaysia has a multi-ethnic population, the patients' ethnicity and their HbA1c levels need to be considered in the implementation of any intervention to improve medication adherence. Impact statement: Medication adherence is influenced by individual patients' characteristics. To improve adherence to the medication regimen, nurses should consider patients' profiles.
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Affiliation(s)
- Nor Fadhilah Abdullah
- a Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences , Universiti Putra Malaysia , Serdang 43400 , Selangor , Malaysia.,b Department of Nursing, Faculty of Medicine , Universiti Sultan Zainal Abidin , Gong Badak 21300 , Terengganu , Malaysia
| | - Lee Khuan
- a Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences , Universiti Putra Malaysia , Serdang 43400 , Selangor , Malaysia
| | - Cheong Ai Theng
- c Department of Family Medicine, Faculty of Medicine and Health Sciences , Universiti Putra Malaysia , Serdang 43400 , Selangor , Malaysia
| | - Siti Noorkhairina Sowtali
- d Department of Professional Nursing Studies, Kulliyyah of Nursing , International Islamic University Malaysia , Jalan Hospital Campus, Kuantan 25100 , Pahang , Malaysia
| | - Muhamad Hanafiah Juni
- e Department of Community Health, Faculty of Medicine and Health Sciences , Universiti Putra Malaysia , Serdang 43400 , Selangor , Malaysia
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Chew BH, Vos RC, Fernandez A, Shariff Ghazali S, Shamsuddin NH, Ismail M, Rutten GE. The effectiveness of an emotion-focused educational programme in reducing diabetes distress in adults with type 2 diabetes mellitus at 12-month follow-up: a cluster randomized controlled trial. Ther Adv Endocrinol Metab 2019; 10:2042018819853761. [PMID: 31210922 PMCID: PMC6545652 DOI: 10.1177/2042018819853761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diabetes distress (DD) is an increasingly important part of clinical medicine, diabetes self-management and research topic in people with diabetes mellitus. The present study evaluated the effectiveness of a value-based emotion-focused educational program in Malay adults with type 2 diabetes (VEMOFIT) at 12-month follow-up compared with a program with systematic attention to participants' emotions (attention-control). METHODS VEMOFIT consisted of four biweekly group sessions and a booster session after 3 months; the attention-control program consisted of three sessions over the same period. Intention-to-treat analysis with multilevel mixed modelling was done to estimate the intervention effect. RESULTS Participants (n = 124) randomized to VEMOFIT (n = 53) or attention-control (n = 71). Mean (SD) age 55.7 (9.7) years, median diabetes duration 7.0 (8.0) years and mean HbA1c level 9.7% (82 mmol/mol). The mean DD (DDS-17 scale) level decreased in both groups (from 3.4 to 3.3 versus 3.1-2.5, respectively), significantly more in the attention-control group [adjusted difference -0.6, 95% confidence interval (CI) -1.1, -0.2]. The VEMOFIT group had a significant improvement in self-efficacy (DMSES, range 0-200; adjusted difference 16.4, 99.4% CI 1.9, 30.9). Other outcomes did not differ. CONCLUSIONS Because the attention-control program resulted in a decreased DD 1 year later, its implementation on a larger scale seems justified. TRIAL REGISTRATION NCT02730078; NMRR-15-1144-24803.
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Affiliation(s)
| | - Rimke C. Vos
- Department of Public Health and Primary Care/ LUMC Campus The Hague, Leiden University Medical Center, The Netherlands
| | - Aaron Fernandez
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nurainul Hana Shamsuddin
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | | | - Guy E.H.M. Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
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Onwuchuluba E, Soremekun R, Oyetunde O. Medication adherence and influencing factors in patients with type 2 diabetes attending a tertiary hospital in South-West Nigeria. JOURNAL OF CLINICAL SCIENCES 2019. [DOI: 10.4103/jcls.jcls_40_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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A preliminary study of the potential role of Malaysian community pharmacists in type 2 diabetes medicines management clinics. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Chew BH, Vos RC, Pouwer F, Rutten GEHM. The associations between diabetes distress and self-efficacy, medication adherence, self-care activities and disease control depend on the way diabetes distress is measured: Comparing the DDS-17, DDS-2 and the PAID-5. Diabetes Res Clin Pract 2018; 142:74-84. [PMID: 29802952 DOI: 10.1016/j.diabres.2018.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/09/2018] [Accepted: 05/09/2018] [Indexed: 02/08/2023]
Abstract
AIMS To examine whether diabetes distress (DD), when measured by three different instruments, was associated differently with self-efficacy, self-care activity, medication adherence and disease control in people with Type 2 diabetes mellitus. METHODS A cross-sectional study in three health clinics. DD was assessed with the 17-item Diabetes Distress Scale, the 2-item DDS-2 (DDS-2) and the 5-item Problem Areas in Diabetes Scale (PAID-5). Dependent variables included self-efficacy, self-care activities, medication adherence, HbA1c, systolic and diastolic blood pressure (SBP, DBP). Multiple linear and logistic regression were used in analyses. RESULTS In total 338 participants (56% women), with a mean age of 61 years and diabetes duration of 9.8 years, were included. DDS-2 was an independent determinant of SBP (β = 1.89, 95% CI 0.14, 3.64), DBP (β = 1.19, 95% CI 0.16, 2.21) and blood pressure target (OR = 2.09, 95% CI 1.12, 3.83). PAID-5 was an independent determinant of medication adherence (adjusted β = -0.05, 95% CI -0.08, -0.01) and self-care activities (OR = 0.50, 95% CI 0.26, 0.99). CONCLUSIONS Associations of DD with important aspects of diabetes care are substantially influenced by confounders and depend on the way DD is measured. Our findings call for a judicious use of different DD measures in clinical practice and research. The study is registered on ClinicalTrials.gov (NCT02730754).
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Affiliation(s)
- Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; University of Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Rimke C Vos
- University of Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Guy E H M Rutten
- University of Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Lum ZK, Tsou KYK, Lee JYC. Mediators of medication adherence and glycaemic control and their implications for direct outpatient medical costs: a cross-sectional study. Diabet Med 2018. [PMID: 29532548 DOI: 10.1111/dme.13619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To investigate the effects of diabetes-related distress and perception of hyperglycaemia on self-reported medication adherence and glycaemic control, as measured by HbA1c , and to compare the cost outcomes in patients with sub-optimally vs uncontrolled Type 2 diabetes mellitus. METHODS We conducted a retrospective cross-sectional study that involved the review of a chronic disease database in Singapore. Data on clinical characteristics, diabetes-related distress, perception of hyperglycaemia, self-reported medication adherence and costs were obtained from the database. Mediation analyses were conducted using a linear regression-based approach. A final path model was built to illustrate the sequential mediating effects of diabetes-related distress and perception on the association of medication adherence and HbA1c concentration. RESULTS Diabetes-related distress and perception of hyperglycaemia were significantly associated with medication adherence and HbA1c concentration. Mediation analyses showed a significant indirect effect of diabetes-related distress and perception of hyperglycaemia on medication adherence and HbA1c concentration. People with uncontrolled diabetes were found to incur significantly higher total direct medical costs than those with sub-optimally controlled diabetes (P = 0.034), with medication cost as the main cost driver (66.6%). CONCLUSIONS Identifying the influence of the sequential mediating effects of distress and perception was important in understanding the pathway between medication adherence and glycaemic control. This suggests the importance of a team-based approach to address these mediators and thus improve glycaemic control. Poor glycaemic control was also found to be associated with higher direct medical costs.
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Affiliation(s)
- Z K Lum
- Department of Pharmacy, Faculty of Science, National University of Singapore
| | - K Y K Tsou
- National University Polyclinics, Singapore
| | - J Y-C Lee
- Department of Pharmacy, Faculty of Science, National University of Singapore
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Oung AB, Kosirog E, Chavez B, Brunner J, Saseen JJ. Evaluation of medication adherence in chronic disease at a federally qualified health center. Ther Adv Chronic Dis 2017; 8:113-120. [PMID: 28815008 PMCID: PMC5546648 DOI: 10.1177/2040622317714966] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 05/17/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND While medication adherence in chronic disease has been evaluated in the general population, limited data are available among Medicaid recipients, especially within federally qualified health centers (FQHCs). This study determined baseline medication adherence for Medicaid recipients receiving care in an FQHC for first-line medications used in hypertension, hyperlipidemia, and diabetes. Secondary outcomes included baseline adherence for individual patient factors. METHODS Patients from the Salud Family Health Centers, an FQHC with a large percentage of both Spanish-speaking patients and providers, were included in this study. Using retrospective prescription claims reports from 1 January 2015 to 1 October 2015, medication possession ratios (MPRs) and proportion of days covered (PDC) were calculated for each medication group. Patients with adherence ⩾0.80 were considered adherent. RESULTS From 1034 individual patients, 1788 medications were evaluated. Using MPRs, adherence rates were highest among medications for hypertension (67.2% adherent), followed by hyperlipidemia (67.0%), and lastly diabetes (58.0%); p < 0.001. Likewise, using PDC, adherence rates were highest for medications for hypertension (56.6%), followed by hyperlipidemia (52.2%), and lastly diabetes (45.0%); p = 0.010. Lower rates of adherence were seen among men, patients age 18-29 years old, African Americans, and patients with English documented as their preferred language. CONCLUSIONS Although overall medication adherence rates within our FQHC patients were comparable with those in previous literature, differences seen among medication groups and patient individual factors suggest that there is still much to be learned in improving adherence. Future efforts will require a multifaceted approach, tailored to patient-specific needs.
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Affiliation(s)
- Alvin B. Oung
- School of Pharmacy, University of Wyoming, Laramie, WY, USA
| | - Emily Kosirog
- University of Colorado Anschutz Medical Campus, 12850 E. Montview Blvd. (C238), Aurora, CO 80045, USA
| | - Benjamin Chavez
- Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jason Brunner
- Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joseph J. Saseen
- Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- School of Medicine, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Conti C, Di Francesco G, Fontanella L, Carrozzino D, Patierno C, Vitacolonna E, Fulcheri M. Negative Affectivity Predicts Lower Quality of Life and Metabolic Control in Type 2 Diabetes Patients: A Structural Equation Modeling Approach. Front Psychol 2017; 8:831. [PMID: 28596745 PMCID: PMC5443140 DOI: 10.3389/fpsyg.2017.00831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 05/08/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction: It is essential to consider the clinical assessment of psychological aspects in patients with Diabetes Mellitus (DM), in order to prevent potentially adverse self-management care behaviors leading to diabetes-related complications, including declining levels of Quality of Life (QoL) and negative metabolic control. Purpose: In the framework of Structural Equation Modeling (SEM), the specific aim of this study is to evaluate the influence of distressed personality factors as Negative Affectivity (NA) and Social Inhibition (SI) on diabetes-related clinical variables (i.e., QoL and glycemic control). Methods: The total sample consists of a clinical sample, including 159 outpatients with Type 2 Diabetes Mellitus (T2DM), and a control group composed of 102 healthy respondents. All participants completed the following self- rating scales: The Type D Scale (DS14) and the World Health Organization QoL Scale (WHOQOLBREF). Furthermore, the participants of the clinical group were assessed for HbA1c, disease duration, and BMI. The observed covariates were BMI, gender, and disease duration, while HbA1c was considered an observed variable. Results: SEM analysis revealed significant differences between groups in regards to the latent construct of NA and the Environmental dimension of QoL. For the clinical sample, SEM showed that NA had a negative impact on both QoL dimensions and metabolic control. Conclusions: Clinical interventions aiming to improve medication adherence in patients with T2DM should include the psychological evaluation of Type D Personality traits, by focusing especially on its component of NA as a significant risk factor leading to negative health outcomes.
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Affiliation(s)
- Chiara Conti
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy
| | - Giulia Di Francesco
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy
| | - Lara Fontanella
- Department of Legal and Social Sciences, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy
| | - Danilo Carrozzino
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy.,Psychiatric Research Unit, Mental Health Centre North Zealand, University of CopenhagenHillerød, Denmark
| | - Chiara Patierno
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy
| | - Ester Vitacolonna
- Department of Medicine and Aging, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy
| | - Mario Fulcheri
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy
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Chew BH, Vos RC, Stellato RK, Rutten GEHM. Diabetes-Related Distress and Depressive Symptoms Are Not Merely Negative over a 3-Year Period in Malaysian Adults with Type 2 Diabetes Mellitus Receiving Regular Primary Diabetes Care. Front Psychol 2017; 8:1834. [PMID: 29089913 PMCID: PMC5651035 DOI: 10.3389/fpsyg.2017.01834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 10/02/2017] [Indexed: 02/05/2023] Open
Abstract
For people with type 2 diabetes mellitus (T2DM) the daily maintenance of physical and psychological health is challenging. However, the interrelatedness of these two health domains, and of diabetes-related distress (DRD) and depressive symptoms, in the Asian population is still poorly understood. DRD and depressive symptoms have important but distinct influences on diabetes self-care and disease control. Furthermore, the question of whether changes in DRD or depressive symptoms follow a more or less natural course or depend on disease and therapy-related factors is yet to be answered. The aim of this study was to identify the factors influencing changes in DRD or depressive symptoms, at a 3-year follow-up point, in Malaysian adults with T2DM who received regular primary diabetes care. Baseline data included age, sex, ethnicity, marital status, educational level, employment status, health-related quality of life (WHOQOL-BREF), insulin use, diabetes-related complications and HbA1c. DRD was assessed both at baseline and after 3 years using a 17-item Diabetes Distress Scale (DDS-17), while depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Linear mixed models were used to examine the relationship between baseline variables and change scores in DDS-17 and PHQ-9. Almost half (336) of 700 participants completed both measurements. At follow-up, their mean (SD) age and diabetes duration were 60.6 (10.1) years and 9.8 (5.9) years, respectively, and 54.8% were women. More symptoms of depression at baseline was the only significant and independent predictor of improved DRD at 3 years (adjusted β = -0.06, p = 0.002). Similarly, worse DRD at baseline was the only significant and independent predictor of fewer depressive symptoms 3 years later (adjusted β = -0.98, p = 0.005). Thus, more "negative feelings" at baseline could be a manifestation of initial coping behaviors or a facilitator of a better psychological coaching by physicians or nurses that might be beneficial in the long term. We therefore conclude that initial negative feelings should not be seen as a necessarily adverse factor in diabetes care.
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Affiliation(s)
- Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- *Correspondence: Boon-How Chew ;
| | - Rimke C. Vos
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rebecca K. Stellato
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Guy E. H. M. Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Chew BH, Vos R, Mohd-Sidik S, Rutten GEHM. Diabetes-Related Distress, Depression and Distress-Depression among Adults with Type 2 Diabetes Mellitus in Malaysia. PLoS One 2016; 11:e0152095. [PMID: 27002728 PMCID: PMC4803274 DOI: 10.1371/journal.pone.0152095] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 03/08/2016] [Indexed: 02/08/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) brings about an increasing psychosocial problem in adult patients. Prevalence data on and associated factors of diabetes related distress (DRD) and depression have been lacking in Asia. This study aimed to examine the prevalence of DRD and depression, and their associated factors in Asian adult T2DM patients. This study was conducted in three public health clinics measuring DRD (Diabetes Distress Scale, DDS), and depression (Patient Health Questionnaire, PHQ). Patients who were at least 30 years of age, had T2DM for more than one year, with regular follow-up and recent laboratory results (< 3 months) were consecutively recruited. Associations between DRD, depression and the combination DRD-depression with demographic and clinical characteristics were analysed using generalized linear models. From 752 invited people, 700 participated (mean age 56.9 years, 52.8% female, 52.9% Malay, 79.1% married). Prevalence of DRD and depression were 49.2% and 41.7%, respectively. Distress and depression were correlated, spearman's r = 0.50. Patients with higher DRD were younger (OR 0.995, 95% CI 0.996 to 0.991), Chinese (OR 1.2, 95% CI 1.04 to 1.29), attending Dengkil health clinic (OR 1.1, 95% CI 1.00 to 1.22) and had higher scores on the PHQ (OR 1.1, 95% CI 1.04 to 1.06). Depression was less likely in the unmarried compared to divorced/separately living and those attending Dengkil health clinic, but more likely in patients with microvascular complications (OR 1.4, 95% CI 1.06 to 1.73) and higher DDS (OR 1.03, 95% CI 1.02 to 1.03). For the combination of DRD and depression, unemployment (OR 4.7, 95% CI 1.02 to 21.20) had positive association, whereas those under medical care at the Salak health clinics (OR 0.28, 95% CI 0.12 to 0.63), and those with a blood pressure > 130/80 mmHg (OR 0.53, 95% CI 0.32 to 0.89) were less likely to experience both DRD and depression. DRD and depression were common and correlated in Asian adults with T2DM at primary care level. Socio-demographic more than clinical characteristics were related to DRD and depression.
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Affiliation(s)
- Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Department of General Practice, Huispost Str.6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- * E-mail:
| | - Rimke Vos
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Department of General Practice, Huispost Str.6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Sherina Mohd-Sidik
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Guy E. H. M. Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Department of General Practice, Huispost Str.6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Zioga E, Kazakos K, Dimopoulos E, Koutras C, Marmara K, Marmara EE, Marmaras A, Lavdaniti M. ADHERENCE AND QUALITY OF LIFE IN PATIENTS WITH TYPE II DIABETES MELLITUS IN NORTHERN GREECE. Mater Sociomed 2016; 28:258-262. [PMID: 27698597 PMCID: PMC5034999 DOI: 10.5455/msm.2016.28.258-262] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/11/2016] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Adherence as a concept includes various types of health-related behavior. Better medical adherence leads to improved disease control and fewer diabetes-related complications. Quality of life and medication adherence are interrelated. Patients with diabetes who adhere to their treatment can experience an improvement in quality of life and vice versa. AIM To assess treatment adherence in patients with type II diabetes, as well as the connection between adherence and quality of life. METHODOLOGY A descriptive non-experimental study was conducted in a provincial hospital in Northern Greece. The sample examined was a convenience sample consisting of 108 patients with type II diabetes mellitus. They completed the "Diabetes Self-Care Activities Questionnaire" and SF-36 "Quality of Life Questionnaire". RESULTS Participants demonstrated good adherence to diet and blood test / blood glucose test routines, but did not experience high levels of quality of life. The type of treatment affected the adherence to blood tests with a statistically significant difference (p=0,000). Also, marital status affected mental health with a statistically significant difference (p=0,032). The adherence sub scales are correlated with the all domains of quality of life. CONCLUSIONS According to our findings, it is important to plan interventions to enhance adherence to other types of treatment and to help patients to further improve their quality of life.
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Affiliation(s)
| | - Kyriakos Kazakos
- Faculty of Nursing, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece
| | | | | | - Kalliopi Marmara
- Faculty of Physical Education, Aristotele University of Thessaloniki, Thessaloniki, Greece
| | | | - Athanasios Marmaras
- Physiotherapy Department, Metropolitan College - UEL of Thessaloniki, Thessaloniki, Greece
| | - Maria Lavdaniti
- Faculty of Nursing, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece
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