Comparison of medication adherence between type 2 diabetes mellitus patients who pay for their medications and those who receive it free: a rural Asian experience

Abstract

BackgroundTreatment plans fail if patients have poor medication adherence. Our aim was to compare medication adherence, reasons for non-adherence, and satisfaction with community support among type 2 diabetes mellitus patients who pay for their medications and those who receive it free.MethodsA descriptive cross-sectional study was conducted at Anuradhapura, Sri Lanka, among patients who were on oral anti-diabetic drugs for at least 3 months. They were grouped into two: universal-free group and fee-paying group. Three different scales were used to score medication adherence, reasons for non-adherence, and satisfaction with community support. Fisher’s exact test was performed to determine if there was a significant difference between the two groups (p < 0.05) concerning medication adherence and satisfaction with community support.ResultsThe median (IQR) medication adherence scores for fee-paying group and universal-free group were 3 (2-3) and 3 (3-3), respectively; the median (IQR) scores for satisfaction with community support were 5 (2–6) and 4 (4–6), respectively. Both the adherence and the satisfaction failed to show a significant difference between the two groups. Forgetfulness, being away from home, complex drug regime, and willingness to avoid side effects were common reasons of non-adherence for both the groups.ConclusionsThere was no significant difference in medication adherence between the universal-free group and fee-paying group, despite of having a significantly different income. The universal-free health service would be a probable reason.Electronic supplementary materialThe online version of this article (10.1186/s41043-019-0161-9) contains supplementary material, which is available to authorized users.

Clinicians' Values and Preferences for Medication Adherence and Cost Clinical Decision Support in Primary Care: A Qualitative Study

“…While medication nonadherence is a universal issue, the burden of medication cost on the patient may vary in other countries due to different health care system models being utilized (e.g., universal health care system vs. subsidized vs. mixed). [54][55][56][57] Additionally, drug prices in the United States are high due to lack of regulation or negotiation about prices of new prescription medications introduced into the market, whereas other countries employ methods to control drug pricing. 58 Despite these variations, even patients being cared for within a different health care system model may experience medication cost barriers and, as a result, experience poor outcomes; thus, research on what tools clinicians practicing in those areas would desire to help minimize cost barriers at point of prescribing would be beneficial.…”

Determinants of Non-Adherence to Treatment Among Patients with Type 2 Diabetes in Kenya: A Systematic Review

“…Elsewhere in an Asian study researchers noted that willingness to avoid side effects were common reasons of nonadherence. 41 In Iran, Benrazavy and Khalooei's study showed that education level was the most important predicting factor of adherence to medication. 10…”

“…42 Similar trends were noted in a study in Sudan 39 and Asia. 41 Not surprisingly, treatment adherence becomes more challenging when the treatment itself is perceived as more difficult, onerous, or burdensome. 13 In Iran it was found that non-adherence among patients with T2DM was influenced by lack of a deep understanding of the medical knowledge on diabetes in many aspects, and those who had little faith in doctors' prescriptions and recommendations.…”

Medication adherence and glycemic control among diabetes patients in developing countries

“…The study by Rathish et al from a rural province in Sri Lanka makes an important contribution to the sparse literature on the subject in the country and establishes the benefits of government-funded universal free-health services in enhancing medication coverage and adherence in low-income diabetes patients [3]. However, there are certain concerns regarding the study methodology and interpretation that are discussed below.…”

“…A study in Brazil also observed a high-rate of clinical inertia during diabetes care [8]. The Rathish et al [3] study had reported the lack of availability of some anti-diabetes agents like DPP-4 inhibitors in the free service compared to the paid service which could have significant implications on patient glycemic status. Future studies from the region should therefore evaluate the potential interconnectedness of adherence, glycemic control, and clinical inertia in their settings.…”