Medication adherence and persistence in type 2 diabetes mellitus: perspectives of patients, physicians and pharmacists on the Spanish health care system

Abstract

ObjectiveA good relationship between diabetes patients and their health care team is crucial to ensure patients’ medication adherence and self-management. To this end, we aimed to identify and compare the views of type 2 diabetes mellitus (T2DM) patients, physicians and pharmacists concerning the factors and strategies that may be associated with, or could improve, medication adherence and persistence.MethodsAn observational, cross-sectional study was conducted using an electronic self-administered questionnaire comprising 11 questions (5-point Likert scale) concerning factors and strategies related to medication adherence. The survey was designed for T2DM patients and Spanish National Health System professionals.ResultsA total of 963 T2DM patients, 998 physicians and 419 pharmacists participated in the study. Overall, a lower proportion of pharmacists considered the proposed factors associated with medication adherence important as compared to patients and physicians. It should be noted that a higher percentage of physicians in comparison to pharmacists perceived that “complexity of medication” (97% vs 76.6%, respectively) and “adverse events” (97.5% vs 72.2%, respectively) were important medication-related factors affecting adherence. In addition, both patients (80.8%) and physicians (80.8%) agreed on the importance of “cost and co-payment” for adherence, whereas only 48.6% of pharmacists considered this factor important. It is also noteworthy that nearly half of patients (43%) agreed that “to adjust medication to activities of daily living” was the best strategy to reduce therapeutic complexity, whereas physicians believed that “reducing the frequency of administration” (47.9%) followed by “reducing the number of tablets” (28.5%) was the most effective strategy to improve patients’ adherence.ConclusionOur results highlight the need for pharmacists to build a stronger relationship with physicians in order to improve patients monitoring and adherence rates. Additionally, these findings may help to incorporate greater patient-centeredness when developing management strategies, focusing on adjusting medication regimens to patients’ daily lives.

Factors Associated with Non-Adherence to Drugs in Patients with Chronic Diseases Who Go to Pharmacies in Spain

“…Therefore, the magnitude found corresponds more closely with clinical practice. In addition, most adherence studies have been conducted in primary care centers and hospitals [ 4 , 5 , 6 , 7 , 21 , 22 , 23 , 27 ], but very few in community pharmacies [ 24 , 25 , 26 ]. Our results indicate that this setting is particularly appropriate for addressing issues related to therapeutic non-adherence in complex chronic patients, and the participation of healthcare professionals should be encouraged to overcome this important health problem.…”

“…In Spain, community pharmacies are ideal places not only to measure and investigate therapeutic non-adherence, but also to carry out interventions to help reduce pharmacological non-adherence in chronic patients [ 23 , 24 , 25 , 26 ]. The majority of studies undertaken on therapeutic adherence have been conducted in primary care or specialized care [ 5 , 6 , 7 , 8 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ], but fewer studies are conducted in pharmacies [ 27 , 28 , 29 ].…”

Effect of hospital pharmacist counseling on clinical outcomes of type 2 diabetes mellitus outpatients

“…In addition, patients' involvement in the selection of the therapy can also increase their adherence to the therapy they undergo, especially patients on insulin therapy. [15]…”

Health-related quality of life in type 2 diabetes mellitus patients with different risk for obstructive sleep apnea

“…Disease chronicity, numerous complications, and long-term therapy have significant physical and psychological consequences affecting individual’s everyday functioning and well-being. 14 …”