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Open Access 01-10-2020 | Original Research

Modifiable Factors Associated with Non-adherence to Antihypertensive or Antihyperlipidemic Drugs Are Dissimilar: a Multicenter Study Among Patients with Diabetes in Indonesia

Authors: Sofa D. Alfian, MPH, Nurul Annisa, MPharm, Fajriansyah Fajriansyah, MSc, Dyah A. Perwitasari, PhD, Rizky Abdulah, PhD, Eelko Hak, PhD, Petra Denig, PhD

Published in: Journal of General Internal Medicine | Issue 10/2020

Abstract

Background

To develop targeted and tailored interventions for addressing medication non-adherence, it is important to identify underlying factors.

Objective

To identify factors associated with non-adherence as well as subtypes of non-adherence to antihypertensive or antihyperlipidemic drugs among patients with type 2 diabetes in Indonesia.

Design

An observational multicenter cross-sectional survey.

Participants

Patients with type 2 diabetes using either antihypertensive or antihyperlipidemic drugs in four regions in Indonesia.

Main Measures

Non-adherence and its subtypes of intentional and unintentional non-adherence were assessed using the Medication Adherence Report Scale. Necessity and concern beliefs were assessed with the Beliefs about Medicines Questionnaire. We applied binary and multinomial logistic regression to assess associations of medication beliefs, sociodemographic factors, and clinical-related factors to non-adherence and report odds ratios (OR) with 95% confidence intervals (CI).

Key Results

Of 571 participating patients (response rate 97%), 45.5% and 52.7% were non-adherent to antihypertensive and antihyperlipidemic drugs, respectively. Older age was associated with non-adherence to antihypertensive drugs (60–69 years) (OR, 5.65; 95% CI, 2.68–11.92), while higher necessity beliefs (OR, 0.92; 95% CI, 0.88–0.95) were associated with less non-adherence. Factors associated with non-adherence to antihyperlipidemic drugs were female gender (OR, 1.84; 95% CI, 1.03–3.27) and higher concern beliefs (OR, 1.10; 95% CI, 1.03–1.18), while higher necessity beliefs (OR, 0.89; 95% CI, 0.83–0.96) were associated with less non-adherence.

Conclusions

The main factors associated with non-adherence to antihypertensive and antihyperlipidemic drugs are modifiable. In general, beliefs about the necessity of the drug are important but for antihyperlipidemic drugs concerns are important as well. Healthcare providers should pay attention to identify and address medication beliefs during patient counselling.

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Islam SMS, Purnat TD, Phuong NTA, Mwingira U, Schacht K, Fröschl G. Non-Communicable Diseases (NCDs) in developing countries: a symposium report. Global Health. 2014;10:1–7. doi:https://doi.org/10.1186/s12992-014-0081-9CrossRef

International Diabetes Federation (IDF). IDF Diabetes Atlas. http://www.diabetesatlas.org/resources/2017-atlas.html. Published 2017.

Sarwar N, Gao P, Kondapally Seshasai SR, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: A collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–2222. doi:https://doi.org/10.1016/S0140-6736(10)60484-9CrossRefPubMed

Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: A systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovasc Diabetol. 2018;17(1). doi:https://doi.org/10.1186/s12933-018-0728-6

American Diabetes Association. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2019;42(Supplement 1):S103-S123. doi:https://doi.org/10.2337/dc19-S010

Akrom A, Anggitasari W. Adherence and quality of life on diabetic patients with hypertension at bantul public hospital in yogyakarta special region, indonesia. Int J Public Heal Sci. 2018;8(1). doi:https://doi.org/10.11591/ijphs.v8i1.15240

Khan R, Socha-Dietrich K. Investing in medication adherence improves health outcomes and health system efficiency: adherence to medicines for diabetes, hypertension, and hyperlipidaemia. OECD Heal Work Pap. 2018;(105). https://doi.org/10.1787/8178962c-en

Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009;119(23):3028–3035. doi:https://doi.org/10.1161/CIRCULATIONAHA.108.768986CrossRefPubMed

Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–497. doi:https://doi.org/10.1056/NEJMra050100CrossRefPubMed

10.

Alfian S, Sukandar H, Lestari K, Abdulah R. Medication adherence contributes to an improved quality of life in type 2 diabetes mellitus patients : a cross-sectional study . Diabetes Ther. 2016;7(4):755–764. doi:https://doi.org/10.1007/s13300-016-0203-xCrossRefPubMedPubMedCentral

11.

Krass I, Schieback P, Dhippayom T. Adherence to diabetes medication: A systematic review. Diabet Med. 2015;32(6):725–737. doi:https://doi.org/10.1111/dme.12651CrossRefPubMed

12.

Indonesia KKR. Peraturan Menteri Kesehatan Republik Indonesia Nomor 73 Tahun 2016 Tentang Standar Pelayanan Kefarmasian Di Apotek. Jakarta; 2016.

13.

Indonesia KKR. Peraturan Menteri Kesehatan Republik Indonesia Nomor 74 Tahun 2016 Tentang Standar Pelayanan Kefarmasian Di Puskesmas. Jakarta; 2016.

14.

Indonesia KKR. Peraturan Menteri Kesehatan Republik Indonesia Nomor 72 Tahun 2016 Tentang Standar Pelayanan Kefarmasian Di Rumah Sakit. Jakarta; 2016.

15.

Kirkman MS, Rowan-Martin MT, Levin R, et al. Determinants of adherence to diabetes medications: findings from a large pharmacy claims database. Diabetes Care. 2015;38(4):604–609.PubMedPubMedCentral

16.

Tunceli K, Zhao C, Davies MJ, et al. Factors associated with adherence to oral antihyperglycemic monotherapy in patients with type 2 diabetes. Patient Prefer Adherence. 2015;9:191–197. doi:https://doi.org/10.2147/PPA.S71346CrossRefPubMedPubMedCentral

17.

Alfian SD, Sukandar H, Arisanti N, Abdulah R. Complementary and alternative medicine use decreases adherence to prescribed medication in diabetes patients. Ann Trop Med Public Heal. 2016;9(3). https://doi.org/10.4103/1755-6783.179108

18.

Schüz B, Marx C, Wurm S, et al. Medication beliefs predict medication adherence in older adults with multiple illnesses. J Psychosom Res. 2011;70(2):179–187. doi:https://doi.org/10.1016/j.jpsychores.2010.07.014CrossRefPubMed

19.

Gadkari AS, Mchorney CA. Unintentional non-adherence to chronic prescription medications: How unintentional is it really? BMC Health Serv Res. 2012;12. doi:https://doi.org/10.1186/1472-6963-12-98.

20.

Mann DM, Ponieman D, Leventhal H, Halm EA. Predictors of adherence to diabetes medications: the role of disease and medication beliefs. J Behav Med. 2009;32(3):278–284. doi:https://doi.org/10.1007/s10865-009-9202-yCrossRefPubMed

21.

Karuniawati H, Ikawati Z, Gofir A. Adherence to secondary stroke prevention therapies in ischemic stroke patients at teaching hospital in Central Java Indonesia. Asian J Pharm Clin Res. 2017;10(14):28. doi:https://doi.org/10.22159/ajpcr.2017.v10s2.19478CrossRef

22.

Phatak HM, Thomas J. Relationships between beliefs about medications and use of prescribed chronic medications. Ann Pharmacother. 2006;40:1737–1742. doi:https://doi.org/10.1345/aph.1H153CrossRefPubMed

23.

Horne R, Graupner L, Frost S, Weinman J, Wright SM, Hankins M. Medicine in a multi-cultural society: the effect of cultural background on beliefs about medications. Soc Sci Med. 2004;59(6):1307–1313. doi:https://doi.org/10.1016/j.socscimed.2004.01.009CrossRefPubMed

24.

Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Heal. 1999;14(1):1–24. doi:https://doi.org/10.1080/08870449908407311CrossRef

25.

Horne R, Chapman SCE, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: A meta-analytic review of the Necessity-Concerns Framework. PLoS One. 2013;8(12). https://doi.org/10.1371/journal.pone.0080633

26.

de Vries ST, Keers JC, Visser R, et al. Medication beliefs, treatment complexity, and non-adherence to different drug classes in patients with type 2 diabetes. J Psychosom Res. 2014;76(2):134–138. doi:https://doi.org/10.1016/j.jpsychores.2013.11.003CrossRefPubMed

27.

Stack RJ, Bundy CE, Eliott RA, New JP, Gibson M, Noyce PR. Intentional and unintentional non-adherence in community dwelling people with type 2 diabetes: The effect of varying numbers of medicines. Br J Diabetes Vasc Dis. 2010;10(3):148–152. doi:https://doi.org/10.1177/1474651409357034CrossRef

28.

Chan AHY, Horne R, Hankins M, Chisari C. The Medication Adherence Report Scale (MARS-5): a measurement tool for eliciting patients’ reports of non-adherence. Br J Clin Pharmacol. 2019. doi:https://doi.org/10.1111/bcp.14193

29.

Alfian R, Putra AMP. Uji validitas dan reliabilitas kuesioner medication adherence report scale (MARS) terhadap pasien diabetes mellitus [in Bahasa Indonesia]. J Ilm Ibnu Sina. 2017;2:176–183.

30.

van der Laan DM, Elders PJM, Boons CCLM, Beckeringh JJ, Nijpels G, Hugtenburg JG. Factors associated with antihypertensive medication non-adherence: a systematic review. J Hum Hypertens. 2017;31(11):687–694. doi:https://doi.org/10.1038/jhh.2017.48CrossRefPubMed

31.

Birtcher K. When compliance is an issue—how to enhance statin adherence and address adverse effects. Curr Atheroscler Rep. 2015;17(1). doi:https://doi.org/10.1007/s11883-014-0471-8

32.

Adikusuma W, Perwitasari DA, Supadmi W. Evaluasi kepatuhan pasien diabetes melitus tipe 2 di Rumah Sakit Umum PKU Muhammadiyah Bantul, Yogyakarta [in Bahasa Indonesia]. Media Farm. 2014;11(2):208–220.

33.

Lee CS, Tan JHM, Sankari U, Koh YLE, Tan NC. Assessing oral medication adherence among patients with type 2 diabetes mellitus treated with polytherapy in a developed Asian community: a cross-sectional study. BMJ Open. 2017;7(9):e016317. doi:https://doi.org/10.1136/bmjopen-2017-016317CrossRefPubMedPubMedCentral

34.

Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373–1379. doi:https://doi.org/10.1016/s0895-4356(96)00236-3CrossRefPubMed

35.

Rahmawati R, Bajorek B. Factors affecting self-reported medication adherence and hypertension knowledge: A cross-sectional study in rural villages, Yogyakarta Province, Indonesia. Chronic Illn. 2018;14(3):212–227. doi:https://doi.org/10.1177/1742395317739092

36.

Barber N, Parsons J, Clifford S, Darracott R, Horne R. Patients’ problems with new medication for chronic conditions. Qual Saf Health Care. 2004;13(3):172–175. doi:https://doi.org/10.1136/qhc.13.3.172CrossRefPubMedPubMedCentral

37.

Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27(5):1218–1224. doi:https://doi.org/10.2337/diacare.27.5.1218CrossRefPubMed

38.

Gellad WF, Grenard JL, Marcum ZA. A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. Am J Geriatr Pharmacother. 2011;9(1):11–23. doi:https://doi.org/10.1016/J.AMJOPHARM.2011.02.004CrossRefPubMedPubMedCentral

39.

Gibson DS, Nathan AG, Quinn MT, Laiteerapong N. Patient expectations of hypertension and diabetes medication: Excessive focus on short-term benefits. SAGE Open Med. 2018;6:205031211882111. doi:https://doi.org/10.1177/2050312118821119CrossRef

40.

Donnelly LA, Doney ASF, Morris AD, Palmer CNA, Donnan PT. Long-term adherence to statin treatment in diabetes. Diabet Med. 2008;25(7):850–855. doi:https://doi.org/10.1111/j.1464-5491.2008.02476.xCrossRefPubMed

41.

Mann DM, Woodward M, Muntner P, Falzon L, Kronish I. Predictors of nonadherence to statins: a systematic review and meta-analysis. Ann Pharmacother. 2010;44(9):1410–1421. doi:https://doi.org/10.1345/aph.1P150CrossRefPubMedPubMedCentral

42.

Krueger KP, Berger BA, Felkey B. Medication adherence and persistence: A comprehensive review. Adv Ther. 2005;22(4):313–356. doi:https://doi.org/10.1007/BF02850081CrossRefPubMed

43.

Lin C-Y, Huang-Tz Ou, Nikoobakht M, et al. Validation of the 5-Item medication adherence report scale in older stroke patients in Iran. J Cardiovasc Nurs. 2018;00(0). https://doi.org/10.1097/JCN.0000000000000488

44.

Tedla YG, Bautista LE. Factors associated with false-positive self-reported adherence to antihypertensive drugs. J Hum Hypertens. 2017;31(5). https://doi.org/10.1038/jhh.2016.80

Title: Modifiable Factors Associated with Non-adherence to Antihypertensive or Antihyperlipidemic Drugs Are Dissimilar: a Multicenter Study Among Patients with Diabetes in Indonesia
Authors: Sofa D. Alfian, MPH
Nurul Annisa, MPharm
Fajriansyah Fajriansyah, MSc
Dyah A. Perwitasari, PhD
Rizky Abdulah, PhD
Eelko Hak, PhD
Petra Denig, PhD
Publication date: 01-10-2020
Publisher: Springer International Publishing
Published in: Journal of General Internal Medicine / Issue 10/2020
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-020-05809-y

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Modifiable Factors Associated with Non-adherence to Antihypertensive or Antihyperlipidemic Drugs Are Dissimilar: a Multicenter Study Among Patients with Diabetes in Indonesia

Abstract

Background

Objective

Design

Participants

Main Measures

Key Results

Conclusions

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Conclusions

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