Department of Clinical Pharmacy, Pharmacy Practice and Pharmaceutics, Faculty of Pharmacy, University of Mansoura, Mansoura, Egypt ; Department of Pharmacy Practice and Dosage Forms, Oman Pharmacy Institute, Ministry of Health, Muscat, Sultanate of Oman, Oman.
Saudi Pharm J. 2010 Oct;18(4):225-32. doi: 10.1016/j.jsps.2010.07.004. Epub 2010 Jul 30.
The promotion of therapeutic adherence is considered as an integral component of pharmaceutical care practice and patient healthcare. It has been shown that despite effective methods of treatment, 50% of diabetic patients fail to achieve satisfactory glycemic control, which leads to accelerated development of complications and increased mortality. Clinical experience indicates that no improvement of metabolic control is possible without patients' adherence to medications. This study sought to examine the rate of medication adherence and different factors affecting it among Type 2 diabetic patients in Egypt.
A total of 226 Type 2 diabetic patients who fulfilled the inclusion criteria were recruited in the current study. Adherence to the treatment was evaluated during patients' hospitalization in the Outpatient Clinics of Internal Medicine Department at University of Mansoura, Egypt. The medication adherence has been assessed during a personal interview with each patient using a multiple-choice graded questionnaire.
In the study population, the adherence rates to medication, dietary/exercise and appointment were observed to be suboptimal. The most important social factors that were significantly affecting adherence rate to the prescribed oral hypoglycemic agent(s) included marital status (P < 0.01), family support (P < 0.01), and socio-economical level (P < 0.01). Other patient factors that were significantly affecting therapeutic adherence were patient knowledge about the disease (P < 0.01), patients' beliefs and motivation about prescribed drugs (P < 0.01), and regularity of patients' self monitoring of blood glucose level (P < 0.01). Among drug factors which found to affect significantly the rate of medication adherence are the number of drugs taken (P < 0.05), complexity of drug regimen (P < 0.01), and the presence of drug side effects (P < 0.01). Economical factor played an equally important role. Direct and indirect care costs in relation to patients' income were significantly affecting the rate of adherence to medication (P < 0.01).
An improvement with the adherence to oral hypoglycemic agent(s) may be achieved through continuing patient education about diabetes, improvement of patients' economical levels as well as a reduction in the cost of medication. Pharmaceutical companies have to be involved and pharmacists have to be payed for helping chronically ill patients to take their medicines correctly for improving clinical outcomes.
促进治疗依从性被认为是药物治疗实践和患者医疗保健的一个组成部分。已经表明，尽管有有效的治疗方法，50%的糖尿病患者无法达到满意的血糖控制，这导致并发症加速发展和死亡率增加。临床经验表明，如果患者不遵守药物治疗，代谢控制就不可能得到改善。本研究旨在检查埃及 2 型糖尿病患者的药物治疗依从率及其影响因素。
共招募了 226 名符合纳入标准的 2 型糖尿病患者。在埃及曼苏拉大学内科门诊住院期间，通过个人访谈对每位患者使用多项选择分级问卷评估治疗依从性。
在研究人群中，观察到药物、饮食/运动和预约的依从率不理想。对服用口服降糖药的依从率有显著影响的最重要的社会因素包括婚姻状况（P<0.01）、家庭支持（P<0.01）和社会经济水平（P<0.01）。对治疗依从性有显著影响的其他患者因素包括患者对疾病的了解程度（P<0.01）、患者对所开药物的信念和动机（P<0.01）以及患者自我监测血糖水平的规律性（P<0.01）。药物因素中，服用药物的数量（P<0.05）、药物方案的复杂性（P<0.01）和药物副作用的存在（P<0.01）显著影响药物依从率。经济因素也起着同样重要的作用。患者收入与直接和间接护理费用的关系显著影响药物治疗的依从率（P<0.01）。
通过继续对糖尿病患者进行教育、提高患者的经济水平以及降低药物费用，可能会提高口服降糖药的依从率。制药公司必须参与进来，药剂师必须得到报酬，以帮助慢性病患者正确服用药物，改善临床结果。
