Abstract
The aim of the study was to answer the questions whether a chronic disease can have a significant impact on the level of adherence and whether there are differences in adherence-related predictors depending on the chronic disease. The study included 1,571 patients (mean age 64.7 ± 11.3) with chronic diseases [1,030 diabetes mellitus (DM) type 2 and 541 hypertension (HA)]. Adherence was assessed using the Adherence Refills Medication Scale (ARMS). The average adherence score for the whole group was 18.9. Fifty-five percent of patients had a low level of adherence. A comparison between DM and HA shows a statistically significant difference and a higher level of adherence with pharmacological recommendations in the group of patients with type 2 DM (17.5 ± 12.0 vs 19.2 ± 8.0). In the single factors analysis, HA diagnosis had a statistically significant negative effect on adherence (β=0.92, p ≤ 0.001). In simple linear regression analysis, independent of chronic disease, a higher level of adherence was observed among women (β=−0.40, p=0.015), people with secondary education (β=−1.26, p ≤ 0.001), and inactive patients (β=−0.48; p=0.005). However, place of residence - countryside (β =0.35, p=0.044) and higher education (β=0.90, p ≤ 0.001) had a negative influence on the level of adherence. In multiple linear regression analysis HA (B=0.99; p ≤ 0.001), female gender (B=−0.47; p=0.003) and secondary education (B=−1.16; p ≤ 0.001) were important independent determinants of adherence. (1) Hypertension is an independent, statistically significant predictor that reduces the adherence level. (2) Female gender and higher education are the most important determinants improving adherence to pharmacological therapy. (3) There is a different pattern of predictors of adherence among patients: occupational activity plays an important role in DM, while education plays a role in HA.
Highlights
Chronic diseases are the most common cause of death worldwide; they develop unnoticed over a long period and are usually diagnosed at an advanced stage of development
It is important to answer the question of whether a chronic disease such as HA or diabetes mellitus (DM) can have a significant impact on the level of adherence and whether there are differences in adherence-related predictors depending on the chronic disease
Comparison of Adherence Refills Medication Scale (ARMS) results depending on selected factors were statistically analyzed by two-way ANOVA in both HA vs. DM groups
Summary
Chronic diseases are the most common cause of death worldwide; they develop unnoticed over a long period and are usually diagnosed at an advanced stage of development. The treatment of chronic diseases involves a considerable proportion of the budget for general expenditure related to health care systems. Hypertension (HA) or diabetes mellitus (DM) are the most common risk factors for cardiovascular diseases, strokes, and chronic kidney disease (Centers for Disease Control and Prevention, 2011; Menke et al, 2015; American Diabetes Association, 2017). In 2018, due to HA, 20.4 million consultations within the framework of basic health care, 2.8 million consultations within the framework of outpatient specialist care and 877,000 hospitalizations within the framework of hospital treatment occurred (NFZ, 2018). Effective treatments are widely available, about half of the patients treated do not have adequate blood pressure (BP) or balanced metabolic control (Gupta and Guptha et al, 2010). The literature indicates that about 20–30% of drugs prescribed will never be purchased, and 50% of patients will cease their therapy prematurely within a year of starting treatment
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