|Year : 2017 | Volume
| Issue : 1 | Page : 63-68
Medication knowledge as a determinant of medication adherence in geriatric patients, Serse Elian City, Menoufia Governorate, Egypt
Aml A Salama MD 1, Abd El-Rahman A Yasin2, Walaa Elbarbary3
1 Family Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Clinical Pharmacology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department Family Medicine, Faculty of Medicine, Menoufia University, Egypt
|Date of Submission||23-Jan-2016|
|Date of Acceptance||10-May-2016|
|Date of Web Publication||25-Jul-2017|
Aml A Salama
Family Medicine Department, Faculty of Medicine, Menoufia University, Shbeen El-koom District, Menoufia Governorate, 32511
Source of Support: None, Conflict of Interest: None
Adherence to therapies is the corner stone of treatment success. Medication nonadherence in geriatric patients leads to substantial worsening of disease, increased healthcare costs, and death. Knowledge about the drug's indication, side effects, and interactions with other drugs may constitute a barrier to drug adherence.
The aim of this study was to assess the effect of medication knowledge as a determinant factor of medication adherence in elderly patients living in their own houses.
Participants and methods
This is a cross-sectional study of a random sample of 438 geriatric patients aged 70–85 years, living in their own homes in Serse Elian City, Menoufia Governorate. Patients' information was collected from the prescriptions in the file of the patient and home visits were carried out to examine their daily drug consumption.
Male geriatric patients were found to be more adherent to their medications than female patients (63.9 vs. 36.1%). Correct knowledge regarding the name of the drug, it's timing, the correct dose, and indications constituted a statistically significant difference among adherent and nonadherent groups, whereas awareness about side effects of the drug did not have a significant effect on medication adherence.
Knowledge about medication in general constituted a significant determinant of medication adherence in elderly patients.
Keywords: adherence, geriatric, knowledge, medications
|How to cite this article:|
Salama AA, Yasin ARA, Elbarbary W. Medication knowledge as a determinant of medication adherence in geriatric patients, Serse Elian City, Menoufia Governorate, Egypt. Menoufia Med J 2017;30:63-8
|How to cite this URL:|
Salama AA, Yasin ARA, Elbarbary W. Medication knowledge as a determinant of medication adherence in geriatric patients, Serse Elian City, Menoufia Governorate, Egypt. Menoufia Med J [serial online] 2017 [cited 2019 Aug 22];30:63-8. Available from: http://www.mmj.eg.net/text.asp?2017/30/1/63/211476
| Introduction|| |
Adherence has been defined as the 'active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behavior to produce a therapeutic result' . This definition implies that the patient has a choice and that both patients and providers mutually establish treatment goals and the medical regimen . Medication adherence usually refers to whether patients take their medications as prescribed (e.g., twice daily) as well as whether they continue to take a prescribed medication . Medication adherence behavior has thus been divided into two main concepts, namely, adherence and persistence. Although conceptually similar, adherence refers to the intensity of drug use during the duration of therapy, whereas persistence refers to the overall duration of drug therapy .
Rates of adherence for individual patients are usually reported as the percentage of the prescribed doses of the medication actually taken by the patient over a specified period. Some investigators have further refined the definition of adherence to include data on dose taking (taking the prescribed number of pills each day) and the timing of doses (taking pills within a prescribed period). Adherence rates are typically higher among patients with acute conditions, as compared with those with chronic conditions; persistence among patients with chronic conditions is disappointingly low, decreasing most drastically after the first 6 months of therapy .
Knowledge about the effects and purpose of medication positively correlated with drug compliance. Pharmacist counseling plays an important role in preventing drug noncompliance and in making home care more effective. Hence, it is important for pharmacists to cooperate with other care workers, including the care manager to provide written information on prescription medicine to caregivers and home helpers as well as to elderly patients .
Measures to facilitate patient medication adherence should be considered as an integral part of the comprehensive care of older patients with multiple diseases. Performance-based assessments might be useful for screening medication adherence, in addition to a careful drug history, inspection of all medicines used (including over-the-counter drugs), and proxy information .
| Participants and Methods|| |
The present study was a cross-sectional one of a random sample that was taken from health records of the patients. Every third elderly persons (438 geriatric) was included in the study (aged 70–85 years) during their monthly follow-up visits for chronic diseases such as diabetes, hypertension, etc., in the primary healthcare center. These patients were living in their own homes in Serse Elian City of Menoufia Governorate. Exclusion criteria included patients with an active psychotic illness that makes them unable to give informed consent and interferes with their own, judgment. Human rights and ethical considerations were followed during the study with total confidentiality of any obtained data. The Menoufia Faculty of Medicine committee for medical ethics of research formally approved the study before it began. A written consent form was obtained from all participants after explaining the aim of the study. The study was conducted during the period of 6 months from the beginning of April to the end of September 2014.
Information on the intake of all drugs was collected from patients' family records in the selected family health center (the only primary healthcare in the Serse Elian City). Detailed information was collected from the prescription in the file of the patients before visiting them at home. The participants were followed at their homes and examined for their daily drug consumption. Their drug storage was examined. Data from patients, including age, sex, education, occupation, and their socioeconomic level according to El-Gilany et al.  were assessed and calculated as low, middle, and high. The participants were asked about dose, the real frequency of use, and the time of intake. The risk of inappropriate prescribed drug use was assessed through reporting the medication used by older patients and comparing it with doctors' perceived medication regimens for their patients.
The method of calculating adherence scores : For each participant, adherence scores were calculated on the basis of observations of the participants' actual use of drugs and information given by the prescription of the family physician. The drug score was based on the ratio of the number of prescribed drugs used by the participants to the number of drugs prescribed by the family physician. Drugs prescribed by doctors other than the patient's family physician were also included. Ratios below 0.8 were scored as deviating, and above 0.8 as not deviating. Two scores were calculated: the dose score was based on daily doses that agreed with the' physicians information; the regimen score was based on the adherence to the regimen prescribed for a particular drug (once daily, twice daily, etc.). Study participants were divided into two groups, adherent and nonadherent (score below 0.8), to study the possible determinants of adherence to medication in geriatrics.
Knowledge about medications received was assessed through a predesigned questionnaire filled by the researcher after explaining each question to the patient in an easy language to assess the awareness of geriatric patients about their received medication. Validation of the questionnaire was performed by conducting a pilot study using a structured interview to test the reliability of the questions (the pilot study was done by interviewing 20 elderly patients according to inclusion and exclusion criteria from the same area of the research. the pilot sample was excluded from the study sample), and modifications to questions were applied according to the feedback of the participants. They were asked whether they knew the name, indication, prescribed dose, and side effects of each medication that they received. Each correct answer for all prescribed drugs was given a score of 3 according to scientific data for each prescribed drug, a wrong answer was given a score of 0, and each 'I don't know' answer was given a score of 1. A total score of at least 60% was considered good, a score between 30 and 60% was considered fair, and a score of 30% or less was considered poor.
The data were coded, tabulated, and analyzed by Statistical Package of Social Science program (SPSS) version 20 using a personal computer (SPSS Inc., Chicago, Il, USA). Quantitative data were expressed as mean and SD (X ± SD) and analyzed by the Student t-test for comparison of two groups of normally distributed variables. Qualitative data were expressed as the number and percentage and analyzed by the χ2-test. The level of significance was set at P value less than 0.05.
| Results|| |
The sample size consisted of 438 geriatric patients who lived alone in their houses. According to their adherence to their medications, they were divided into two groups: adherent (73.2%) and nonadherent groups (26.8%) [Figure 1]. The mean age of patients was lower in the adherent group (73.33 ± 3.35) than in the nonadherent group (74.55 ± 3.71). This was statistically significant. Male patients constituted a higher percentage of the adherent group than female patients (64% were male vs. 36% female). The sex constituted a statistically significant determinant of adherence. Education and socioeconomic standard showed a nonstatistically significant difference in terms of adherence of geriatric patients to medications. Retired employees constituted approximately half of the adherent group, whereas patients with nonspecified work in the past constituted ~47.9% of the nonadherent group. This difference constituted a statistically significant difference (P < 0.01) [Table 1].
|Figure 1: Prevalence of medication adherence in the studied geriatric patients.|
Click here to view
|Table 1 Demographic data of the studied group as a determinant of drug adherence in geriatric patients|
Click here to view
Regarding the ability of elderly patients to recall the name of their prescribed medications, ~69.5% of the adherent group named the drugs correctly compared with 41.9% of the nonadherent group. This difference was statistically significant between the two groups (P < 0.01). Awareness of indication, timing, dose, and duration of the prescribed medication showed a statistically significant difference between both groups (P < 0.01) [Table 2].
|Table 2 Knowledge about medication as a determinant of adherence of geriatric patients to their medications|
Click here to view
Medication parameters such as the price of the drugs, the number of prescribed drugs, and the presence of health insurance constituted statistically significant determinants for adherence to medications in the studied elderly patients (P < 0.01) [Table 3].
|Table 3 Medication parameters as determinants of adherence of geriatric patients to their medications|
Click here to view
Patient satisfaction regarding their medication was higher in the adherent group [Figure 2].
|Figure 2: Effect of patient satisfaction with their medications on their medication adherence score.|
Click here to view
| Discussion|| |
Medication nonadherence lowers treatment effectiveness, and is thus a very important problem in the management of patients with chronic diseases requiring long-term treatments. For calculating adherence scores for each participant based on observations of the participants' actual use of drugs and information given by the prescription of the family physician, the study group was classified as adherent and nonadherent (73 and 27%), respectively, regarding their prescribed medication. Another study  reported a higher rate (81%) of medication adherence to their medications. To detect the factors affecting adherence to their medication, the study compared the two groups (adherent and nonadherent group). Regarding sociodemographic data, the sex of the patient and previous occupations constituted a statistically significant difference between the adherent and nonadherent groups, whereas education and socioeconomic standard constituted a nonsignificant difference. Female patients were found by some researchers to have better compliance , whereas other studies suggested otherwise .
Another study  reported that adherence was significantly high in the group with a low financial level. A study  reported that inadequate patient education influenced medication compliance in older patients. A study  reported that medication adherence was significantly lower in patients with a moderate rather than lower financial status.
In the current study, a significantly higher percentage of the adherent group could name their drugs correctly and could also mention indication, dosage, timing, and duration of its use. A study  of elderly patients' compliance to medication and their medical knowledge reported that knowledge about the effects and purpose of the medication were positively correlated with drug compliance.
A study  identified modifiable factors such as depression, health literacy, and medication knowledge to be associated with medication nonadherence.
Another study  reported that medication knowledge such as names, purposes, recommended doses, frequencies, and side effects of the medications to be positively correlated with medication adherence.
Regarding medication parameters such as the number of medication, the price of all received drugs, and having health insurance to cover the cost of the prescribed drugs constituted a statistically significant difference among the adherent and nonadherent groups. According to Kim et al. , a cause of low medication adherence among elderly patients was having to take multiple medications. In contrast, another study  reported no association between medication numbers and adherence. A study  reported that in private clinic cases, the adherence to a medication of one drug per day was higher than with more than two drugs in elderly patients. A study  reported that female sex, advanced age, number of chronic diseases, and number of medications taken all significantly increased the likelihood of receiving potentially inappropriate medications such as poor adherence to prescribed drugs in geriatric patients.
In a study conducted in Brazil , nonadherence proved to be lower when the drugs were not available from the public healthcare network.
| Conclusion|| |
In the present study, a statistically significant difference was found between adherent and nonadherent geriatric patients regarding patient factors such as their sex, age, knowledge about medications, and satisfaction towards the management plan. Drug factors such as being less expensive, available through health insurance, and less in number were associated with better adherence. Different strategies should be used to increase medication adherence in geriatric patients to achieve better outcomes in their health status.
Family physicians and other healthcare providers should improve their current educational practices about medications and personal communication skills to increase patients' knowledge about their medications, which in turn enhances adherence to their medication among elderly patients.
Identifying specific barriers for each elderly patient, especially their satisfaction regarding their medications, and adopting suitable techniques to overcome them, especially family members' involvement, will be necessary to improve medication adherence.
The authors thank all patients who accepted to participate in this work.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Delamater AM. Improving patient adherence. Clin Diabetes 2006; 24:71–77.
Caetano PA, Lam JM, Morgan SG. Toward a standard definition and measurement of persistence with drug therapy: examples from research on statin and antihypertensive utilization. Clin Ther 2006; 28:1411–1424.
Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK. Medication compliance and persistence: terminology and definitions. Value Health 2008; 11:44–47.
Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002; 288:462–467.
Okuno J, Yanagi H, Tomura S. Compliance and knowledge about prescribed medication among elderly home-care recipients by method of providing medications. Japan J Geriatr 2001; 38:644–650.
Arlt S, Lindner R, Rösler A, von Renteln-Kruse W. Adherence to medication in patients with dementia: predictors and strategies for improvement. Drugs Aging 2008; 25:1033–1047.
El-Gilany A, El-Wehady A, El-Wasify M. Updating and validation of the socioeconomic status scale for health research in Egypt. EMHJ 2012; 18:962–968.
Barat I, Andreasen F, Damsgaard EMS. Drug therapy in the elderly: what doctors believe and patients actually do. Br J Clin Pharmacol 2001; 51:615–622.
TsaiK-T, Chen J-H, Wen C-J, Kuo H-K, Lu I-S, Chiu L-S, et al.
Medication adherence among geriatric outpatients prescribed multiple medications. Am J Geriatr Pharmacother 2010; 10:61–86.
Dominick KL, Golightly YM, Bosworth HB. Racial differences in analgesic/anti-inflammatory medication adherence among patients with osteoarthritis. Ethn Dis 2005; 15:116–122.
Hertz RP, Unger AN, Lustik MB. Adherence with pharmacotherapy for type 2 diabetes: a retrospective cohort study of adults with employer-sponsored health insurance. Clin Ther 2005; 27:1064–1073.
Park K-A, Kim J-G, Kim B-W, Kam S, Kim K-Y, Ha S-W, Hyun S-T. Factors that affect medication adherence in elderly patients with diabetes mellitus. Korean Diabetes J 2010; 34:
Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther 2001; 26:331–342.
Park KA, Kim JG, Kim BW, Kam S, Kim KY, Ha SW, Hyun ST. Factors that affect medication adherence in elderly patients with diabetes mellitus. Korean Diabetes J 2010; 34:55–65.
Lee SK, Kang BY, Kim HG, Son YJ. Predictors of medication adherence in elderly patients with chronic diseases using support vector machine models. Health Inform Res 2013; 19:33–41.
Burge S, White D, Bajorek E, Bazaldua O, Trevino J, Albright T, Wright F, Cigarroa L. Correlates of medication knowledge and adherence: findings from the residency research network of South Texas. Fam Med 2005; 37:712–718.
Kim MO, Kim JH, Kim JE, Park BR, Lee JW, Park HG, et al.
Degree of compliance with polypharmacy and its influential factors in rural elderly patients with chronic diseases in South Korea. J Korean Acad Fam Med 2008; 29:604–611.
Lin HY, Liao CC, Cheng SH, Wang PC, Hsueh YS. Association of potentially inappropriate medication use with adverse outcomes in ambulatory elderly patients with chronic diseases: experience in a Taiwanese medical setting. Drugs Aging 2008; 25:49–59.
Schmitt AAJr, Lindner S, de Santa Helena ET. Assessment of adherence in elderly patients in primary care. Rev Assoc Med Bras 2013; 59:6.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]