Abstract
Background The prevalence of diabetes in Jordan is among the highest in the world, making it a particularly alarming health problem there. It has been indicated that poor adherence to the prescribed therapy lead to poor glycemic control and enhance the development of diabetes complications and unnecessary hospitalization. Objective To explore factors associated with medication nonadherence in patients with type 2 diabetes in Jordan. Findings would help guide the development of future pharmaceutical care interventions for patients with type 2 diabetes. Setting This study was conducted in an outpatient diabetes clinic at the Royal Medical Services Hospital. Method Variables including sociodemographics, disease and therapy factors, diabetes knowledge, health-related quality of life in addition to adherence assessment were collected for 171 patients with type 2 diabetes using medical records, custom-designed and validated questionnaires. Logistic regression was performed to develop a model with variables that best predicted medication non-adherence in patients with type 2 diabetes in Jordan. Main outcome measure Variables which significantly and independently associated with medication nonadherence in patients with type 2 diabetes in Jordan. Results Patients were found four times less likely to adhere to their medications with each unit increase in the number of prescribed medications (OR = 0.244, CI = 0.08–0.63) and nine times less likely to adhere to their medications if they received more than once daily dosing of diabetic medication (OR = 0.111, CI = 0.04–2.01). Patients in the present study were also approximately three times less likely (OR = 0.362, CI = 0.24–0.87) and twice less likely (OR = 0.537, CI = 0.07–1.31) to adhere to their medications if they reported having concerns about side effects and if they were taking metformin therapy respectively. Finally, participants were found twice more likely to adhere to medications if they had one or more Microvascular complication (OR = 0.493, CI = 0.08–1.16). Conclusion Simplifying dosage regimen, selecting treatments with lower side effects along with an emphasis on diabetes complications should be taken into account in future interventions designed to improve health outcomes for patients with type 2 diabetes.
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References
Ajlouni K, Khader YS, Batieha A, Ajlouni H, El-Khateeb M. An increase in prevalence of diabetes mellitus in Jordan over 10 years. J Diabetes Complications. 2008;22(5):317–24.
Waly MI, Essa MM, Ali A, Al-Shuaibi YM, Al-Farsi YM. The global burden of type 2 diabetes: a review. Int J Biol Med Res. 2010;1(4):326–9.
Ajlouni K, Jaddou H, Batieha A. Diabetes and impaired glucose tolerance in Jordan: prevalence and associated risk factors. J Intern Med. 1998;244(4):317–23.
World Health Organization. Noncommunicable diseases: country profiles. 2011. ISBN:9789241502283.
American Diabetes Association. Implications of the United Kingdom prospective diabetes study. Diabetes Care. 2003;26(Suppl 1):S28–32.
Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. J Diabetes Complic. 2010;24:84–9.
Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405–12.
Karter AJ, Moffet HH, Liu J, Parker MM, Ahmed AT, Ferrara A, et al. Achieving good glycemic control: initiation of new anti hyperglycemic therapies in patient with type 2 diabetes from the Kaiser Permanente Northern California diabetes registry. Am J Manag Care. 2005;11(4):262–70.
World Health Organization. Adherence to long-term therapies: evidence for action. Geneva; 2003. ISBN: 92 4 154599 2. http://whqlibdoc.who.int/publications/2003/9241545992.pdf.
Armour CL, Taylor SJ, Hourihan F. Implementing and evaluation of Australian pharmacists’ diabetes care services. J Am Pharm Assoc. 2004;44(4):455–66.
Cramer J. A systemic review of adherence with medications for diabetes. Diabetes Care. 2004;27:1218–24.
Bezie Y, Molina M, Hernandez N, Batista R, Niang S, Huet D. Therapeutic compliance: a prospective analysis of various factors involved in the adherence rate in type 2 diabetes. Diabetes Metab. 2006;32(6):611–6.
McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2002;288(22):2868–79.
Irons BK, Lenz RJ, Anderson SL, Wharton BL, Habeger B, Anderson HG. A retrospective cohort analysis of the clinical effectiveness of a physician-pharmacist collaborative drug therapy management diabetes clinic. Pharmacotherapy. 2002;22(10):1294–300.
Armitage CJ, Conner M. Social cognition models and health behaviour: a structured review. Psychol Health. 2000;15(2):173–89.
Jarab AS, Alqudah SG, Mukattash TL, Shattat G, Al-Qirim T. Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan. JMCP. 2012;18(7):516–26.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. MedCare. 1986;24(1):67–74.
Speight J, Bradley C. The ADKnowl: identifying knowledge deficits in diabetes care. Diabet Med. 2001;18(8):626–33.
EuroQol–a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy. 1990;16(3):199–208.
Krabbe P, Weijnen T. Guidelines for analysing and reporting EQ-5D outcomes. The measurement and valuation of health status using EQ-5D: A European Perspective. Edited by Brooks R, Rabin R, De Charro F. Dordrecht: Kluwer Academic Publishers. 2003;7-19. ISBN: 978-94-017-0233-1.
Sakamaki H, Ikeda S, Ikegami N, Uchigata Y, Iwamoto Y, Origasa H, et al. Measurement of HRQL using EQ-5D in patients with type 2 diabetes mellitus in Japan. Value Health. 2006;9(1):47–53.
Field A. Discovering statistics using SPSS. (3rd edition). 2009; London: Sage. ISBN: 978-1-84787907-3.
Hosmer DW, Lemeshow S. Applied logistic regression. 2nd ed. New York; 2000. ISBN: 0-471-35632-8.
Nichols-English G, Poirier S. Optimizing adherence to pharmaceutical care plans. J Am Pharm Assoc. 2000;40(4):475–85.
Krapek K, King K, Warren S, George K, Caputo D, Mihelich K, et al. Medication adherence and associated hemoglobin A1c in type 2 diabetes. Ann Pharmacother. 2004;38(9):1357–62.
Venturini F, Nichol MB, Sung JC, Bailey KL, Cody M, McCombs JS. Compliance with sulfonylureas in a health maintenance organization: a pharmacy record-based study. Ann Pharmacother. 1999;33(3):281–8.
George CF, Peveler RC, Heiliger S, Thompson C. Compliance with tricyclic antidepressants: the value of four different methods of assessment. Br J Clin Pharmacol. 2000;50(2):166–71.
Patel RP, Taylor SD. Factors affecting medication adherence in hypertensive patients. Ann Pharmacother. 2002;36(1):40–5.
Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999;47(6):555–67.
Kripalani S, Risser J, Gatti ME, Jacobson TA. Development and evaluation of the adherence to refills and medications scale (ARMS) among low literacy patients with chronic disease. Value Health. 2009;12(1):118–23.
Guillausseau PJ. Influence of oral antidiabetic drugs compliance on metabolic control in type 2 diabetes. Diabetes Metab. 2003;29(1):79–81.
Shaw KM. Overcoming the hurdles to achieving glycemic control. Metabolism. 2006;55(5 Suppl 1):S6–9.
McNabb WL. Adherence in diabetes: can we define it and can we measure it? Diabetes Care. 1997;20(2):215–8.
Lee VW, Leung PY. Glycemic control and medication compliance in diabetic patients in a pharmacist-managed clinic in Hong Kong. Am J Health Syst Pharm. 2003;60(24):2593–6.
Lerman I, Lozano L, Villa AR, Hernández-Jiménez S, Weinger K, Caballero AE, et al. Psychosocial factors associated with poor diabetes self-care management in a specialized Center in Mexico City. Biomed Pharmacother. 2004;58(10):566–70.
Dailey G, Kim MS, Lian JF. Patient compliance and persistence with antihyperglycemic drug regimens: evaluation of a Medicaid population with type 2 diabetes mellitus. Clin Ther. 2001;23(8):1311–20.
Donnan PT, MacDonald TM, Morris AD. Adherence to prescribed oral hypoglycaemic medication in a population of patients with type 2 diabetes: a retrospective cohort study. Diabet Med. 2002;19(4):279–84.
Melikian C, White TJ, Vanderplas A, Dezii CM, Chang E. Adherence to oral antidiabetic therapy in a managed care organization a comparison of monotherapy, combination therapy, and fixed-dose combination therapy. Clin Ther. 2002;24(3):460–7.
Lerman I. Adherence to treatment: the key for avoiding long-term complications of diabetes. Arch Med Res. 2005;36(3):300–6.
Rubin RR. Adherence to pharmacologic therapy in patients with type 2 diabetes mellitus. Am J Med. 2005;118(Suppl 5A):S27–34.
Paes AH, Bakker A, Soe-Agnie CJ. Impact of dosage frequency on patient compliance. Diabetes Care. 1997;20(10):1512–7.
George J, Kong DC, Thoman R, Stewart K. Factors associated with medication non adherence in patients with COPD. Chest. 2005;128(5):3198–204.
Morningstar BA, Sketris IS, Kephart GC, Sclar DA. Variation in pharmacy prescription refill adherence measures by type of oral anti hyperglycaemic drug therapy in seniors in Nova Scotia, Canada. J Clin Pharm Ther. 2002;27(3):213–20.
Glasgow RE, Toobert DJ, Gillette CD. Psychological barriers to diabetes self management and quality of life. Diabetes Spectr. 2001;14(1):33–41.
Acknowledgments
The authors wish to thank Imad Aldoghim (Lieutenant Colonel Pharmacist), Department of Pharmacy, Royal Medical Services Hospital for his assistance to obtain the ethical approval for the present study. The authors also wish to express their sincere appreciation to all medical staff at the diabetic clinic in the Royal Medical Services Hospital.
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There was no external funding for this study.
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The authors declare that they have no conflict of interest.
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Jarab, A.S., Almrayat, R., Alqudah, S. et al. Predictors of non-adherence to pharmacotherapy in patients with type 2 diabetes. Int J Clin Pharm 36, 725–733 (2014). https://doi.org/10.1007/s11096-014-9938-5
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DOI: https://doi.org/10.1007/s11096-014-9938-5