Evaluation of medication adherence in Lebanese hypertensive patients.

Controlling hypertension is essential in cardiovascular diseases. Poor medication adherence is associated with poor disease outcomes, waste of healthcare resources, and contributes to reduced blood pressure control. This study evaluates treatment adherence to antihypertensive therapy in Lebanese hypertensive patients by estimating the proportion of adherent hypertensive patients using a validated tool and investigates what factors predict this behavior. A questionnaire-based cross-sectional study was conducted on a random sample of 210 hypertensive outpatients selected from clinics located in tertiary-care hospitals and from private cardiology clinics located in Beirut. Adherence level was measured using a validated 8-item Modified Morisky Medication Adherence Scale (MMMAS). Among 210 patients, 50.5% showed high adherence, 27.1% medium adherence, and 22.4% low adherence to medication. Mean MMMAS score was 6.59±2.0. In bivariate analyses, having controlled blood pressure (p=0.003) and taking a combination drug (p=0.023) were predictors of high adherence. Forgetfulness (p<0.01), complicated drug regimen (p=0.001), and side effects (p=0.006) were predictors of low adherence after multiple liner regression. Logistic regression results showed that calcium channel blockers (p=0.030) were associated with increased adherence levels. In conclusion, developing multidisciplinary intervention programs to address the factors identified, in addition to educational strategies targeting healthcare providers, are necessary to enhance patient adherence.

Factors affecting medication adherence in Lebanese patients with chronic diseases / Factores que afectan a la adherencia a la medicación en pacientes libaneses con enfermedades crónicas

Background: Non-adherence to prescribed medications represents an obstacle toward achieving treatment goals. This problem is more pronounced in patients with chronic illness. Objective: To identify the extent of adherence in Lebanese outpatients with chronic diseases, and to suggest possible predictors of non-adherence in this population. The secondary objective was to assess if medication adherence affects patients' quality of life. Methods: A questionnaire was administered face-to-face to a sample of Lebanese adults visiting the external clinics at two Tertiary Care Hospitals in Beirut. The level of adherence was assessed using the 8-item Morisky Medication Adherence Scale which was first validated. The health-related quality of life (HRQoL) of patients was measured using the EQ-5D. Linear regression and logistic regression analyses examined possible predictors of adherence. Results: Out of the 148 patients included in this study, 42.6% were classified as adherent. In the univariate analyses, statistically significant predictors of high adherence included good physician-patient relationship (p=0.029) and counseling (p=0.037), a high level of HRQoL (p<0.001), and a high level of perceived health (p<0.001). Predictors of low adherence included a declining memory (p<0.001), anxiety/depression (p=0.002), little drug knowledge (p<0.001), and postponing physician appointments (p<0.001). The multivariate analyses revealed similar results. In the linear regression, the most powerful predictor of non-adherence was the disbelief that the drug is ameliorating the disease (beta=0.279), however, in logistic regression, patient who were willing to skip or double doses in case of amelioration/deterioration were found to be 7.35 times more likely to be non-adherent than those who were not (aOR=0.136, 95%CI: 0.037-0.503). Conclusion: The findings of this study reassure the view that patients should be regarded as active decision makers. Patient education should be regarded as a cornerstone for treatment success. Additional studies as well are needed to test the practicability and effectiveness of interventions suggested to enhance adherence (AU)

Antecedentes: La no adherencia a la medicación prescrita representa un obstáculo hacia la consecución de los objetivos terapéuticos. Este problema es más grave en pacientes con enfermedades crónicas. Objetivo: Identificar la proporción de adherencia en los pacientes ambulatorios libaneses con enfermedades crónicas y sugerir posibles predictores de adherencia en esta población. El objetivo secundario fue evaluar si la adherencia a la medicación afecta a la calidad de vida de los pacientes. Métodos: Se administró presencialmente un cuestionario a una muestra de adultos libaneses que visitan las consultas ambulatorias de dos hospitales terciarios de Beirut. El nivel de adherencia se midió usando la Morisky Medication Adherence Scale de 8 ítems, que fue primeramente validada. La calidad de vida relacionada con la salud (HRQoL) de los pacientes se midió usando el EQ-5D. Análisis de regresión lineal y regresión logística examinaron los posibles predictores de adherencia. Resultados: De los 148 pacientes incluidos en este estudio, el 42,6% fueron clasificados como adherentes. En el análisis univariado, entre los predictores estadísticamente significativos se incluían la buena relación paciente-médico (p=0,029) y el asesoramiento (p=0,037), un elevado nivel de HRQoL (p<0,001), y un elevado nivel de salud percibida (p<0,001). Los predictores de baja adherencia incluían el descenso de la memoria (p=0,002), bajo conocimiento de los medicamentos (p<0,001), y posponer las citas con el médico (p<0,001). El análisis multivariado reveló resultados similares. En la regresión lineal, el predictor más potente de no adherencia fue la falta de confianza en que el medicamento mejoraba la enfermedad (beta=0,279), sin embargo en la regresión logística, los pacientes que estaban dispuestos a doblar o saltarse la dosis en caso de mejora/empeoramiento aparecieron con 7,35 veces más probabilidad de ser no adherentes que los otros (ORa=0,136, 95%CI: 0,037-0,503). Conclusión: Los hallazgos de este estudio refuerzan el hecho de que los pacientes deben ser considerados como decisores activos. La educación de los pacientes debería ser considerada como un elemento clave del éxito del tratamiento. Deben realizarse estudios para probar la efectividad y práctica de las intervenciones propuestas para mejorar la adherencia (AU)