Baah-Nyarkoh Emmanuella, Alhassan Yakubu, Dwomoh Andrews K, Kretchy Irene A
Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana.
Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana.
Heliyon. 2023 Apr 13;9(4):e15448. doi: 10.1016/j.heliyon.2023.e15448. eCollection 2023 Apr.
Medication adherence is an integral component in the management of patients with co-morbid type 2 diabetes mellitus (T2DM) and hypertension. However due to their combined conditions, there is likelihood of polypharmacy and medication-related burden, which could negatively impact adherence to therapy. This study aimed to assess the perceived medication-related burden among patients with co-morbid T2DM and hypertension and to evaluate the association between the perceived burden and adherence to medication therapy.
A cross-sectional study was conducted among adult patients with co-morbid T2DM and hypertension attending a primary health facility. The living with medicines questionnaire and the medication adherence report scale were used to assess extent of medication-related burden and adherence respectively. Binary logistic regression model was used to estimate the adjusted odds and their corresponding 95% confidence interval for medication-related burden and adherence outcomes. All observed categorical variables were considered for the multivariable binary logistic regression model.
The total number of participants was 329 with a median age of 57.5 ± 13.2 years. The median score for the overall burden was 99 (IQR: 93-113), and this significantly varied by sex (p = 0.012), monthly income (p = 0.025), monthly expenditure on medications (p = 0.012), frequency of daily dose of medications (p = 0.020) and family history of T2DM (p < 0.001). About 30.7% and 36.8% of participants reported moderate/high burden and medication adherence respectively. Uncontrolled diastolic blood pressure (AOR: 2.46, 95% CI: 1.20-5.05, p = 0.014), high glucose (AOR: 4.24, 95% CI: 2.13-8.46, p < 0.001) and no family history of T2DM (AOR: 2.14, 95% CI: 1.14-4.02, p = 0.026) were associated with moderate/high medication burden. Uncontrolled diastolic blood pressure (AOR: 0.48, 95% CI: 0.25-0.94, p = 0.031), at least 5 years since hypertension diagnosis (AOR: 0.55, 95% CI: 0.30-0.99, p = 0.045) and moderate/high medication-related burden (AOR: 0.33, 95% CI: 0.16-0.69, p = 0.003) were associated with lower odds of medication adherence.
These findings suggest that to improve the preventive and optimal care of patients with T2DM and hypertension, interventions that aim to reduce medication-related burden and morbidity are recommended. The study proposes that health stakeholders such as clinicians, pharmacists, and policy makers, develop multidisciplinary clinical and pharmaceutical care interventions to include provision of counselling to patients on adherence. In addition, developing policies and sensitization activities on deprescribing and fixed-dose drug combinations aimed at reducing medication-related burden, while promoting better adherence, blood pressure and blood glucose outcomes are recommended.
药物依从性是合并2型糖尿病（T2DM）和高血压患者管理的一个重要组成部分。然而，由于他们的合并病症，存在多药联用和药物相关负担的可能性，这可能对治疗依从性产生负面影响。本研究旨在评估合并T2DM和高血压患者的药物相关负担感知情况，并评估感知负担与药物治疗依从性之间的关联。
对一家初级卫生机构中合并T2DM和高血压的成年患者进行了一项横断面研究。分别使用《药物生活问卷》和《药物依从性报告量表》来评估药物相关负担程度和依从性。采用二元逻辑回归模型来估计药物相关负担和依从性结果的调整比值及其相应的95%置信区间。多变量二元逻辑回归模型考虑了所有观察到的分类变量。
参与者总数为329人，中位年龄为57.5±13.2岁。总体负担的中位得分为99（四分位间距：93 - 113），且在性别（p = 0.012）、月收入（p = 0.025）、每月药物支出（p = 0.012）、每日服药次数（p = 0.（此处原文有误，应为0.020））和T2DM家族史（p < 0.001）方面存在显著差异。分别有30.7%和36.8%的参与者报告有中度/高度负担和药物依从性。未控制的舒张压（调整后的比值比：2.46，95%置信区间：1.20 - 5.05，p = 0.014）、高血糖（调整后的比值比：4.24，95%置信区间：2.13 - 8.46，p < 0.001）和无T2DM家族史（调整后的比值比：2.14，
