Nonadherent Behavior Research Articles

Measurement of Medication Adherence Behavior in Type 2 Diabetes Mellitus Patients Using Probabilistic Medication Adherence Scale (ProMAS)

Diabetes is a chronic metabolic disease characterized by an increase in blood glucose levels. Diabetes mellitus is a chronic disease that requires long-term treatment, which affects medication adherence. Adherence measurement can be done using a questionnaire approach, such as the Probabilistic Medication Adherence Scale (ProMAS) questionnaire. This study aims to determine the relationship between demographic factors and medication adherence scores in patients with diabetes mellitus. The research uses a quantitative research approach with a cross-sectional design. Convenience sampling method was used to select 112 respondents between January-April 2023 at various primary healthcare facilities in the Special Region of Yogyakarta. The ProMAS scoring results showed that 42.9% of respondents had moderate-to-high adherence levels and 41.1% had high adherence levels. It can be said that patients with diabetes mellitus in Yogyakarta are adherent in using medication. The most frequent non-adherent behavior was found in 4 questions: respondents forgot to take or inject medication (61.61%); respondents took or injected medication (one of them) slower than usual schedule (55.36%); respondents did not always take or inject medication at exactly the same time every day (62.5%); and respondents forgot to take or inject medication at least once in the past month (58.04%). Based on the Shapiro-Wilk normality test, a p-value of <0.001 was obtained, indicating that the data was not normally distributed. Statistical analysis showed no significant relationship between age (p=0.059) and adherence level. For the variables of total adherence score with total number of medications (p=0.472) and frequency of medication (p=0.485), the results showed no significant relationship between these variables. The relationship between total adherence score and gender (p=0.422); payment method (p=0.937); need for assistance (p=0.597); type of medication (p=0.467); highest education level (p=0.251); and employment status (p=0.521) showed no significant relationship between these variables. This indicates that diabetes mellitus patients with low or high adherence levels are not affected by the above factors.

Constructing a prognostic tool for predicting the risk of non-adherence to antiplatelet therapy in discharged patients with coronary heart disease: a retrospective cohort study.

To investigate the incidence and influencing factors affecting the non-adherence behavior of patients with coronary heart disease (CHD) to antiplatelet therapy after discharge and to construct a personalized predictive tool. In this retrospective cohort study, 289 patients with CHD who were admitted to the Department of Cardiology of The First Affiliated Hospital of the University of Science and Technology of China between June 2021 and September 2021 were enrolled. The clinical data of all patients were retrospectively collected from the hospital information system, and patients were followed up for 1 year after discharge to evaluate their adherence level to antiplatelet therapy, analyze their present situation and influencing factors for post-discharge adherence to antiplatelet therapy, and construct a nomogram model to predict the risk of non-adherence. Based on the adherence level to antiplatelet therapy within 1 year after discharge, the patients were divided into the adherence (n=216) and non-adherence (n=73) groups. Univariate analysis revealed statistically significant differences between the two groups in terms of variable distribution, including age, education level, medical payment method, number of combined risk factors, percutaneous coronary intervention, duration of antiplatelet medication, types of drugs taken at discharge, and CHD type (P<0.05). Furthermore, multivariate logistic regression analysis revealed that, except for the medical payment method, all the seven abovementioned variables were independent risk factors for non-adherence to antiplatelet therapy (P<0.05). The areas under the receiver operating characteristic curve before and after the internal validation of the predictive tool based on the seven independent risk factors and the nomogram were 0.899 (95% confidence interval [CI]: 0.858-0.941) and 0.89 (95% CI: 0.847-0.933), respectively; this indicates that the tool has good discrimination ability. The calibration curve and Hosmer-Lemeshow goodness of fit test revealed that the tool exhibited good calibration and prediction consistency (χ2=5.17, P=0.739). In this retrospective cohort study, we investigated the incidence and influencing factors affecting the non-adherence behavior of patients with CHD after discharge to antiplatelet therapy. For this, we constructed a personalized predictive tool based on seven independent risk factors affecting non-adherence behavior. The predictive tool exhibited good discrimination ability, calibration, and clinical applicability. Overall, our constructed tool is useful for predicting the risk of non-adherence behavior to antiplatelet therapy in discharged patients with CHD and can be used in personalized intervention strategies to improve patient outcomes.

Evaluation of Medication Adherence in Chronic Kidney Disease Patients with and without Hemodialysis

Abstract Background: Poor long-term adherence and persistence to pharmacological therapy is widely acknowledged as one of the primary clinical difficulties in the management of chronic diseases such as chronic kidney disease (CKD). The present study was aimed to measure treatment adherence using the Morisky Medication Adherence Scale (MMAS)-8 questionnaire in CKD patients with or without hemodialysis. Methodology: It was a cross-sectional study conducted in 120 clinically stable CKD patients with Stage 3 onward with or without hemodialysis. The sociodemographic and clinical characteristics of participants were collected in a predesigned format. Individual participants were scheduled for interviews and asked to complete inventory questionnaires. Medication adherence was assessed using a validated diagnostic tool MMAS-8 questionnaire. Results: Out of 120 individuals, the average number of medicines prescribed per prescription was 5.63 ± 2.22 and 4.65 ± 1.72 in the dialysis and nondialysis groups, respectively. Patients on dialysis had a higher pill burden than nondialysis patients, with more than three-fourths (78.3%) of them taking more than five medications every prescription. Low, moderate, and good adherence were reported in 61.7% (n = 37) versus 26.7% (n = 16), 33.3% (n = 20) versus 71.7% (n = 43), and 5% (n = 3) versus 1.6% (n = 1) of patients with and without dialysis, respectively, in MMAS-8. The most often reported nonadherence behaviors were forgetting to take medications, forgetting to pack medications while traveling, and feeling pressured to follow a treatment plan. There was an association between the dialysis and nondialysis groups in education level, employment, and pill load among patients with low adherence. Conclusion: Majority of the respondents (more than 90%) reported low-to-moderate adherence in both dialysis and nondialysis populations. Physicians and all other health-care professionals should work together to reduce the obstacles to good adherence by enhancing communication, reducing the burden of taking a lot of pills, and, if possible, by occasionally checking on patient adherence when there is suspicion of poor adherence.

Investigation of the adhesion conditions of the micro-surfacing applied on asphalt concrete

The role of the adhesion layer on pavements is to guarantee that the structure works as a monolithic system, making it difficult for early cracks to appear due to fatigue or slipping. Thus, this work investigated the factors influencing the adherent behavior between the micro-surfacing and the asphalt concrete. The Leutner shear strengths were analyzed at the interface with bonding paint using the RR-1 C, RR-2 C, and RC1C-E emulsions for three application rates (0.5 l/m², 0.75 l/m², and 1.0 l/m²). Tests were performed at three temperatures (10 °C, 30 °C, and 50 °C). The temperature variable is the main influential factor in the adherent behavior of the asphalt mixtures analyzed. The bonding paint layer increased the shear strength at low temperatures; however, at high temperatures, the bonding layer did not improve adhesion. The RR-2 C type emulsion presented the best performance among those evaluated. The application rate variable was not statistically significant for shear strength. The data indicate that the application of micro-surfacing on asphalt concrete in regions with high temperatures must be performed carefully because, for high temperatures, the technique showed non-adherent behavior.

Medication adherence in patients with cluster headache and migraine: an online survey

To examine factors for adherent and non-adherent behavior in patients with cluster headache and migraine. Adults with cluster headache or migraine were included in this anonymous online survey using a questionnaire accessed via homepages of headache support groups. Medication adherence in preventive treatment was measured with the Medication Adherence Report Scale (MARS-D). Factors for non-adherent behavior were examined (subjective socioeconomic status, psychological comorbidities, self-efficacy, coping, side effects, expectations of treatment, information on medical treatment, and trust in the physician/treatment concept). 200 participants (n = 58 with cluster headache, n = 142 with migraine) were included. The rate of medication adherence in preventive treatment was 32.8% for participants with cluster headache and 20.4% for migraine. The most common reasons for low adherence in participants with cluster headache were altering the prescribed medication dose (34%) or taking less than instructed (14%), which was mostly due to insufficient benefit from the medication or side effects. Positive expectations of medical treatment (p ≤ 0.05) correlated significantly with adherent behavior in cluster headache. Furthermore, the adherence-promoting factors coping and self-efficacy were more pronounced in patients with cluster headache than in those with migraine (p < 0.05). This study is the first to comprehensively investigate medication adherence and factors influencing adherent/non-adherent behavior in patients with cluster headache. Patients with cluster headache had similar adherence levels to patients with migraine, but had higher resources of adherence-promoting factors.

Parental Nonadherence to Health Policy Recommendations for Prevention of COVID-19 Transmission Among Children

This survey study assesses whether parents had ever engaged in specific misrepresentation and nonadherence behaviors regarding public health measures for preventing COVID-19 transmission among children.

The Most Common Predictors of Uncontrolled Blood Pressure Among Hypertensive Elders: A Systematic Review

Aging process implies challenges for the elderly, specifically related to degeneration in the vascular system. The uncontrolled blood pressure has detrimental effects on brain, heart and kidney that cause organ failure. Hypertension is getting harder to control if the patients unaware with the factors that outweigh blood pressure control. Medication nonadherence and unhealthy behavior are known as the essential factors related to uncontrolled blood pressure. The study aims to assess the most common predictors of uncontrolled blood pressure, which involved elders with hypertension. The method used is a systematic review obtained from databases of Scopus, Science Direct, PMC, and SAGE. The total of eight full text articles in English language and randomized controlled trial design determined from 2018 to 2022 included in the assessed articles. The result did not reveal medication adherence as the most common factor, but obesity as modifiable predictor is obesity, whereas unmodifiable are age and comorbid. It is indicated that the require intervention for hypertensive elder is focused on body weight and comorbid management. The implication of this systematic review is beneficial for the elderly to achieve blood pressure control by enhancing the awareness of changeable factors and adopt a healthy lifestyle. Furthermore, the nurse also easier to determine the appropriate intervention for elders.

The Association Between Cost-Related Non-Adherence Behaviors and Diabetes Outcomes.

We examined the impact of various comorbid conditions on diabetes and condition-specific cost-related nonadherence (CRN), and HbA1c in adults with diabetes. This was a cross-sectional analysis of participants with diabetes and poor glycemic control in an ongoing trial (n = 600). We computed prevalence of condition-specific CRN, prevalence of specific types of diabetes-related CRN by comorbid condition, prevalence of specific types of condition-specific CRN within each comorbidity, and the association between condition-specific and diabetes-related CRN and HbA1c for each comorbid condition. Fifty-eight percent (n = 350) of participants reported diabetes-related CRN. Diabetes-related CRN rates were highest in those with liver problems (63%), anemia (61%), respiratory diseases (60%), and hyperlipidemia (60%). Condition-specific CRN rates were high in those with respiratory diseases (44%), back pain (41%), and depression (40%). Participants with cancer and kidney diseases reported the lowest rates of diabetes-related and condition-specific CRN. Delaying getting diabetes prescriptions filled was the most commonly reported form of diabetes-related CRN across all comorbid conditions and was the highest in those with liver problems (47%), anemia (46%), and respiratory diseases (45%). In adjusted models, those with back pain (beta-coefficient, 0.45; 95%CI 0.02-0.88; P = .04) and hyperlipidemia (beta-coefficient, 0.50; 95%CI 0.11-0.88; P = .01) who reported both diabetes-related and condition-specific CRN had higher HbA1c. CRN in patients with diabetes is higher than in other comorbid conditions and is associated with poor diabetes control. These findings may be driven by higher out-of-pocket costs for medications to manage diabetes, lack of symptoms associated with poor diabetes control, or other factors, with implications for both clinicians and health insurance programs.

The RAS-24: Development and validation of an adherence-to-medication scale for severe mental illness patients

Several studies have found that most patients with severe mental illness (SMI) and comorbid (physical) conditions are partially or wholly nonadherent to their medication regimens. Nonadherence to treatment is a serious concern, affecting the successful management of patients with SMIs. Psychiatric disorders tend to worsen and persist in nonadherent patients, worsening their overall health. The study described herein aimed to develop and validate a scale (the Ralat Adherence Scale) to measure nonadherence behaviors in a culturally sensitive way. Guided by a previous study that explored the primary reasons for nonadherence in Puerto Rican patients, we developed a pool of 147 items linked to the concept of adherence. Nine experts reviewed the meaning, content, clarity, and relevance of the individual items, and a content validity ratio was calculated for each one. Forty items remained in the scale's first version. This version was administered to 160 patients (21-60 years old). All the participants had a diagnosis of bipolar disorder, major depressive disorder, or schizoaffective disorder. The STROBE checklist was used as the reporting guideline. The scale had very good internal consistency (Cronbach's alpha = 0.812). After a factor analysis, the scale was reduced to 24 items; the new scale had a Cronbach's alpha of 0.900. This adherence scale is a self-administered instrument with very good psychometric properties; it has yielded important information about nonadherence behaviors. The scale can help health professionals and researchers to assess patient adherence or nonadherence to a medication regimen.

Team approach for nonmedical opioid use

Team approach for nonmedical opioid use

Clinical characteristics do not reliably identify non-adherence in patients with uncontrolled hypertension

Purpose Chemical adherence testing is a reliable method to assess adherence to antihypertensive drugs. However, it is expensive and has limited availability in clinical practice. To reduce the number and costs of chemical adherence tests, we aimed to develop and validate a clinical screening tool to identify patients with a low probability of non-adherence in patients with uncontrolled hypertension. Materials and Methods In 495 patients with uncontrolled hypertension referred to the University Medical Centre Utrecht (UMCU), the Netherlands, a penalised logistic regression model including seven pre-specified easy-to-measure clinical variables was derived to estimate the probability of non-adherence. Non-adherence was defined as not detecting at least one of the prescribed antihypertensive drugs in plasma or urine. Model performance and test characteristics were evaluated in 240 patients with uncontrolled hypertension referred to the Heartlands Hospital, United Kingdom. Results Prevalence of non-adherence to antihypertensive drugs was 19% in the UMCU and 44% in the Heartlands Hospital population. After recalibration of the model’s intercept, predicted probabilities agreed well with observed frequencies. The c-statistic of the model was 0.63 (95%CI 0.53–0.72). Predicted probability cut-off values of 15%–22.5% prevented testing in 5%–15% of the patients, carrying sensitivities between 97% (64–100) and 90% (80–95), and negative predictive values between 74% (10–99) and 70% (50–85). Conclusion The combination of seven clinical variables is not sufficient to reliably discriminate adherent from non-adherent individuals to safely reduce the number of chemical adherence tests. This emphasises the complex nature of non-adherence behaviour and thus the need for objective chemical adherence tests in patients with uncontrolled hypertension.

Adherence With Oral Anticancer Therapies: Clinical Trial versus Real-World Experiences with a Focus on Prostate Cancer.

In this review, we address adherence rates in clinical settings, barriers to compliance with dosing schedules, and potential strategies to overcome challenges in maintaining high levels of adherence. Four studies reporting real-world adherence to prostate cancer medications, 52 studies describing barriers to adherence, and 16 studies on methods to minimize poor adherence were reviewed. Mean nonadherence rates of 25 to 51% have been identified in prostate cancer patients prescribed oral therapies, with higher rates in older patients. An extensive review of prostate cancer patients receiving gonadotropin hormone-releasing hormone agonist injections found an overall nonadherence rate of over 27%. Patients may encounter barriers to complying with dosing instructions related to the medication (eg, complex dosing schedules, the total burden of medication management, fasting or dietary requirements, high medication costs, adverse effects, and drug-drug interactions). Barriers may also be related to patient-specific factors (eg, suboptimal education regarding the importance of adherence, physical limitations and cognitive decline associated with advancing age, living alone without a care partner, high symptom burden, needle phobia, and comorbid mental disorders). Interventions to improve dosing adherence may include automated reminders, treatment diaries, educational materials, and the involvement of patients, family members, care partners, and healthcare teams. Many oral anticancer medications improve survival in men with prostate cancer and therefore it is vital to establish good adherence by understanding the pitfalls that patients may encounter. In situations where both oral and injectable drugs are interchangeable, injections of long-acting drugs lead to fewer opportunities for dosing nonadherence than oral therapies. In contrast, oral medicines do not require scheduling for injections and travel for injection appointments. Therefore, maximizing adherence to all treatment regimens will reduce the chance of efficacy failures and likely lead to improved clinical outcomes.

Obstacles to home-based dietary management for caregivers of children with citrin deficiency: a qualitative study

BackgroundDietary management is the most important and effective treatment for citrin deficiency, as well as a decisive factor in the clinical outcome of patients. However, the dietary management ability of caregivers of children with citrin deficiency is generally poor, especially in East Asia where carbohydrate-based diets are predominant. The aim of this study was to identify the difficulties that caregivers encounter in the process of home-based dietary management, and the reasons responsible for these challenges.ResultsA total of 26 caregivers of children with citrin deficiency were recruited, including 24 mothers, one father, and one grandmother. Grounded theory was employed to identify three themes (covering 12 sub-themes) related to the dilemma of dietary management: dietary management that is difficult to implement; conflicts with traditional concepts; and the notion that children are only a part of family life. The first theme describes the objective difficulties that caregivers encounter in the process of dietary management; the second theme describes the underlying reasons responsible for the non-adherent behavior of caregivers; the third theme further reveals the self-compromise by caregivers in the face of multiple difficulties.ConclusionsThis study reflects the adverse effects of multi-dimensional contradictions on the adherence of caregivers to dietary management. These findings reveal that the dietary management of citrin deficiency is not only a rational process, rather it is deeply embedded in family, social, and dietary traditions.

Adhésion médicamenteuse en greffe rénale : évaluation, facteurs prédictifs et impact sur l’allo-réactivité humorale

The aims of this study were to assess medication adherence to immunosuppressive treatment in kidney transplanted patients, to identify predictive factors of medication non-adherence and to analyse its impact on the development of Donor Specific Antibodies (DSA) de novo, biomarkers of rejection in transplant recipients. A cross-sectional single-centre study was conducted to assess medication adherence to immunosuppressive treatment with the BAASIS (Basel Assessment of Adherence Scale for Immunosuppressives) self-report questionnaire. Univariate and multivariate analyses were performed to determine non-adherence predictive factors and its role in the development of DSA de novo. A total of 212renal transplanted patients completed the BAASIS questionnaire: 36,3% were non-adherent to their immunosuppressive treatment. Patient's age and taking azathioprine were independent predictors of non-adherence and "married or living together" family status was a protective factor in the multivariate analysis. Medication non-adherence was associated with DSA de novo development in the multivariate model and it multiplied their risk of development by 3. This study, which detected a large proportion of patients who did not adhere to immunosuppressive treatment, highlighted non-adherence predictors and showed the association between non-adherence and development of DSA de novo. In case of non-adherent behavior, it is crucial to set up a personalised support for patients with a multidisciplinary approach of therapeutic education, in which the clinical pharmacist has a role.

Effectiveness of a Nursing Intervention Module on Adherence, Knowledge, Quality of Life, and Complications Among Patients Receiving Anticoagulation therapy-a Randomized Controlled Trial Protocol.

BackgroundCardiovascular diseases are one of the major causes of mortality at the global level. They account for approximately 17.9 million deaths per year. Warfarin and acenocoumarol are the commonly used oral anticoagulants to treat and prevent thromboembolic disorders in patients with cardiovascular diseases. In India, approximately 2–2.5 million patients with rheumatic heart disease are receiving oral anticoagulation therapy. Additionally, this therapy is provided for stroke prevention in the case of atrial fibrillation and the treatment of valvular heart disease, stroke, and deep vein thrombosis. As the therapeutic range of these drugs is narrow and is affected by many factors, their use is challenging. This study aims to evaluate the effectiveness of a nursing intervention module in terms of adherence to therapy, knowledge, quality of life, and complications among patients receiving oral anticoagulation therapy. Furthermore, this study will address factors that affect adherence and the risk for bleeding by using a randomized controlled trial design.MethodsThis single-blind, single-center, randomized controlled trial will focus on adherence to oral anticoagulation therapy. A total of 320 patients who are on oral anticoagulation therapy will be randomized into blocks and allocated to either the intervention or standard care group. The intervention will comprise the use of a nursing intervention module that includes a booklet, log sheet, and decision aid on oral anticoagulation therapy adherence. Outcome measures, that is, knowledge regarding oral anticoagulation therapy, adherence, complications, and quality of life, will be assessed at the baseline and during follow-ups.DiscussionPatient safety can be best achieved through patients’ adherence to medication dose and monitoring of blood test values. Thromboembolic and bleeding complications are likely to occur when either the patient does not adhere to the treatment or the therapeutic range of the international normalized ratio is not maintained. This study will assess the nonadherence behavior and the effectiveness of a nursing intervention module toward adherence behavior.Trial RegistrationThis research project is registered under the Clinical Trial Registry of India (CTRI/2019/06/019610).

A Qualitative Study Evaluating the Factors Affecting Families' Adherence to the First COVID-19 Lockdown in England Using the COM-B Model and TDF.

The ability of families to adhere to public health guidance is critical to controlling a pandemic. We conducted qualitative interviews with 30 parents of children aged 18 and under, between 16 and 21 April 2020 when schools in England were closed due to the COVID-19 pandemic. Using the Theoretical Domains Framework, we classified the factors that influenced adherence to seven non-pharmaceutical interventions. We found 40 factors that influenced a family’s ability to adhere. Parents generally indicated they could adhere and reported how their family had changed their behaviour to comply with the guidance. Parents primarily reported they were motivated to adhere out of concern for the health consequences of COVID-19, and because the guidance was delivered by the government. However, we found that reduced access to resources (e.g., technology, transport, and outside space) and social influences that encouraged non-adherent behaviour, decreased adherence. Furthermore, we suggest that families with low psychological and physical ability may face additional challenges to adherence and need to be supported. During future school closures, public health agencies should account for these factors when developing guidance.

LEVEL OF ADHERENCE TO THE PHARMACOLOGICAL AND NON-PHARMACOLOGICAL TREATMENT OF PATIENTS WITH DIABETES MELLITUS

Objective: To identify the level of adherence to pharmacological and non-pharmacological treatments according to age, sex and time of evolution in patients with diabetes mellitu Design and method: Cross-sectional observational analytical descriptive study, population 739 patients, with a sample of 272, which were randomly selected. Bonilla questionnaire validated with a Crombach alpha of 0.86 was applied. Tests were made for the variables age, sex and time of evolution to compare it with the variable level of adherence, with the corresponding descriptive statistics. Additionally, bivariate analysis to determine the association of the level of adherence with the variables age, sex and time of evolution. Results: 63% were female, 37% were male. The average age was 54.93 +/- 12.44 years and the evolution time was 7.6 +/- 3.7 years. Regarding the level of adherence, the 272 participants had an average score of 70.53 +/- 11.38, which indicates that they are at risk of non-adherence to treatments Conclusions: Non-adherent behavior in patients with diabetes continues to be a concern, which is why governments continue to invest in educational programs for patients and their families to control diabetes and prevent its complications.

A Trauma-Informed Care Model: Addressing Adverse Childhood Experiences in Patients with End-Stage Kidney Disease

In the healthcare field, there has been increased recognition of the long-term consequences that adverse childhood experiences (ACEs) have on the health and well-being of people. It is imperative that a trauma-informed care (TIC) approach is utilized in the treatment of patients with end-stage kidney disease (ESKD) because of high rates of non-adherence and health risk behaviors. The purpose of this article is to explore current nephrology practices and TIC approaches utilized in the healthcare field. A TIC approach, through a health-belief model lens specific to the ESKD population, can be introduced by providers to better assess and treat patients. Implications for practice include standardization of TIC in social work practice, better outcomes for patients, and ongoing research considerations.

Medication availability and economic barriers to adherence in asthma and COPD patients in low-resource settings

Inhaled medication is essential to control asthma and COPD, but availability and proper adherence are challenges in low-middle income countries (LMIC). Data on medication availability and adherence in Central Asia are lacking. We aimed to investigate the availability of respiratory medication and the extent of financially driven non-adherence in patients with COPD and asthma in Kyrgyzstan. A cross-sectional study was conducted in two regions of Kyrgyzstan. Patients with a physician- and spirometry confirmed diagnosis of asthma and/or COPD were included. The main outcomes were (1) availability of respiratory medication in hospitals and pharmacies, assessed by a survey, and (2) medication adherence, assessed by the Test of Adherence to Inhalers (TAI). Logistic regression analyses were used to identify predictors for adherence. Of the 300 participants (COPD: 264; asthma: 36), 68.9% were buying respiratory medication out-of-pocket. Of all patients visiting the hospital, almost half reported medication not being available. In pharmacies, this was 8%. Poor adherence prevailed over intermediate and good adherence (80.7% vs. 12.0% and 7.3%, respectively). Deliberate and erratic non-adherence behavior patterns were the most frequent (89.7% and 88.0%), followed by an unconscious non-adherent behavioral pattern (31.3%). In total, 68.3% reported a financial reason as a barrier to proper adherence. Low BMI was the only factor significantly associated with good adherence. In this LMIC population, poor medication availability was common and 80% were poorly adherent. Erratic and deliberate non-adherent behaviors were the most common pattern and financial barriers play a role in over two-thirds of the population.

Treatment Adherence and Incidence of Coronary Heart Disease in Type 2 Diabetes Mellitus Patients

Previous studies showed that uncontrolled blood sugar and long-term use of several types of antidiabetic could increase the risk of coronary heart disease (CHD). This study aimed to compare the incidence of CHD in type 2 diabetes mellitus (T2DM) patients showing treatment adherence and non-adherence behavior over four years. This was a retrospective cohort study with data sets obtained from the Bogor Cohort Study of Non-Communicable Disease Risk Factors. All study subjects were not diagnosed with CHD at the beginning of the study. The sample was divided into two groups; one had adhered to treatment from health centers and followed the treatment instructions (adherent group), while the other had not followed the treatment instructions (non-adherent group). Of 5,690 subjects, 276 were eligible for this study (84 in the adherent and 192 in the non-adherent group). The incidence of CHD in the non-adherent group was 2.3% higher than in the adherent group (p-value = 0.564) and had a 1.7 times greater risk of developing CHD, but not statistically significant (adjusted HR = 1.739; 95% CI = 0.673-4.490). The non-adherent T2DM patients had a greater risk of developing CHD than adherent T2DM patients.