Patient Compliance: Challenges in Management of Cardiac Diseases in Kuala Lumpur and Perak, Malaysia
Corresponding Author(s) : Nagarajan Srinivasan
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 2 No. 2 (2014): 2014 Volume 2- Issue -2
Abstract
Background
The objective of this study was to investigate the degree of compliance among cardiac patients who attend the health facilities in Kuala Lumpur and Perak, Malaysia. The reasons for non-compliance and recommendations from healthcare professionals were also evaluated.
Method
A cross-sectional study of 400 patients and 100 healthcare professionals was carried out. This study utilizes variables on external factors and internal factors as the measurement tools. The questionnaire which consists of Morisky self-reported medication adherence questions was administered to patients and causes for non-compliance sought. Questionnaire for healthcare professionals was used to determine strategies that can improve compliance rate.
Results
The study revealed a 15.8% of high adherence rate, 54.3% of moderate adherence rate and 30% of poor adherence to cardiovascular disease medications. The chi-square tests showed the strong association between dependent and independent variables. The model chosen for testing the patient compliance through external and internal factors gives an R2 value of 85.0% with an adjusted R2 of 84.7%. The F value (317.187) was also significant (p=0.000) which means that the variables have better fit in the multivariate model. The major reasons determined for non-adherence were attitudes and beliefs, lifestyle, side effects and cost of medications. The study recommends that pharmacists and dispensing technicians should be adequately qualified to provide proper counselling to cardiac patients on their medicines and disease conditions.
Conclusion
The result of this study is of value to health care providers. Compliance to cardiovascular medications will avoid treatment failures encountered in therapy.
Keywords
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- Bridget B. Kelly, Fuster, Valentin . Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. National Academies Press 2010; 100: 49-60.
- Murphy, J., Coster, G. Issues in Patient Compliance. Drugs 1997; 54(6): 797-800.
- Wroe AL. Intentional and unintentional noncompliance: a study of decision making.J Behav Med 20022; 25(4):355-72.
- McGuigian, Ka., Sokol, M., Yao, J., Haynes, J., Qian, Q., and Boscarino, J. The value of compliance: evidence from two patient cohorts.Value in Health 2000; 4(2): 55.
- Girerd, X., Hanon, O,. Anagnostopoulos, K., Ciupek, C., Mourad, JJ., and Consoli, S. Assessment of antihypertensive compliance using a self-administered questionnaire: development and use in a hypertension clinic. Pressed Medicine 2001; 30(21) : 1044-1048.
- Plange-Rhule J., Phillips R., Acheampong J.W. Hypertension in renal failure in Ghana1. J Hum Hypert 1999; 3: 37 – 40.
- Roth HP, Caron HS Accuracy of doctor’s estimates and patients’ statements on adherence to a drug regimen. ClinPharmacolTher 1978, 52: 361 – 370.
- World Health Statistics 2012, Annual Report 2012, World Health Organization, Switzerland.
- Munoz, Eric; Rosner, Fred; Friedman, Richard; Sterman, Harris; Goldstein, Jonathan; Wise, Leslie. Financial risk, hospital cost, and complications and comorbidities in medical non-complications and comorbidity-stratified diagnosis-related groups. The American Journal of Medicine 1988, 84 (5): 933–9.
- Institute of Public Health (IPH). The third National Health and Morbidity Survey 2006, Malaysia.
- Kyngas, HA & Lahdenpera, TN. Compliance of patients with hypertension and associated factors. Journal of Advanced Nursing 1999, 29 (4): 832-839.
- Buck D, Jacoby A, Baker GA, et al. Factors influencing compliance with antiepileptic drug regimes. Seizure. 1997;6:87–93.
- Sherbourne CD, Hays RD, Ordway L, DiMatteo MR, Kravtiz RL: Antecendents of adherence to medical recommendations: results from the Medical Outcomes Study. J Behav Med 15:447 -468, 1992.
- Christensen DB. Drug-taking compliance: a review and synthesis. Health Serv Res. 1978;13:171–87.
- Quick JD, Rankin JR, Laing RO, O'Connor RW, Hogerzeil HV, et al., editors. (1997) Managing drug supply. 2nd Ed. West Hartford (Connecticut): Kumarian Press. pp. 7–9.
- Lancaster GA et al,. J Eval Clin Pract 2004: 10; 307-12
- Krejcie, R. V., & Morgan, D. W. Determining sample size for research sctivities. Educational and Psychological Measurement 1970,30 : 607-610.
- Babbie, E. The practice of social research. In E. Babbie. Belmont California: Thomson Wadsworth 2007.
- Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self- reported measure of medication adherence.Med Car 1986, 24: 67 – 74.
- Sekaran U. Research Methods for Business: A skill building approach 2003.
- Burns, N & Grove, SK. The practice of nursing research: conduct, critique & utilisation; 5th edition, 2005.
- Connelly CE. Compliance with outpatient lithium therapy. Perspect Psychiatr Care. 1984;22:44–50.
- Chizzola PR, Mansur AJ, da Luz PL, et al. Compliance with pharmacological treatment in outpatients from a Brazilian cardiology referral center. Sao Paulo Med J. 1996;114:1259–64.
- Okuno J, Yanagi H, Tomura S. Is cognitive impairment a risk factor for poor compliance among Japanese elderly in the community? Eur J Clin Pharmacol. 2001;57:589–94.
- Gascon JJ, Sanchez-Ortuno M, Llor B, et al. Treatment Compliance in Hypertension Study Group. Why hypertensive patients do not comply with the treatment: results from a qualitative study. Fam Pract. 2004;21:125–30.
References
Bridget B. Kelly, Fuster, Valentin . Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. National Academies Press 2010; 100: 49-60.
Murphy, J., Coster, G. Issues in Patient Compliance. Drugs 1997; 54(6): 797-800.
Wroe AL. Intentional and unintentional noncompliance: a study of decision making.J Behav Med 20022; 25(4):355-72.
McGuigian, Ka., Sokol, M., Yao, J., Haynes, J., Qian, Q., and Boscarino, J. The value of compliance: evidence from two patient cohorts.Value in Health 2000; 4(2): 55.
Girerd, X., Hanon, O,. Anagnostopoulos, K., Ciupek, C., Mourad, JJ., and Consoli, S. Assessment of antihypertensive compliance using a self-administered questionnaire: development and use in a hypertension clinic. Pressed Medicine 2001; 30(21) : 1044-1048.
Plange-Rhule J., Phillips R., Acheampong J.W. Hypertension in renal failure in Ghana1. J Hum Hypert 1999; 3: 37 – 40.
Roth HP, Caron HS Accuracy of doctor’s estimates and patients’ statements on adherence to a drug regimen. ClinPharmacolTher 1978, 52: 361 – 370.
World Health Statistics 2012, Annual Report 2012, World Health Organization, Switzerland.
Munoz, Eric; Rosner, Fred; Friedman, Richard; Sterman, Harris; Goldstein, Jonathan; Wise, Leslie. Financial risk, hospital cost, and complications and comorbidities in medical non-complications and comorbidity-stratified diagnosis-related groups. The American Journal of Medicine 1988, 84 (5): 933–9.
Institute of Public Health (IPH). The third National Health and Morbidity Survey 2006, Malaysia.
Kyngas, HA & Lahdenpera, TN. Compliance of patients with hypertension and associated factors. Journal of Advanced Nursing 1999, 29 (4): 832-839.
Buck D, Jacoby A, Baker GA, et al. Factors influencing compliance with antiepileptic drug regimes. Seizure. 1997;6:87–93.
Sherbourne CD, Hays RD, Ordway L, DiMatteo MR, Kravtiz RL: Antecendents of adherence to medical recommendations: results from the Medical Outcomes Study. J Behav Med 15:447 -468, 1992.
Christensen DB. Drug-taking compliance: a review and synthesis. Health Serv Res. 1978;13:171–87.
Quick JD, Rankin JR, Laing RO, O'Connor RW, Hogerzeil HV, et al., editors. (1997) Managing drug supply. 2nd Ed. West Hartford (Connecticut): Kumarian Press. pp. 7–9.
Lancaster GA et al,. J Eval Clin Pract 2004: 10; 307-12
Krejcie, R. V., & Morgan, D. W. Determining sample size for research sctivities. Educational and Psychological Measurement 1970,30 : 607-610.
Babbie, E. The practice of social research. In E. Babbie. Belmont California: Thomson Wadsworth 2007.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self- reported measure of medication adherence.Med Car 1986, 24: 67 – 74.
Sekaran U. Research Methods for Business: A skill building approach 2003.
Burns, N & Grove, SK. The practice of nursing research: conduct, critique & utilisation; 5th edition, 2005.
Connelly CE. Compliance with outpatient lithium therapy. Perspect Psychiatr Care. 1984;22:44–50.
Chizzola PR, Mansur AJ, da Luz PL, et al. Compliance with pharmacological treatment in outpatients from a Brazilian cardiology referral center. Sao Paulo Med J. 1996;114:1259–64.
Okuno J, Yanagi H, Tomura S. Is cognitive impairment a risk factor for poor compliance among Japanese elderly in the community? Eur J Clin Pharmacol. 2001;57:589–94.
Gascon JJ, Sanchez-Ortuno M, Llor B, et al. Treatment Compliance in Hypertension Study Group. Why hypertensive patients do not comply with the treatment: results from a qualitative study. Fam Pract. 2004;21:125–30.