Abstract
ObjectivesTreatment adherence is crucial to the success of a management plan. The objectives of this study are (i) to assess medication adherence in patients with chronic diseases, (ii) to assess if physicians correctly perceive medication adherence among said patients, and (iii) to investigate the factors associated with low drug adherence.Materials & methodsThis observational cross-sectional study included 283 patients and 208 physicians from various hospitals in Karachi, Pakistan. The participants in the “patient group” completed the eight-item Morisky Medication Adherence Scale form. The participants in the “physician group” completed a questionnaire with questions related to their perception of their patients’ characteristics of adherence to medical prescriptions. Data were entered and analyzed using the Statistical Package for Social Sciences (SPSS) for Windows, Version 22.0. (IBM Corp., Armonk, NY).ResultsThe actual incidence of low drug adherence among patients with chronic diseases is 85%. However, the perceived incidence by physicians is 40%. Low adherence was common in women, individuals aged 35 to 50 years, and individuals who were single and illiterate. Adherence decreased with an increasing number of pills, duration of treatment, and increasing average expense of medications. The actual most common barrier to adherence among patients is medication cost; however, physicians perceive forgetfulness to be the more common barrier.ConclusionPatients with chronic illnesses have low medication adherence levels. Physicians, however, misinterpret the frequency of low adherence. Our findings will help physicians have a more real and accurate understanding of the challenges their patients face in long-term adherence to treatment regimens. It may ultimately lead to improved treatment adherence and quality of management once patients’ actual challenges are addressed and necessary steps are taken.
Highlights
The selection of appropriate investigations and treatment regimen forms the basis of disease management in the practice of medicine
The participants included in the “patient group” were ≥ 20 years old and suffered from chronic illnesses, such as diabetes mellitus (DM), hypertension (HTN), ischemic heart disease (IHD), or a chronic physiological condition, such as pregnancy
The Morisky Medication Adherence Scale (MMAS) was originally administered in patients with HTN; where the results were reliable (α = 0.83), a significant correlation was seen with blood pressure control (P < 0.05), and the tool proved to be 93% sensitive in detecting patients with poor blood pressure control [10]
Summary
The selection of appropriate investigations and treatment regimen forms the basis of disease management in the practice of medicine. The role of patient compliance/treatment adherence in the success of a management plan should not be underestimated [1]. The World Health Organization defines compliance as the degree of accuracy to which a patient follows the medical advice of his/her healthcare provider (HCP). Treatment adherence is defined as the degree to which the person’s behavior correlates with the agreed upon recommendations from his/her HCP. Both the terms are interrelated; “compliance” suggests the patient is passively abiding by the orders of the physician, while “adherence” highlights how the patient is a part of the management plan, making it the preferred term [2]. Steiner and Earnest [3] have rightly stated these terms “exaggerate the physician’s control over the process of taking medications.” No single term can successfully encompass the wholesome phenomenon of abiding by physician recommendations for chronic illness sufferers
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