A qualitative exploration of barriers to medication adherence among patients with uncontrolled diabetes in Qatar: integrating perspectives of patients and health care providers

Abstract

PurposeTo develop an in-depth understanding of the barriers to medication adherence among patients with uncontrolled diabetes attending primary health care (PHC) centers in Qatar by exploring and integrating patients’ and health care providers’ perspectives.Participants and methodsA descriptive qualitative methodology was used in this study. A trained researcher conducted semi-structured face-to-face interviews at two PHC centers. Patients with uncontrolled diabetes (with varied sociodemographic characteristics) and their respective health care providers (physicians, pharmacists, nurses, dieticians, and others) were purposively selected from the two PHC centers. All interviews were audio recorded, transcribed verbatim, and analyzed using thematic content analysis.ResultsThirty interviews (14 patients and 16 health care providers) were conducted. A number of barriers to medication adherence were identified and classified broadly under three main themes: 1) patient-related factors, which included patients’ individual characteristics and patients’ perception, attitude, and behavior; 2) patient–provider factors, which included communication and having multiple health care providers caring for the patient; and 3) societal and environmental factors, which included social pressure and traveling to visit friends and relatives.ConclusionPatients with uncontrolled diabetes face multiple barriers to medication adherence. Similar themes emerged from both patients and their care providers. This research highlights the need for concerted multidimensional efforts and series of interventions to overcome these barriers. One vital intervention is expanding the scope of pharmacists’ role within the PHC centers through providing medication reconciliation, patient-tailored medication counseling, and medicines use review, which may improve treatment outcomes among patients with diabetes.

Association between attendance at outpatient follow-up appointments and blood pressure control among patients with hypertension

“…Better disease knowledge and awareness about potential complications among university graduates may explain higher likelihood to attend treatment follow-up visits. [38] 190 [62] Secondary care hospital 203 123 [61] 80 [39] Primary healthcare centre 151 33 [22] 118 (78) Overall 662 274 [41] 388 [59] Entitlement to free medical care…”

“…The intervention to increase regularity in treatment follow-up visits may include, providing entitlement to free medical care, educational interventions for educating the patients regarding the benefits of regular treatment follow-up, motivational interviewing, family support, providing better services at healthcare settings, providing incentives to the patients on every visit for follow-up, sending reminders to the patients through phone calls, sms, and emails etc. [55][56][57][58][59][60][61][62]. There is a need to educate the patients who are at early stage of their disease to carefully follow the instructions provided by the healthcare professionals to halt further progression of their disease and its complications.…”

<p>The perspectives of patients and physicians on the role of pharmacists in improving medication adherence in type 2 diabetes: a qualitative study</p>

“…In Kuwait, a number of studies conducted since 2006 have shown that pharmacists perceive the lack of time and staff as a barrier to counselling and providing a more educational role for patients 8,13,54,61,62. In Qatar, pharmacists have also related their lack of counselling to heavy workloads and lack of time 63. Pharmacists in New Zealand and European countries have stated that insufficient time is a barrier to pharmaceutical care implementation 64,65…”

Qualitative Exploration of Barriers to Medication Adherence Among Patients with Uncontrolled Diabetes in Saudi Arabia

“…For example, the healthcare providers observed that aging patients would forget to take their medications, informed patients could understand the purpose of adherence, some patients could not buy the medications, and incorrectly took their medications with insufficient time for the healthcare providers to explain the correct usage. In contrast, patients disclosed that they changed their medication dose when fasting, would not use the medications, did not believe that the medications affected maintaining blood glucose, and would be healthy without medications when returning to their home country [ 12 ]. Many of the barriers identified were directly related to patient information and knowledge about diabetes and its management.…”