Dangaura Nripa Raj, Khanal Pratik, Kuikel Bihari Sharan, Marasini Sabina, Timilsina Ashish, Joshi Prakash Chandra, Mahato Roshan, Shrestha Archana, Karmacharya Biraj Man
Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
Bergen Centre for Ethics and Priority Setting in Health (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
PLoS One. 2025 Sep 19;20(9):e0332602. doi: 10.1371/journal.pone.0332602. eCollection 2025.
Noncompliance of medication among patients with chronic disease is a major challenge for the health system. Expanding of national health insurance among patients might increase their access to health care services, reduce out of pocket expenditures, and improve health outcomes. This study aimed to determine the association between enrollment in health insurance and medication adherence among hypertensive patients in Nepal.
A cross-sectional study was conducted among 402 patients visiting the outpatient department of Tikapur Hospital located in Kailali, Nepal. Data was collected by face-to-face interviews using a structured questionnaire. Adherence to hypertensive medication was assessed using the Hill Bone Medication Adherence Scale (HB-MAS). A multivariable logistic regression model was constructed to ascertain the association between enrollment in health insurance and medication adherence.
Overall, 52.7% (60.2% of uninsured and 45.3% of insured) of the patients was medication adherence. Enrollment in health insurance was not significantly associated with medication adherence. The participants among those who had reported more than secondary level education was higher odds of medication adherence (AOR = 3.30; 95% CI: 1.25-8.73); those who reported more than five minutes of interaction with doctors (AOR = 2.97; 95% CI: 1.56-5.65); those on medication for more than 10 years had higher odds of adherence (AOR:2.56; 95% CI:1.35-4.86); aged group 50-59 years was lower odds of medicatio n (AOR = 0.46; 95% CI: 0.23-0.91); compared to patients with no formal education;those who reported less than or equal to 5 minutes of interaction with doctors; those who had less than 5 years of medication; participants younger than 50 years respectively.
Our study showed that enrollment in health insurance was not associated with medication adherence among patients with hypertension. Health system interventions such as improving counseling, patient education, and follow-up, and ensuring availability of medicines might improve medication adherence among patients. Health professionals also should set up education, and interventions aimed at increased awareness of the consequences of non-adherence to antihypertensive medication.
慢性病患者的用药依从性是卫生系统面临的一项重大挑战。扩大患者的国家医疗保险覆盖面可能会增加他们获得医疗服务的机会，减少自付费用，并改善健康状况。本研究旨在确定尼泊尔高血压患者的医疗保险参保情况与用药依从性之间的关联。
对尼泊尔凯拉利蒂卡布尔医院门诊部的402名患者进行了一项横断面研究。通过使用结构化问卷进行面对面访谈收集数据。使用希尔·博恩用药依从性量表（HB-MAS）评估高血压用药的依从性。构建多变量逻辑回归模型以确定医疗保险参保情况与用药依从性之间的关联。
总体而言，52.7%的患者（未参保患者中的60.2%和参保患者中的45.3%）用药依从。医疗保险参保与用药依从性无显著关联。报告受过高中以上教育的参与者用药依从性几率更高（调整后比值比[AOR]=3.30；95%置信区间[CI]：1.25-8.73）；报告与医生互动超过五分钟的参与者（AOR=2.97；95%CI：1.56-5.65）；用药超过10年的参与者依从性几率更高（AOR：2.56；95%CI：1.35-4.86）；50-59岁年龄组的用药几率较低（AOR=0.46；95%CI：0.23-0.91）；分别与未接受正规教育的患者、报告与医生互动少于或等于五分钟的患者、用药少于五年的患者、年龄小于50岁的参与者相比。
我们的研究表明，高血压患者的医疗保险参保情况与用药依从性无关。改善咨询、患者教育和随访以及确保药品供应等卫生系统干预措施可能会提高患者的用药依从性。卫生专业人员还应开展教育，并进行旨在提高对不坚持服用抗高血压药物后果认识的干预。
