Factors affecting adherence to treatment in patients on chronic medication at Mokopane Hospital

Abstract

Introduction: Many patients with chronic illnesses including asthma, hypertension, diabetes mellitus and HIV/AIDS, have difficulties adhering to their recommended regimens. This may result in sub-optimal management and control of the illness. What a patient understands about a specific regimen, including the reason for taking each medication and the intricacies of dosing schedules and administration requirements, can have a profound influence on adherence. Monitoring the effectiveness and safety of the treatment administered helps to decide whether this should be continued, changed or stopped. Any drug may produce unwanted or unexpected adverse reactions. The choice of drugs depends on many factors, such as the pattern of diseases, the treatment facilities, the training and experience of the available personnel, the financial resources available and demographic or environmental factors. The level of adherence to medication among with hypertension and diabetes mellitus or anti-retroviral therapy has not been studied in Limpopo province Aim: The aim of the study was to determine the adherence patterns and the factors contributing to the adherence to treatment by diabetic, hypertensive and HIV/AIDS patients at Mokopane Hospital. Methodology: This was a cross-sectional, descriptive study conducted through use of a questionnaire administered as an exit interview at the pharmacy after the patients had consulted the doctor and received their medication from the pharmacy. Results: The data was collected over a period of two months, where every patient was seen only once using their hospital numbers to avoid repetition. The study included a total of 307 participants, 201 (60%) were patients on ARVs, 48 (16%) were on anti-hypertensive, 35 (11%) on anti-diabetic, and 23 (8%) on both anti-hypertensive and anti-diabetics. The respondents were predominantly female (n = 234; 76%) while 73 (24%) male. Similarly of the 201 participants on ARVs treatment, 153 (76%) were females and 48 (24%) were males; among those on anti-hypertensives only 11 (22%) were males. For the diabetics 6 (17%) were males and 29 (83%) were females. Of participants with both hypertension and diabetes 9 (39.1%) were males and 14 (60.9%) were females. Seventy-nine percent (79%) of respondents on ART, 69% of those on anti-hypertensive, 72% of those on anti-diabetics, and 66% of those on both anti-diabetics and anti-hypertensives were adherent to their treatment. The younger patients (21 to 40 years) were less likely to have forgotten to take their treatment in the last one month (21% of respondents) than the older patients (41 to 87 years), 34% of whom forgot to take medication in the month prior to the study. Most respondents 250 (81%) reportedly used an alarm system/timer as reminder to take their medication. Most of them reported that they received information regarding their condition and medication, though some were not sure of the side effects or indications for the medications. Adherence was attributed to faith in the healthcare worker, fear of complications of the condition, and a desire to control the condition. Non-adherence was seen as an active decision, partly based on misunderstandings of the condition and general disapproval of medication which was only taken in order to facilitate daily life or minimize adverse effects. Conclusion: The levels of non-adherence (21% to 34%) among the patients on chronic medication are not acceptable. Elderly patients were more likely to be non-adherent to their treatment compared to the younger patients. Some information gaps were identified regarding their conditions and indications for medications. It is therefore important for the health professional to provide patients with full information about the indications, efficacy, and side effects of the medication given to them. Ways should be found to support elderly patients who are on chronic medications; for instance through directly observed therapy and/or using treatment supporters.