A comparison of medication adherence between subsidized and self-paying patients in Malaysia

BACKGROUND

Limited efforts have been made to evaluate medication adherence among subsidized and self-paying patients.

OBJECTIVE

To investigate medication adherence among patients with and without medication subsidies and to identify factors that may influence patients' adherence to medication. Setting: Government healthcare institutions in Kuala Lumpur, Selangor, and Negeri Sembilan and private healthcare institutions in Selangor and Negeri Sembilan, Malaysia.

METHODS

This cross-sectional study sampled patients with and without medication subsidies (self-paying patients). Only one of the patient's medications was re-packed into Medication Event Monitoring Systems (MEMS) bottles, which were returned after four weeks. Adherence was defined as the dose regimen being executed as prescribed on 80% or more of the days. The factors that may influence patients' adherence were modelled using binary logistic regression. Main outcome measure: Percentage of medication adherence.

RESULTS

A total of 97 patients, 50 subsidized and 47 self-paying, were included in the study. Medication adherence was observed in 50% of the subsidized patients and 63.8% of the self-paying patients (χ²=1.887, df=1, p=0.219). None of the evaluated variables had a significant influence on patients' medication adherence, with the exception of attending drug counselling. Patients who attended drug counselling were found to be 3.3 times more likely to adhere to medication than those who did not (adjusted odds ratio of 3.29, 95% CI was 1.42 to 7.62, p = 0.006).

CONCLUSION

There is no significant difference in terms of medication adherence between subsidized and self-paying patients. Future studies may wish to consider evaluating modifiable risk factors in the examination of non-adherence among subsidized and self-paying patients in Malaysia.

Attitudes and reactions of Arab medical students to the dissecting room

A questionnaire on the emotional and psychological reactions of Arab medical students to the dissecting room (DR) was distributed to 272 students in four successive pre-clinical and clinical years in the same academic year (1993-1994) at Sultan Qaboos University (SQU) Medical College; 205 students responded. Varying degrees of fear on first entering the DR was reported by 46%. The most frequent reactions were recurring visual images of cadavers (total 38%) and temporary loss of appetite (total 22.5%). Students' reactions were most commonly elicited by the smell of the DR (total 91%) and by fear of infection (total 62%). The most frequent method of coping with such fears was by rationalization (total 65%). Significant gender differences (P < 0.05) were found concerning all aspects of the DR experience. Female students showed higher levels of fear, reported stronger physical and behavioral reactions, were more disturbed by certain stimuli in the DR, and used certain coping methods more frequently than their male peers. The need for appropriate psychological preparation of students before studying human cadaveric anatomy is discussed.