Medication adherence and persistence in type 2 diabetes mellitus: perspectives of patients, physicians and pharmacists on the Spanish health care system
Authors Labrador Barba E, Rodríguez de Miguel M, Hernández-Mijares A, Alonso-Moreno FJ, Orera Peña ML, Aceituno S, Faus Dader MJ
Received 17 September 2016
Accepted for publication 25 January 2017
Published 4 April 2017 Volume 2017:11 Pages 707—718
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Johnny Chen
Elena Labrador Barba,1 Marta Rodríguez de Miguel,1 Antonio Hernández-Mijares,2,3 Francisco Javier Alonso-Moreno,4 Maria Luisa Orera Peña,1 Susana Aceituno,5 María José Faus Dader6
1Department of Medicine, Mylan, Madrid, 2Department of Endocrinology and Nutrition, Doctor Peset University Hospital, Valencia, 3Department of Medicine, University of Valencia, Valencia, 4Department for Primary Health Care, Centro de Salud Sillería, Toledo, 5Outcomes’10, Castellon, 6Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, University of Granada, Granada, Spain
Objective: A good relationship between diabetes patients and their health care team is crucial to ensure patients’ medication adherence and self-management. To this end, we aimed to identify and compare the views of type 2 diabetes mellitus (T2DM) patients, physicians and pharmacists concerning the factors and strategies that may be associated with, or could improve, medication adherence and persistence.
Methods: An observational, cross-sectional study was conducted using an electronic self-administered questionnaire comprising 11 questions (5-point Likert scale) concerning factors and strategies related to medication adherence. The survey was designed for T2DM patients and Spanish National Health System professionals.
Results: A total of 963 T2DM patients, 998 physicians and 419 pharmacists participated in the study. Overall, a lower proportion of pharmacists considered the proposed factors associated with medication adherence important as compared to patients and physicians. It should be noted that a higher percentage of physicians in comparison to pharmacists perceived that “complexity of medication” (97% vs 76.6%, respectively) and “adverse events” (97.5% vs 72.2%, respectively) were important medication-related factors affecting adherence. In addition, both patients (80.8%) and physicians (80.8%) agreed on the importance of “cost and co-payment” for adherence, whereas only 48.6% of pharmacists considered this factor important. It is also noteworthy that nearly half of patients (43%) agreed that “to adjust medication to activities of daily living” was the best strategy to reduce therapeutic complexity, whereas physicians believed that “reducing the frequency of administration” (47.9%) followed by “reducing the number of tablets” (28.5%) was the most effective strategy to improve patients’ adherence.
Conclusion: Our results highlight the need for pharmacists to build a stronger relationship with physicians in order to improve patients monitoring and adherence rates. Additionally, these findings may help to incorporate greater patient-centeredness when developing management strategies, focusing on adjusting medication regimens to patients’ daily lives.
Keywords: type 2 diabetes mellitus, adherence, persistence, factors, strategies
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