Medication adherence practices among patients attending the primary health care medical consultant clinics in Malta

Abstract

This study aimed to explore factors of adherence/non-adherence among patients attending the medical consultant follow-up clinic within five health centres in Malta These health centres were B'Kara, Gzira, Paola, Rabat and Mosta This was a quantitative cross-sectional study and regarded both current and past practices regarding treatment adherence to medication. The research objective aimed to assess: a) Prevalence of medication adherence within the said population b) Barriers to adherence practices c) If socio-demographic and socioeconomic factors within the chosen population affect medication adherence. d) If polypharmacy can affect medication adherence. e) If attendance to the medical clinics affects adherence to prescription medication. As the population chosen for the study is being followed-up at the medical consultant clinic [MCC], the research aimed to see if patients who attend for follow-up are more likely to adhere to their medications. For study eligibility patients had to be over 40 years of age, in possession of a Schedule V card as they had to be suffering from a chronic disease, and attending for MCC follow-up in one of the said clinics at the time the data collection took place.

Structured interviews were carried out using the ©MMAS-8 questionnaire. A sample size of 480 patients was needed to achieve a 95% confidence level and a 5% confidence interval. A response rate of 85% was achieved after 401 questionnaires were collected by the researcher using face to face interviews with the patients involved in the study. Of the respondents 159 (39.65%) were male and 242 (60.53%) were female. Age distribution ranged from 40 to 80+years, the most prevalent age group in the cohort of patients was in the 60-69 age groups. Statistical analysis was carried out using STATA-software and Microsoft excel. Where population numbers were >5 the Pearson chi squared test was used. The Fishers' exact test was used to analyse the categorical variables in tables that had numbers <5. Spearman correlation coefficient, a measure of association between two variables was used to calculate if there is an association between number of tablets taken by respondents and adherence to medication. A p-value of less than 0.05 was considered as being statistically significant. Results of the study revealed an overall medium medication adherence level of 6.5. As predicted in the literature effects of non-adherence were gender, socioeconomic factors, smoking and polypharmacy especially in the older age group. A borderline p-value was achieved for age and patients who self-manage their medications. From the data collected educational level, marital status and living situation did not show any association to adherence levels.

Future research would need to be more specific to involve other populations, as this study involved a specific population within a specified environment. Research should also include other disease and conditions to be able to assess if medication non-adherence exists within other areas and disease conditions.