Barasa Masaba Brian, Mmusi-Phetoe Rose M
University of South Africa, Pretoria, South Africa.
J Multidiscip Healthc. 2021 Jan 5;13:2069-2076. doi: 10.2147/JMDH.S270137. eCollection 2020.
Non-adherence to the prescribed treatment regimen in patients with type 2 diabetes mellitus is quite high. Furthermore, it has been associated with higher rates of hospital admissions, suboptimal health outcomes, increased morbidity and mortality, and increased health care costs. The present systematic review study aimed to explore the determinants that contribute to non-adherence to treatment among patients with type 2 diabetes mellitus in Kenya.
A systematic review of studies conducted in Kenya on the present research problem published in English between December 2013 and May 2020. The databases included Scopus, Web of Science, Science Direct, Cochrane Library, PUBMED, OVID and Google Scholar. The following were the key words used in the search: "Non-adherence Diabetes Patients", "Determinants of Non-adherence Diabetes Patients" AND "Health Facilities" AND "Kenya". Qualitative analysis was used to present data under thematic domains.
The search generated 17,094 articles of which only 15 met the inclusion criteria. The major determinants were presented under three thematic domains: 1) Cost - income, insurance, distance, bills of drugs and food; 2) Patient characteristics - perception of (efficacy, severity, effects of non-adherence), knowledge, co-morbidity, family support, self unfounded beliefs; and 3) Health system - health education, multiple drugs, evaluations and support, guidelines, poor perception of system.
A multitude of factors including unaffordable care, patient's poor knowledge on the disease process, less family support in patient's daily self-care management, complex drug regimen and unsatisfactory health messages from the health providers were observed to be associated with non-adherence. Implementing integrated care programs will help in reducing levels of non-adherence among type 2 diabetes mellitus patients.
2型糖尿病患者对规定治疗方案的依从性相当低。此外，这还与更高的住院率、不理想的健康结果、发病率和死亡率增加以及医疗保健成本上升有关。本系统综述研究旨在探讨肯尼亚2型糖尿病患者治疗不依从的影响因素。
对2013年12月至2020年5月期间在肯尼亚开展的关于本研究问题且以英文发表的研究进行系统综述。数据库包括Scopus、科学网、科学Direct、考克兰图书馆、PubMed、OVID和谷歌学术。搜索使用的关键词如下：“糖尿病患者治疗不依从”、“糖尿病患者治疗不依从的决定因素”以及“医疗机构”和“肯尼亚”。采用定性分析在主题领域下呈现数据。
搜索共产生17094篇文章，其中只有15篇符合纳入标准。主要决定因素在三个主题领域下呈现：1）成本——收入、保险、距离、药品和食品账单；2）患者特征——（疗效、严重性、不依从的影响）认知、知识、合并症、家庭支持、无端自我信念；3）卫生系统——健康教育、多种药物、评估与支持、指南、对系统的不良认知。
观察到多种因素与治疗不依从有关，包括难以负担的医疗费用、患者对疾病过程的了解不足、患者日常自我护理管理中家庭支持较少、复杂的药物治疗方案以及医疗服务提供者提供的健康信息不令人满意。实施综合护理计划将有助于降低2型糖尿病患者的治疗不依从水平。
