Adherence behavior assessment of oral antidiabetic medication use: a study of patient decisions in long-term disease management in primary health care centers in Surabaya

Abstract

BackgroundAdherence to medication has an important role in the long-term management of diabetes. The Indonesian Endocrinologist Association found that of the 50% of the entire population who have been diagnosed with diabetes, two-thirds are undergoing therapy and only one-third have been achieving the intended outcomes of the drug therapy. This study aimed to identify patients’ adherence behavior and the root causes of non-adherence.MethodsThis study used a non-experimental mixed-methods approach. A total of 40 patients with type 2 diabetes mellitus (T2DM), who were part of the referral program of the National Health Care Security System (BPJS Kesehatan) were recruited by purposive sampling from 17 primary health care centers in Surabaya, Indonesia.ResultsThe adherence behavior assessment revealed non-adherence among 80% of the patients. The highest instances of non-adherence based on the percentage scores involved the following: patients forgot to take the medications (38.23%), patients preferred not to take the medications (20.59%) and the drug products were not available for the patient (14.71%). The factors influencing non-adherence included the complex instructions for taking medication, the absence of a reminder, the unwanted side effects of the drug, the feeling of repetition, the feeling that drugs were ineffective and the concern for the drug’s effects on the kidney.ConclusionsThe high rates of non-adherence identified in this study encourage pharmacists to implement better medication therapy management for chronic diseases. The patients’ understanding of drug therapy indications and regimens is very important in increasing the expectations of achieving effective treatment, awareness and concern for medication safety and treatment compliance.

Exploring of Determinants Factors of Anti-Diabetic Medication Adherence in Several Regions of Asia – A Systematic Review

“…Insurance coverage and medication availability factors were positively associated in four studies from three countries (Indonesia, China, and India). 37 , 38 , 62 Meanwhile, the high medication cost factor was negatively associated in one study in Bangladesh and India. 30 , 52 Healthcare systems determine medication adherence in several ways.…”

“…Several studies have found that five factors are more dominant in this category. These factors are the level of education, 35 , 36 , 40 , 42 , 52 knowledge about diabetes and its medications, 35 , 42 , 52 , 53 medication availability, 36 , 38 , 62 social support, 31 , 37 , 46 and socioeconomic status. 31 , 32 , 35 , 44 , 46 More than half of the studies in this review found these four factors to be positively associated (n = 16).…”

“…The five factors are negative illness perceptions, 38 , 39 , 43 little faith in medications, 38 , 53 , 62 forgetfulness, 38 , 52 , 62 diabetes complications, 45 , 46 , 50 and a high level of HbA1c. 16 , 41 , 50 Possible explanations for each of these factors are: (1) the symptoms of diabetes tend to be felt more severe by patients who have negative perceptions and do not accept their disease; 38 , 43 (2) limited belief in drugs prescribed by doctors and concerns with side effects; 38 , 53 , 62 (3) diabetic patients who are under stress tend to forget their various treatment instructions; 38 , 53 , 62 (4) the emergence of diabetes complications makes the treatment more complex so that patients are confused and choose not to take it. 45 , 46 , 50 These reasons may underlie the patient skipping or increasing the dose of the medicines.…”

“…Most studies used the MMAS-8 scale, which was validated by other studies in different settings and populations from the population studied. 16 , 30–32 , 34 , 36 , 39–41 , 43 , 44 , 46 , 47 , 53 , 62 , 74 The MMAS-8 was created and developed as a medication adherence scale for hypertensive patients, so validation studies through psychometric testing are needed before being used in other disease populations. 48 , 75 Psychometric tests on a measurement scale are still needed because the characteristics of the questions, responses to the scale, population, context, conditions, and timing of measurements can affect the results.…”

“… (Aditama et al, 2020)/Indonesia/primary health care/Qualitative Explanatory sequential/T2DM. 62 40 Adherence behavior questionnaire ● Mean scores of <1 (non-adherence) ● Mean scores of 1 (Adherence) ● Non-adherence (80%) ● Adherence (20%) ● Forgetfulness ● Not to take the medication ● Non-availability of the Drug product - 59 18. (Hussain et al, 2020)/Pakistan/Hospital/Cross-sectional/T2DM.…”