Adherence behavior assessment of oral antidiabetic medication use: a study of patient decisions in long-term disease management in primary health care centers in Surabaya
-
Lisa Aditama
,
Umi Athiyah
Abstract
Background
Adherence to medication has an important role in the long-term management of diabetes. The Indonesian Endocrinologist Association found that of the 50% of the entire population who have been diagnosed with diabetes, two-thirds are undergoing therapy and only one-third have been achieving the intended outcomes of the drug therapy. This study aimed to identify patients’ adherence behavior and the root causes of non-adherence.
Methods
This study used a non-experimental mixed-methods approach. A total of 40 patients with type 2 diabetes mellitus (T2DM), who were part of the referral program of the National Health Care Security System (BPJS Kesehatan) were recruited by purposive sampling from 17 primary health care centers in Surabaya, Indonesia.
Results
The adherence behavior assessment revealed non-adherence among 80% of the patients. The highest instances of non-adherence based on the percentage scores involved the following: patients forgot to take the medications (38.23%), patients preferred not to take the medications (20.59%) and the drug products were not available for the patient (14.71%). The factors influencing non-adherence included the complex instructions for taking medication, the absence of a reminder, the unwanted side effects of the drug, the feeling of repetition, the feeling that drugs were ineffective and the concern for the drug’s effects on the kidney.
Conclusions
The high rates of non-adherence identified in this study encourage pharmacists to implement better medication therapy management for chronic diseases. The patients’ understanding of drug therapy indications and regimens is very important in increasing the expectations of achieving effective treatment, awareness and concern for medication safety and treatment compliance.
Appendix
The Adherence Behavior Questionnaire.
| No | Adherence behavior | Yes | No |
|---|---|---|---|
| 1 | I need help from other people every time I read the instructions for use of my medicine | ||
| 2 | The information written on the label is unclear, I use my own rules | ||
| 3 | I don’t always use my medicine on time | ||
| 4 | I am not sure how to use my medicine correctly (*) | ||
| 5 | I don’t redeem medicine that are prescribed to be purchased at other pharmacies (if you have never experienced them, no need to answer) | ||
| 6 | I replace my medicine with another drugs (herbs or alternative therapies) | ||
| 7 | I save on the use of my medicine so that it is enough to use | ||
| 8 | I only take my medicine when I feel my blood sugar level is high/rising | ||
| 9 | When I feel dizzy, weak or unhealthy, I decide not to use my medicine without checking my blood sugar level | ||
| 10 | I feel that my medicine caused a negative change to me, so I don’t use it | ||
| 11 | I feel my condition does not improve with medication, so I stop it | ||
| 12 | I am worried that my medicine will affect the kidneys, so I don’t use it regularly | ||
| 13 | I often feel uncomfortable when using my medicine, so I don’t use it regularly | ||
| 14 | I sometimes forget to use my medicine, because I get more than 1 drug with different instructions for use | ||
| 15 | I sometimes forget to use my medicine, because my activities are crowded | ||
| 16 | I sometimes forget to use my medicine, because nobody reminds me | ||
| 17 | I sometimes forget to use my medicine because I fall asleep | ||
| 18 | Prescription medicine are not available at the Primary Health Center, so I don’t use the medicine | ||
| 19 | Sometimes the medicine at the Primary Health Center is lacking, I don’t go back to the Primary Health Center to get the rest of my medicine | ||
| 20 | When my medicine is running out, I don’t buy my medicine myself at the pharmacy | ||
| 21 | I have difficulty using medicine, because I cannot swallow or use the medicine |
(*) If you have a special drug, show how to use it after filling out the questionnaire.
Acknowledgments
The authors would like to thank The Ministry of Research, Technology and Higher Education of Indonesia for providing grants for the implementation of this research. The authors are also grateful for the support of the heads of the Surabaya City Health Office who have given us permission to carry out this research.
Research funding: A doctoral dissertation grant from The Ministry of Research, Technology and Higher Education of Indonesia.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, gifts, or honoraria.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: This research has obtained permission from the Surabaya City Health Office with a permit number for research: 072/20362/436.7.2/2018.
References
[1] Ministry of Health of the Republic of Indonesia. Health Research and Development Agency. Jakarta,Report on Indonesian Basic Health Research Results (Riskesdas). 2013. March 2018.Suche in Google Scholar
[2] International Diabetes Federation. IDF Diabetes Atlas Eighth Edition, International Diabetes Federation, 2017.Suche in Google Scholar
[3] The Indonesian Endocrinologist Association. Consensus on the management and prevention of type 2 diabetes mellitus in Indonesia. Jakarta: PB. PERKENI, 2015.Suche in Google Scholar
[4] National Health Care Security System (BPJS). Practical guideline gate keeper concept health care facility BPJS of Health. Jakarta, 2014.Suche in Google Scholar
[5] National Health Care Security System (BPJS). Practical guideline referral program for JKN member. Jakarta: BPJS of Health, 2014.Suche in Google Scholar
[6] Bailey C, Kodack M. Patient adherence to medication requirements for therapy of type 2 diabetes. Wiley: International Journal of Clinical Practice, 2011.10.1111/j.1742-1241.2010.02544.xSuche in Google Scholar PubMed
[7] Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the patient centered approach to medication management services, Third edition. New York: McGraw-Hill Companies Inc., 2012.Suche in Google Scholar
[8] Gellad WF, Grenard J, McGlynn EA. A review of barriers to medication adherence: a framework for driving policy options. Santa Monica, CA: RAND Corporation, 2009.Suche in Google Scholar
[9] Miller TA. Health literacy and adherence to medical treatment in chronic and acute illness: a meta-analysis. United States: Elsevier, 2016.10.1016/j.pec.2016.01.020Suche in Google Scholar
[10] The American Pharmacists Association and the National Association of Chain Drug Stores Foundation. Medication Therapy management in pharmacy practice: core elements of an MTM service model version 2.0, 2008.Suche in Google Scholar
[11] Creswell JW, Plano Clark VL. Designing and conducting mixed methods research, 2nd edition (Chapter 4). Thousand Oaks, CA: Sage Publications, Inc., 2011.Suche in Google Scholar
[12] Israel GD. Determining sample size. University of Florida, 1998:4.Suche in Google Scholar
[13] Gadkari AS, McHorney CA. Unintentional non-adherence to chronic prescription medications: How unintentional is it really? USA: BioMedCentral, 2012.10.1186/1472-6963-12-98Suche in Google Scholar PubMed PubMed Central
[14] Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J 2011;26:155–9.10.5001/omj.2011.38Suche in Google Scholar PubMed PubMed Central
[15] Jordan J, Buchbinder R, Briggs AM, Elsworth GR, Busija L, Batterham R, et al. The Health Literacy Management Scale (HeLMS): a measure of an individual’s capacity to seek, understand and use health information within the healthcare setting. Patient Educ Couns 2013;91:228–35.10.1016/j.pec.2013.01.013Suche in Google Scholar PubMed
[16] Jordan J, Rachelle B, Osborne RH. Conceptualising health literacy from the patient perspective. Australia: Elsevier, 2009.Suche in Google Scholar
[17] Shoemaker SJ, Ramalho de Oliveira D, Alves M, Ekstrand M. The medication experience: preliminary evidence of its value for patient education and counseling on chronic medications. Patient Educ Couns 2011;83:443–50.10.1016/j.pec.2011.02.007Suche in Google Scholar PubMed
[18] Brundisini F, DeJean D, Giacomini M, Hulan D, Vanstone M. Patient experiences of medication adherence: a systematic review and qualitative meta-synthesis. CHEPA Working Paper Series. 2014.Suche in Google Scholar
[19] Indonesian Ministry of Health. Minister of Health Regulation No. 75 about the Primary Health Center (Puskesmas), 2014.Suche in Google Scholar
[20] Abebe SM, Berhane Y, Worku A. Barriers to diabetes medication adherence in North West Ethiopia. SpringerPlus 2014;3:195.10.1186/2193-1801-3-195Suche in Google Scholar PubMed PubMed Central
[21] Nash J. Understanding barriers to medication adherence in people with diabetes. J Diabetes Nurs 2013;17:263–7.Suche in Google Scholar
[22] Nguyen T-M, La Caze A, Cottrell N. Validated adherence scales used in a measurement-guided medication management approach to target and tailor a medication adherence intervention: a randomized controlled trial. BMJ Open 2016;6:e013375.10.1136/bmjopen-2016-013375Suche in Google Scholar PubMed PubMed Central
© 2019 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Reviews
- Pharmacist contributions in the treatment of diabetes mellitus in Southeast Asia: a narrative review
- The implementation of a chronic disease management program (Prolanis) in Indonesia: a literature review
- Original Articles
- Quercetin attenuates acute predator stress exposure-evoked innate fear and behavioral perturbation
- Evaluating current practices and policies in the use of injectable medicines for treating myalgia in a primary care center in Pamekasan, Indonesia
- The contemporary role and potential of pharmacist contribution for community health using social media
- Evaluation of rational drug use based on World Health Organization prescribing indicators in a primary care center in Pamekasan East Java, Indonesia
- The prescription patterns of second-generation antipsychotics in schizophrenia outpatient setting
- Factors affecting community pharmacist’s service for women with chronic diseases during pregnancy and breastfeeding: application of the Health Belief Model
- Overview of therapeutic changes in antiepileptic drugs in adult patients
- Exploration of barriers affecting job satisfaction among community pharmacists
- Patients’ characteristics and their adherence to insulin therapy
- Correlation of chemotherapy costs with quality of life in nasopharyngeal cancer patients
- Impact of educational preeclampsia prevention booklet on knowledge and adherence to low dose aspirin among pregnant women with high risk for preeclampsia
- Translation, cultural adaptation, and validation of the quality of well being self-administered questionnaire in general population in Indonesia
- Knowledge, attitude, and practice of pharmacists towards management of hypertension in primary care centers
- Medication adherence in diabetes mellitus patients at Tanjung Karang Primary Health Care Center, Mataram
- Decreasing angiogenesis vasa vasorum through Lp-PLA2 and H2O2 inhibition by PSP from Ganoderma lucidum in atherosclerosis: in vivo diabetes mellitus type 2
- Antiaggregation effect of clopidogrel in coronary heart disease patients using omeprazole
- The effect of curcuma (Curcuma xanthorrizha roxb.) extract as an adjuvant of captopril therapy on cardiac histopathology of male mice (Mus musculus) with hypertension
- Coenzyme Q10 nanostructured lipid carriers as an inducer of the skin fibroblast cell and its irritability test in a mice model
- Medical problems in patients with chronic kidney disease undergoing hemodialysis and their therapy
- ADMET properties of novel 5-O-benzoylpinostrobin derivatives
- Development of nonalcoholic fatty liver disease model by high-fat diet in rats
- Molecular docking of novel 5-O-benzoylpinostrobin derivatives as wild type and L858R/T790M/V948R mutant EGFR inhibitor
- The relationship between the level of education and accuracy of insulin injection techniques in DM patients with measurement of HbA1c values
- The effect of premixed insulin to blood glucose concentration in patients with type 2 diabetes mellitus
- Intravenous insulin therapy in diabetes mellitus with hyperglycemic crisis and intercurrent illness
- Adherence behavior assessment of oral antidiabetic medication use: a study of patient decisions in long-term disease management in primary health care centers in Surabaya
- Evaluation to the chemotherapy use in patients with diffuse large B-cell lymphoma
- Analysis of the use and cost of stress ulcer prophylaxis for surgical inpatients
- Antineuroinflammation activity of n-butanol fraction of Marsilea crenata Presl. in microglia HMC3 cell line
- The enhancement of Arg1 and activated ERβ expression in microglia HMC3 by induction of 96% ethanol extract of Marsilea crenata Presl. leaves
- Ternary solid dispersion to improve solubility and dissolution of meloxicam
- Improving solubility and dissolution of meloxicam by solid dispersion using hydroxypropyl methylcellulose 2910 3 cps and nicotinamide
- o-Hydroxycinnamic derivatives as prospective anti-platelet candidates: in silico pharmacokinetic screening and evaluation of their binding sites on COX-1 and P2Y12 receptors
- The change of proinflammatory cytokine tumor necrosis factor α level in the use of meloxicam in rat model of osteoarthritis
- Attenuation of IL-1ß on the use of glucosamine as an adjuvant in meloxicam treatment in rat models with osteoarthritis
- Analysis of effectiveness and drug related problems of pain reliever for knee osteoarthritis: weighing clinical risk and benefit
- Comparison of antibiotic prescriptions in adults and children with upper respiratory tract infections in Bangka Tengah primary health care centers
- Profile of sociodemographics, sources of infection, antiretrovirals and CD4 counts on HIV/AIDS outpatients in Turen Primary Health Centre, Indonesia
- Synergistic anti-hepatitis C virus activity of Ruta angustifolia extract with NS3 protein inhibitor
- In vitro equivalence of generic and branded amoxicillin tablet by microbiological assay method
- Knowledge and attitude: two fundamental factors that determine patient compliance in antibiotic therapy
- Molecular docking study of sappan wood extract to inhibit PBP2A enzyme on methicillin-resistant Staphylococcus aureus (MRSA)
- Effect of curcumin analogue synthetic product from cullilawan oil for the liver damage treatment in male mice (Mus musculus L.)
- Case Report
- A case report of generalized tetanus in a 42-year-old man with dental infection
Artikel in diesem Heft
- Reviews
- Pharmacist contributions in the treatment of diabetes mellitus in Southeast Asia: a narrative review
- The implementation of a chronic disease management program (Prolanis) in Indonesia: a literature review
- Original Articles
- Quercetin attenuates acute predator stress exposure-evoked innate fear and behavioral perturbation
- Evaluating current practices and policies in the use of injectable medicines for treating myalgia in a primary care center in Pamekasan, Indonesia
- The contemporary role and potential of pharmacist contribution for community health using social media
- Evaluation of rational drug use based on World Health Organization prescribing indicators in a primary care center in Pamekasan East Java, Indonesia
- The prescription patterns of second-generation antipsychotics in schizophrenia outpatient setting
- Factors affecting community pharmacist’s service for women with chronic diseases during pregnancy and breastfeeding: application of the Health Belief Model
- Overview of therapeutic changes in antiepileptic drugs in adult patients
- Exploration of barriers affecting job satisfaction among community pharmacists
- Patients’ characteristics and their adherence to insulin therapy
- Correlation of chemotherapy costs with quality of life in nasopharyngeal cancer patients
- Impact of educational preeclampsia prevention booklet on knowledge and adherence to low dose aspirin among pregnant women with high risk for preeclampsia
- Translation, cultural adaptation, and validation of the quality of well being self-administered questionnaire in general population in Indonesia
- Knowledge, attitude, and practice of pharmacists towards management of hypertension in primary care centers
- Medication adherence in diabetes mellitus patients at Tanjung Karang Primary Health Care Center, Mataram
- Decreasing angiogenesis vasa vasorum through Lp-PLA2 and H2O2 inhibition by PSP from Ganoderma lucidum in atherosclerosis: in vivo diabetes mellitus type 2
- Antiaggregation effect of clopidogrel in coronary heart disease patients using omeprazole
- The effect of curcuma (Curcuma xanthorrizha roxb.) extract as an adjuvant of captopril therapy on cardiac histopathology of male mice (Mus musculus) with hypertension
- Coenzyme Q10 nanostructured lipid carriers as an inducer of the skin fibroblast cell and its irritability test in a mice model
- Medical problems in patients with chronic kidney disease undergoing hemodialysis and their therapy
- ADMET properties of novel 5-O-benzoylpinostrobin derivatives
- Development of nonalcoholic fatty liver disease model by high-fat diet in rats
- Molecular docking of novel 5-O-benzoylpinostrobin derivatives as wild type and L858R/T790M/V948R mutant EGFR inhibitor
- The relationship between the level of education and accuracy of insulin injection techniques in DM patients with measurement of HbA1c values
- The effect of premixed insulin to blood glucose concentration in patients with type 2 diabetes mellitus
- Intravenous insulin therapy in diabetes mellitus with hyperglycemic crisis and intercurrent illness
- Adherence behavior assessment of oral antidiabetic medication use: a study of patient decisions in long-term disease management in primary health care centers in Surabaya
- Evaluation to the chemotherapy use in patients with diffuse large B-cell lymphoma
- Analysis of the use and cost of stress ulcer prophylaxis for surgical inpatients
- Antineuroinflammation activity of n-butanol fraction of Marsilea crenata Presl. in microglia HMC3 cell line
- The enhancement of Arg1 and activated ERβ expression in microglia HMC3 by induction of 96% ethanol extract of Marsilea crenata Presl. leaves
- Ternary solid dispersion to improve solubility and dissolution of meloxicam
- Improving solubility and dissolution of meloxicam by solid dispersion using hydroxypropyl methylcellulose 2910 3 cps and nicotinamide
- o-Hydroxycinnamic derivatives as prospective anti-platelet candidates: in silico pharmacokinetic screening and evaluation of their binding sites on COX-1 and P2Y12 receptors
- The change of proinflammatory cytokine tumor necrosis factor α level in the use of meloxicam in rat model of osteoarthritis
- Attenuation of IL-1ß on the use of glucosamine as an adjuvant in meloxicam treatment in rat models with osteoarthritis
- Analysis of effectiveness and drug related problems of pain reliever for knee osteoarthritis: weighing clinical risk and benefit
- Comparison of antibiotic prescriptions in adults and children with upper respiratory tract infections in Bangka Tengah primary health care centers
- Profile of sociodemographics, sources of infection, antiretrovirals and CD4 counts on HIV/AIDS outpatients in Turen Primary Health Centre, Indonesia
- Synergistic anti-hepatitis C virus activity of Ruta angustifolia extract with NS3 protein inhibitor
- In vitro equivalence of generic and branded amoxicillin tablet by microbiological assay method
- Knowledge and attitude: two fundamental factors that determine patient compliance in antibiotic therapy
- Molecular docking study of sappan wood extract to inhibit PBP2A enzyme on methicillin-resistant Staphylococcus aureus (MRSA)
- Effect of curcumin analogue synthetic product from cullilawan oil for the liver damage treatment in male mice (Mus musculus L.)
- Case Report
- A case report of generalized tetanus in a 42-year-old man with dental infection
