Association between availability of glucose-lowering drugs in primary health institutions and diabetes patients’ medication adherence: a cross-sectional study in Shandong Province, China

Abstract

BackgroundPrimary health care system is a critical component of diabetes care and management. This article aimed to analyze the availability of glucose-lowering drugs in primary health institutions (PHIs) in China, and to explore the relationship between availability of glucose-lowering drugs and medication adherence among type 2 diabetes mellitus (T2DM) patients. MethodsThis cross-sectional study conducted in Shandong Province, eastern China (hereafter referred to as Shandong), between August and December 2017. In total, 2 520 community-managed T2DM patients were selected from 68 PHIs in Shandong, including 62 village-level and 6 township-level PHIs. The self-developed questionnaire was used to survey the availability of glucose-lowering drugs in PHIs. Patients’ medication adherence was assessed by four self-reported questions, and was classified as either adherent or non-adherent. Descriptive statistics was used to analyze the availability of glucose-lowering drugs in PHIs and the medication adherence among the T2DM patients. Multilevel logistic regression models were used to explore the relationship between the availability of glucose-lowering drugs in PHIs and patients’ medication adherence. ResultsA total of 1 866 T2DM patients prescribed with at least one glucose-lowering drug were included in analysis. Among them, 58.5% patients followed their antidiabetic treatment well. In village-level PHIs, the patient's adherence rate was lower than in township-level PHIs (55.9% vs. 61.1%, P < 0.05). Among the 68 PHIs, average (2.53±0.97) glucose-lowering products (generic names) were available, which in village-level PHIs were less than in township-level PHIs (2.47 vs. 3.17, P < 0.05). And the number of available glucose-lowering products in PHIs was associated with the adherence of T2DM patients. ConclusionPoor availability of glucose-lowering products was found in PHIs in Shandong. The availability of glucose-lowering products in PHIs was positively associated with patients’ medication adherence, and could be enhanced to improve the control of diabetes in primary care settings.