Interventional Study on Adherence to Pharmacotherapy and Drug Pattern in Elderly Patients at Civil Hospital of Badin, Pakistan
Keywords:
elderly, polypharmacy, pharmacotherapy, adherence
Abstract
Background: To assess the contributing factors to adherence of pharmacotherapy and
perception of elderly patients.
Methods: This prospective cross-sectional study was conducted in the outpatient clinic
of Civil Hospital Badin, Pakistan from January to June 2019. A total of 300 samples
were selected to analyze the results. A self-designed proforma (prescribing indicator
form) was used for collecting data including patient demographics, diagnosis, and the
current medications prescribed for each patient.
Results: Of the 300 selected participants, 221(73.7%) were male, while 79 (26.3%) were
female. Majority of the subjects in the age group of 60–69 (52%) and 70–79 years
(27%) followed by those aged >79 (21%). Antibiotics were prescribed to 17.2% and
vitamins to 14.7%. Patients’ responses related to nonadherence factor were 92.7% for
the cost, 32.7% for the long treatment duration, and 24% for the lack of knowledge. Out
of the total patients, 28% were forgetful, 26.7% complained about complex therapy,
26.3% blamed financial problems, 19.7% patients had side effects, and 14.3% were
negligent in taking the medication.
Conclusion: Patient conformity can be enhanced by dropping polypharmacy and
simplifying complex management, use of extended formulations, rate of medications,
and by creating awareness among elderly patients.
References
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us. Diabetes Spectrum, vol. 22, no. 2, pp. 80–84.
[2] Saleem, F., Hassali, M., Shafie, A., et al. (2012). Drug attitude and adherence: a
qualitative insight of patients with hypertension. Journal of Young Pharmacists, vol.
4, no. 2, pp. 101–107.
[3] Ramanath, K. V., Balaji, D. B. S. S., Nagakishore, C. H., et al. (2012). A study on impact
of clinical pharmacist interventions on medication adherence and quality of life in
rural hypertensive patients. Journal of Young Pharmacists, vol. 4, no. 2, pp. 95–100.
[4] Schumaker, S. A. and Naughton, M. J. (1995). The international assessment of healthrelated
quality of life: a theorical perspective. In: S. A. Schumaker and R. A. Berzon
(Eds.), Quality of Life: Theory, Translation, Measurement and Analysis (pp. 3–10).
Oxford: Rapid Communications.
[5] Zamora-SaÂnchez, J. J., PeÂrez-Tortajada, G., Mendoza-GarcõÂa de Paredes, M. D.,
et al. (2012). Quality of life perceived by complex patients in a case management
program in primary health care. Enfermería Clínica, vol. 22, no. 5, pp. 239–246.
[6] BadõÂa, X., Salamero, M., Alonso, J., et al. (Eds.). (1999). Health measure. In
Measurement Scales Guide in Spanish (2nd ed.). Barcelona: Edimac.
[7] Tudela, L. L. (2009). Health-related quality of life. Aten Primaria, vol. 41, no. 7, pp.
411–416.
[8] World Health Organization. (2013). Adherence to Long-term Therapies: Evidence for
Action. WHO.
[9] Horne, R. and Weinman, J. (1999). Patients’ beliefs about prescribed medicines
and their role in adherence to treatment in chronic physical illness. Journal of
Psychosomatic Research, vol. 47, no. 6, pp. 555–567.
[10] Ferrer, A., Formiga, F., Almeda, J., et al. (2010). Health-related quality of life in
nonagenarians: gender, functional status and nutritional risk as associated factors.
Medicina Clínica, vol. 134, no. 7, pp. 303–306.
[11] De Rivas, B., Permanyer-Miralda, G., Brotons, C., et al. (2008). Health related quality
of life in unselected outpatients with heart failure across Spain in two different health
care levels. Magnitude and determinants of impairment: the INCA study. Quality of
Life Research, vol. 17, no. 10, pp. 1229–1238.
[12] Schuz, B., Marx, C., Wurm, S., et al. (2011). Medication beliefs predict medication
adherence in older adults with multiple illnesses. Journal of Psychosomatic
Research, vol. 70, no. 2, pp. 179–187.
[13] Sirey, J. A., Weinberger, M. I., Greenfield, A., et al. (2013). Medication beliefs and selfreported
adherence among community-dwelling older adults. Clinical Therapeutics,
vol. 35, no. 2, pp. 153–160.
[14] Rajpura, J. R. and Nayak, R. (2014). Role of illness perceptions and medication beliefs
on medication compliance of elderly hypertensive cohorts. Journal of Pharmacy
Practice, vol. 27, no. 1, pp. 19–24.
[15] Krauskopf, K., Federman, A. D., Kale, M. S., et al. (2015). Chronic obstructive
pulmonary disease illness and medication beliefs are associated with medication
adherence. COPD: Journal of Chronic Obstructive Pulmonary Disease, vol. 12, no.
2, pp. 151–164.
[16] Kalichman, S. C., Eaton, L., Kalichman, M. O., et al. (2016). Race-based medical
mistrust, medication beliefs and HIV treatment adherence: test of a mediation model
in people living with HIV/AIDS. Journal of Behavioral Medicine, vol. 39, no. 6, pp.
1056–1064.
[17] Rajpura, J. and Nayak, R. (2014). Medication adherence in a sample of elderly
suffering from hypertension: evaluating the influence of illness perceptions,
treatment beliefs, and illness burden. Journal of Managed Care Pharmacy, vol. 20,
no. 1, pp. 58–65.
[18] Azpiazu, M., Cruz, A., Villagrasa, J. R., et al. (2003). Quality of life in no institutionalized
persons older than 65 years in two health care districts in Madrid. Atención Primaria,
vol. 31, no. 5, pp. 285–294.
[19] Van der Weele, G. M., Gussekloo, J., De Waal, M. W., et al. (2008). Co-occurrence
of depression and anxiety in elderly subjects aged 90 years and its relationship
with functional status, quality of life and mortality. International Journal of Geriatric
Psychiatry, vol. 24, no. 6, p. 595–601.
[20] Tjia, J., Givens, J. L., Karlawish, J. H., et al. (2008). Beneath the surface: discovering
the unvoiced concerns of older adults with type 2 diabetes mellitus. Health Education
Research, vol. 23, no. 1, pp. 40–52.
[21] Vermeire, E., Hearnshaw, H., Van Royen, P., et al. (2001). Patient adherence to
treatment: three decades of research. A comprehensive review. Journal of Clinical
Pharmacy and Therapeutics, vol. 26, pp. 331–342.
[22] Lam, W. Y. and Fresco, P. (2015). Medication adherence measures: an
overview. BioMed Research International, vol. 2015, p. 217047.
[23] Brown, M. T. and Bussell, J. K. (2011). Medication adherence: WHO cares? Mayo
Clinic Proceedings, vol. 86, no. 4, pp. 304–314.
[24] Johnson, M. J., Williams, M., and Marshall, E. S. (1999). Adherent and nonadherent
medication-taking in elderly hypertensive patients. Clinical Nursing Research, vol.
8, no. 4, pp. 318–335.
[25] Nikolaus, T., Kruse, W., Bach, M., et al. (1996). Elderly patients’ problems with
medication. European Journal of Clinical Pharmacology, vol. 49, no. 4, pp. 255–
259.
[26] Navaratnam, P., Jayawant, S. S., Pedersen, C. A., et al. (2008). Asthma
pharmacotherapy prescribing in the ambulatory population of the United States:
evidence of nonadherence to national guidelines and implications for elderly
people. Journal of the American Geriatrics Society, vol. 56, no. 7, pp. 1312–1317.
[27] Roy, N. T., Sajith, M., and Bansode, M. P. (2017). Assessment of Factors Associated
with Low Adherence to Pharmacotherapy in Elderly Patients. Journal of Young
Pharmacists, vol. 9, no. 2, pp. 272–276.
[28] Fernandez-Arias, M., Acuna-Villaorduna, A., Miranda, J. J., et al. (2014). Adherence
to pharmacotherapy and medication-related beliefs in patients with hypertension in
Lima, Peru. PloS ONE, vol. 9, no. 12, p. e112875.
[29] Payne, K. A. and Esmonde-White, S. (2000). Observational studies of antihypertensive
medication use and compliance: is drug choice a factor in treatment
adherence? Current Hypertension Reports, vol. 2, no. 6, pp. 515–524.
