Adherence to oral anti-diabetic drugs among patients attending a Ghanaian teaching hospital
Background: The burden of diabetes mellitus, especially Type-2, continues to increase across the world. Medication adherence is considered an integral component in its management. Poor glycemic controls due to medication nonadherence accelerates the development of long-term complications which consequently leads to increased hospitalization and mortality.
Objective: This study examined the level of adherence to oral antidiabetic drugs among patients who visited the teaching hospital and explored the probable contributory factors to non-adherence.
Methods: A cross-sectional descriptive study using systematic sampling to collect quantitative data was undertaken. Questionnaires were administered to out-patients of the medical department of a teaching hospital in Ghana. Logistic regression was performed with statistical significance determined at p<0.05.
Results: A total of 200 diabetic patients participated in the study. Using the Morisky Medication Adherence scale, the level of adherence determined was 38.5%. There were significant correlations between level of adherence and educational level [(OR)=1.508; (CI 0.805- 2.825), P=0.019), and mode of payment [(OR)=1.631; (CI 0.997- 2.669), P=0.05).
Conclusion: Adherence in diabetic patients was low among respondents and this can be improved through education, counseling and reinforcement of self-care. There were several possible factors that contributed to the low adherence rate which could benefit from further studies.
2. American Diabetes Association. Economic costs of diabetes in the U.S in 2007. Diabetes Care. 2008;31(3):596-615. doi: 10.2337/dc08-9017
3. Haynes RB, Taylor DW, Sackett DL. Compliance in Health care. Baltimore: The Johns Hopkins University Press; 1979.
4. Sabaté E. Adherence to Long-Term Therapies: Evidence for Action. Geneva: World Health Organization; 2003.
5. Bardel A, Wallander MA, Svärdsudd K. Factors associated with adherence to drug therapy: a population-based study. Eur J Clin Pharmacol. 2007;63(3):307-314.
6. Delamater AM. Improving patient adherence. Clin Diabetes. 2006;24(2):71-77. doi: 10.2337/diaclin.24.2.71
7. Amoah A. Comprehensive care in a low-income country: The Ghana Experience. Diabetes Voice. 2002;47(2):20-22.
8. Kalyango JN, Owino E, Nambuya AP. Non-adherence to diabetes treatment at Mulago Hospital in Uganda: prevalence and associated factors. Afr Health Sci. 2008;8(2):67-73.
9. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74.
10. Shams ME, Barakat EA. Measuring the rate of therapeutic adherence among outpatient with T2DM in Egypt. Saudi Pharm J. 2010;18(4):225-232. doi: 10.1016/j.jsps.2010.07.004
11. Hernández-Ronquillo L, Téllez-Zenteno JF, Garduño-Espinosa J, González-Acevez E. Factors associated with therapy noncompliance in type-2 diabetes patients. Salud Publica Mex. 2003;45(3):191-197.
12. Adisa R, Fakeye TO, Fasanmade A. Medication adherence among ambulatory patients with type 2 diabetes in a tertiary healthcare setting in Southwestern Nigeria. Pharm Pract (Granada). 2011;9(2):72-81.
13. Gimenes HT, Zanetti ML, Haas VJ. Factors Related to patient adherence to antidiabetic drug therapy. Rev Lat Am Enfermagem. 2009;17(1):46-51.
14. Kalyango JN, Owino E, Nambaya P. Non-adherence to diabetes treatment at Mulago Hospital in Uganda: prevalence and associated factors. Afr Health Sci. 2008;8(2):67-73.
15. Chua SS, Chua SP. Medication adherence and achievement of glycaemic targets in ambulatory type 2 diabetic patients. J Appl Pharm Sci. 2011;1(4):55-59.
16. Dailey G, Kim MS, Lian JF. Patient compliance and persistence with antihyperglycaemic drug regimens: evaluation of Medicaid patient population with type 2 diabetes mellitus. Clin Ther. 2001;23(8):1311-1320.
17. Dailey G, Kim MS, Lian JF. Patient compliance and persistence with antihyperglycaemic therapy: evaluation of a population of type 2 diabetic patients. J Int Med Res. 2002;30(1):71-79.
18. Melikian C, White TJ, Vanderplas A, Dezii CM, Chang E. Adherence to oral antidiabetic therapy in a managed care organization: a comparison of monotherapy, and fixed-dose combination therapy. Clin Ther. 2002;24(3):460-467.
19. Geok H, Anwar M, Wong PS. A Study on Compliance among Oral Hypoglycaemic Agents (OHA) Users at a public Hospital In Malaysia. 8th Asian Conference on Clinical Pharmacy. Surabaya, 2008.
20. Garay-Sevilla ME, Nava LE, Malacara JM, Huerta R, Díaz de León J, Mena A, Fajardo ME. Adherence to treatment and social support in patients with non-insulin diabetes mellitus. J Diabetes Complications. 1995;9(2):81-86.
21. Mansoor LE, Dowse R. Medicines information and adherence in HIV/AIDS patients. J Clin Pharm Ther. 2006;31(1):7-15.
22. Smith DH, Kramer JM, Perrin N, Platt R, Roblin DW, Lane K, Goodman M, Nelson WW, Yang X, Soumerai SB. A randomized trial of direct-to-patient communication to enhance adherence to beta-blocker therapy following myocardial infarction. Arch Intern Med. 2008;168(5):477-83. doi: 10.1001/archinternmed.2007.132
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.