Abstract :
A descriptive quantitative study in Surigao City, Philippines, investigated the factors affecting medication adherence in elderly individuals with chronic illnesses. The study involved 50 geriatric respondents to whom the researcher-made questionnaires adapted from the Morisky Medication Adherence Scale (MMAS-8) were administered. Most respondents exhibited a predominantly very high adherence level to their medication regimen, indicating overall satisfactory adherence. Various demographic factors such as age, gender, education, occupation, marital status, income, and clinical diagnosis did not significantly associate with adherence. Exploratory factor analysis identified four key factors affecting medication adherence namely: effectiveness of the medicine, desire to be treated, physician’s good prescription, and influence of positive observations. The study recommends that healthcare providers should implement a continuous monitoring and evaluation process, facilitating adjustments and refinements based on evolving circumstances among the elderly population. Healthcare systems and policymakers should explore strategies to make medications more affordable and accessible, particularly for those with limited financial resources. Future research should delve deeper into each factor to gain a comprehensive understanding of medication adherence.
Keywords :
Chronic Illnesses, Descriptive Survey, Elderly, Healthcare, Medication Adherence, Philippines., SurigaoReferences :
- Al-Noumani, H., Wu, J. R., Barksdale, D. J., Sherwood, G., Al-Khasawneh, E., & Knafl, G. J. (2019). Health beliefs and medication adherence in patients with hypertension: A systematic review of quantitative studies. Patient Education and Counseling, 102(6), 1045–1056. https://doi.org/10.1016/j.pec.2019.02.022
- Angadi, N. B., Kavi, A., & Ss, T. (2020). Therapeutic Adherence among Elderly with Chronic Diseases Residing in Urban Area of South India – A Descriptive Cross Sectional Study. Biomedical and Pharmacology Journal, 13(4), 2109–2116. https://doi.org/10.13005/bpj/2092
- Asefzadeh, S., Asefzadeh, M., & Javadi, H. (2005). Care management: Adherence to therapies among patients at Bu-Alicina clinic, Qazvin, Iran. Journal of Research in Medical Sciences (JRMS), 10(6): 343-348. https://www.sid.ir/paper/537572/en
- Balkrishnan, R. (1998). Predictors of medication adherence in the elderly. Clinical Therapeutics, 20(4), 764–771. https://doi.org/10.1016/s0149-2918(98)80139-2
- Bandi, P., Goldmann, E., Parikh, N. U., Farsi, P., & Boden‐Albala, B. (2017). Age-Related differences in antihypertensive medication adherence in Hispanics: a Cross-Sectional Community-Based survey in New York City, 2011–2012. Preventing Chronic Disease, 14. https://doi.org/10.5888/pcd14.160512
- Baroletti, S., & Dell’Orfano, H. (2010). Medication adherence in cardiovascular disease. Circulation, 121(12), 1455–1458. https://doi.org/10.1161/circulationaha.109.904003
- Bernell, S., & Howard, S. W. (2016). Use your words carefully: What is a chronic disease? Frontiers in Public Health, 4. https://doi.org/10.3389/fpubh.2016.00159
- Besdine RW. (2016, July 25) Approach to Geriatric Patient Quality of life & Therapeutic Objectives: The Merck Manual of Diagnosis & Therapy. (19th edition)
- Bhuyan, S. S., Shiyanbola, O. O., Deka, P., Isehunwa, O. O., Chandak, A., Huang, S., Wang, Y., Bhatt, J., Lü, N., Lin, W. J., Wyant, D. K., Kedia, S., & Chang, C. F. (2018). The Role of Gender in Cost-Related Medication Nonadherence Among Patients with Diabetes. Journal of the American Board of Family Medicine, 31(5), 743–751. https://doi.org/10.3122/jabfm.2018.05.180039
- Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO cares? Mayo Clinic
- Proceedings, 86(4), 304–314. https://doi.org/10.4065/mcp.2010.0575
- Burnier, M., Polychronopoulou, E., & Wuerzner, G. (2020). Hypertension and drug adherence in the elderly. Frontiers in Cardiovascular Medicine, 7. https://doi.org/10.3389/fcvm.2020.00049
- Bussell, J. K., Cha, E., Grant, Y. E., Schwartz, D. D., & Young, L. A. (2017). Ways health care providers can promote better medication adherence. Clinical Diabetes, 35(3), 171–177. https://doi.org/10.2337/cd016-0029
- Centers for Disease Control (2022). About Chronic Diseases: National Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control and Prevention.https://www.cdc.gov/chronicdisease/about/index.htm
- Chen, S., Lee, W., Liang, T., & Liao, I. (2014). Factors associated with gender differences in medication adherence: a longitudinal study. Journal of Advanced Nursing, 70(9), 2031–2040. https://doi.org/10.1111/jan.12361
- Christensen, K., Doblhammer, G., Rau, R., & Vaupel, J. W. (2009). Ageing populations: the challenges ahead. The Lancet, 374(9696), 1196–1208. https://doi.org/10.1016/s0140-6736(09)61460-4
- DiBonaventura, M., Gabriel, S. A., Dupclay, L., Gupta, S., & Kim, E. (2012). A patient perspective of the impact of medication side effects on adherence: results of a cross-sectional nationwide survey of patients with schizophrenia. BMC Psychiatry, 12(1). https://doi.org/10.1186/1471-244x-12-20
- Doggrell, S. A. (2010). Adherence to medicines in the older-aged with chronic conditions: does intervention by an allied health professional help? Drugs & aging, 27, 239-254.https://doi.org/10.2165/11532870-000000000-00000
- Dolce, J. J., Crisp, C. A., Manzella, B., Richards, J. M., Hardin, J. M., & Bailey, W. C. (1991). Medication adherence patterns in chronic obstructive pulmonary disease. Chest, 99(4), 837–841. https://doi.org/10.1378/chest.99.4.837
- Ederio, N., Inocian, E., Calaca, N., & Espiritu, J.G. (2023). Ethical research practices in educational institutions: A literature review. International Journal of Current Science Research and Review, 06(5), 2709-2724. DOI: https://doi.org/10.47191/ijcsrr/V6-i5-02
- Fabbri, E., An, Y., Zoli, M., Simonsick, E. M., Guralnik, J. M., Bandinelli, S., Boyd, C. M., & Ferrucci, L. (2014). Aging and the burden of multimorbidity: associations with inflammatory and anabolic hormonal biomarkers. The Journals of Gerontology: Series A, 70(1), 63–70. https://doi.org/10.1093/gerona/glu127
- Fatima, T., Malik, S. A., & Shabbir, A. (2018). Hospital healthcare service quality, patient satisfaction and loyalty: An investigation in context of private healthcare systems. International Journal of Quality & Reliability Management, 35(6), 1195-1214.https://doi.org/10.1108/ijqrm-02-2017-0031
- Gast, A., & Mathes, T. (2019). Medication adherence influencing factors—an (updated) overview of systematic reviews. Systematic Reviews, 8(1). https://doi.org/10.1186/s13643-019-1014-8
- Gutierrez, M. M., & Sakulbumrungsil, R. (2021). Factors associated with medication adherence of hypertensive patients in the Philippines: a systematic review. Clinical Hypertension, 27(1). https://doi.org/10.1186/s40885-021-00176-0
- Holt, E., Joyce, C., Dornelles, A., Morisky, D., Webber, L. S., Muntner, P., & Krousel‐Wood, M. (2013). Sex Differences in Barriers to Antihypertensive Medication Adherence: Findings from the Cohort Study of Medication Adherence Among Older Adults. Journal of the American Geriatrics Society, 61(4), 558–564. https://doi.org/10.1111/jgs.12171
- Iuga, A. O., & McGuire, M. (2014). Adherence and health care costs. Risk Management and Healthcare Policy, 35. https://doi.org/10.2147/rmhp.s19801
- Jin, H. J., Kim, Y. H., & Rhie, S. J. (2016). Factors affecting medication adherence in elderly people. Patient Preference and Adherence, 10, 2117–2125. https://doi.org/10.2147/ppa.s118121
- Jimmy, B., & José, J. (2011). Patient medication adherence: measures in daily practice. Oman Medical Journal, 26(3), 155–159. https://doi.org/10.5001/omj.2011.38
- Kaptchuk, T. J., Shaw, J., Kerr, C. E., Conboy, L., Kelley, J. M., Csordas, T. J., Lembo, A., & Jacobson, E. (2009). “Maybe I made up the whole thing”: Placebos and patients’ experiences in a randomized controlled trial. Culture, Medicine and Psychiatry, 33(3), 382–411. https://doi.org/10.1007/s11013-009-9141-7
- Kearney, S. M., Aldridge, A., Castle, N. G., Peterson, J. T., & Pringle, J. (2016). The association of job strain with medication adherence. Journal of Occupational and Environmental Medicine, 58(7), 707–711. https://doi.org/10.1097/jom.0000000000000733
- Kerse, N., Buetow, S., Mainous, A. G., Young, G. S., Coster, G., & Arroll, B. (2004). Physician-Patient relationship and medication Compliance: A primary care investigation. Annals of Family Medicine, 2(5), 455–461. https://doi.org/10.1370/afm.139
- Khera, R., Valero‐Elizondo, J., Das, S. R., Virani, S. S., Kash, B. A., De Lemos, J. A., Krumholz, H. M., & Nasir, K. (2019). Cost-Related medication adherence in adults with atherosclerotic cardiovascular disease in the United States, 2013 to 2017. Circulation, 140(25), 2067–2075. https://doi.org/10.1161/circulationaha.119.041974
- Kim, S. (2011e). Medication Adherence of Elderly with Hypertension and/or Diabetes-mellitus and its’ Influencing Factors. Korean Journal of Clinical Pharmacy, 21(2), 81–89. https://www.ekjcp.org/journal/download_pdf.php?spage=81&volume=21&number=2
- Kini, V., & Ho, P. M. (2018). Interventions to improve medication adherence. JAMA, 320(23), 2461. https://doi.org/10.1001/jama.2018.19271
- Krames (2022 September 24) Patient Education Improves Compliances and Outcome. https://www.krames.com/insights/the-impact-of-knowledge-patient-education-improves-compliance-and-outcomes
- Krueger, K., Botermann, L., Schorr, S. G., Griese-Mammen, N., Laufs, U., & Schulz, M. (2015, April). Age-related medication adherence in patients with chronic heart failure: a systematic literature review. International journal of cardiology, 184, 728-735. https://doi.org/10.1016/j.ijcard.2015.03.042
- Lam, W. Y., & Fresco, P. (2015). Medication Adherence Measures: An Overview. BioMed Research International, 2015, 1–12. https://doi.org/10.1155/2015/217047
- Lau, D. T., Briesacher, B. A., Mercaldo, N. D., Halpern, L., Osterberg, E. C., Jarzebowski, M., McKoy, J. M., & Mazor, K. M. (2008). Older patients’ perceptions of medication importance and worth. Drugs & Aging, 25(12), 1061–1075. https://doi.org/10.2165/0002512-200825120-00007
- Lee, H., Park, J. H., Floyd, J. S., Park, S., & Kim, H. C. (2019). Combined effect of income and medication adherence on mortality in newly treated hypertension: nationwide Study of 16 million Person‐Years. Journal of the American Heart Association, 8(16). https://doi.org/10.1161/jaha.119.013148
- Lee, S., Lee, S., & Lee, W. (2022). Association between medication adherence to chronic diseases and shift-work schedules in the Korean working population. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-26618-9
- Lee, Y., Yu, H., You, M., & Son, Y. (2017). Impact of health literacy on medication adherence in older people with chronic diseases. Collegian, 24(1), 11–18. https://doi.org/10.1016/j.colegn.2015.08.003
- Leslie, R. S. (2007, April). Using arrays to calculate medication utilization. In SAS Global Forum (pp. 16-19). http://www.lexjansen.com/pharmasug/2008/pr/pr07.pdf
- Manteuffel, M., Williams, S., Chen, W., Verbrugge, R. R., Pittman, D. G., & Steinkellner, A. (2014). Influence of Patient Sex and Gender on Medication Use, Adherence, and Prescribing Alignment with Guidelines. Journal of Womens Health, 23(2), 112–119. https://doi.org/10.1089/jwh.2012.3972
- Marcum, Z. A., & Gellad, W. F. (2012). Medication adherence to multidrug regimens. Clinics in Geriatric Medicine, 28(2), 287–300. https://doi.org/10.1016/j.cger.2012.01.008
- Mårdby, A., Åkerlind, I., & Jörgensen, T. (2007). Beliefs about medicines and self-reported adherence among pharmacy clients. Patient Education and Counseling, 69(1–3), 158–164. https://doi.org/10.1016/j.pec.2007.08.011
- Medvedeff D. (2023, February 6) Patient Access to Clinical Pharmacists Can Improve Medication Adherence. Pharmacy Times.https://www.pharmacytimes.com/view/patient-access-to-clinical-pharmacists-can-improve-medication-adherence
- Modig, S., Kristensson, J., Troein, M., Brorsson, A., & Midlöv, P. (2012). Frail elderly patients’ experiences of information on medication. A qualitative study. BMC Geriatrics, 12(1). https://doi.org/10.1186/1471-2318-12-46
- Mk, O., & Suberu, A. (2010). Effect of Educational Level on Hypertensive Patients’ Compliance with Medication Regimen at a Tertiary Hospital in South West Nigeria. Nigerian Journal of Pharmaceutical Research, 8(1). https://www.ajol.info/index.php/njpr/article/view/73924
- Pan, J., Yu, H., Hu, B., & Li, Q. (2022). Urban-Rural difference in treatment adherence of Chinese hypertensive patients. Patient Preference and Adherence, Volume 16, 2125–2133. https://doi.org/10.2147/ppa.s377203
- Palileo-Villanueva, L. M., Tan, T., Mejia, O. J. B., & Briones Jr, G. M. (2011). T-006 factors associated with adherence to anti-hypertensive medications among patients at the general medicine outpatient clinic, Philippine general hospital. Journal of Hypertension, 29, e52. https://doi.org/10.1097/01.hjh.0000408130.87932.cd
- Peh, K. Q. E., Kwan, Y. H., Goh, H., Ramchandani, H., Phang, J. K., Lim, Z. Y., Loh, D. H. F., Østbye, T., Blalock, D. V., Yoon, S., Bosworth, H. B., Low, L. L., & Thumboo, J. (2021). An Adaptable Framework for Factors Contributing to Medication Adherence: Results from a Systematic Review of 102 Conceptual Frameworks. Journal of General Internal Medicine, 36(9), 2784–2795. https://doi.org/10.1007/s11606-021-06648-1
- Rolnick, S. J., Pawloski, P. A., Hedblom, B., Asche, S. E., & Bruzek, R. (2013). Patient Characteristics Associated with Medication Adherence. Clinical Medicine & Research, 11(2), 54–65. https://doi.org/10.3121/cmr.2013.1113
- Ruscin, J. M., & Linnebur, S. A. (2021, July). Aging and Medications.https://www.msdmanuals.com/home/older-people%E2%80%99s-health-issues/aging-and medications/aging-and-medications
- Sabaté, E., (2003). Adherence to long-term therapies: evidence for action.
- Schoenthaler, A., Chaplin, W. F., Allegrante, J. P., Fernandez, S., Diaz-Gloster, M., Tobin, J. N., & Ogedegbe, G. (2009). Provider communication effects medication adherence in hypertensive African Americans. Patient Education and Counseling, 75(2), 185–191. https://doi.org/10.1016/j.pec.2008.09.018
- Shoemaker, S. J., & De Oliveira, D. R. (2007). Understanding the meaning of medications for patients: The medication experience. Pharmacy World & Science, 30(1), 86–91. https://doi.org/10.1007/s11096-007-9148-5
- Shruthi, R., Jyothi, R., Pundarikaksha, H. P., Nagesh, G. N., & Tushar, T. J. (2016). A Study of Medication Compliance in Geriatric Patients with Chronic Illnesses at a Tertiary Care Hospital. Journal of Clinical and Diagnostic Research. JCRD, 10(12), FC40.https://doi.org/10.7860/jcdr/2016/21908.9088
- Smaje, A., Weston-Clark, M., Raj, R., Orlu, M., Davis, D., & Rawle, M. J. (2018). Factors associated with medication adherence in older patients: A systematic review. Aging Medicine, 1(3), 254–266. https://doi.org/10.1002/agm2.12045
- Souliotis, K., Giannouchos, T. V., Golna, C., & Liberopoulos, E. (2021). Assessing forgetfulness and polypharmacy and their impact on health-related quality of life among patients with hypertension and dyslipidemia in Greece during the COVID-19 pandemic. Quality of Life Research, 31(1), 193–204. https://doi.org/10.1007/s11136-021-02917-y
- Vlasnik, J. J., Aliotta, S. L., & DeLor, B. (2005, March). Medication adherence: factors influencing compliance with prescribed medication plans. The Case Manager, 16(2), 47-51. https://doi.org/10.1016/j.casemgr.2005.01.009World Health Organization (2021). Ageing and health https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
- World Health Organization (2022). Non-communicable Diseases https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
- Williams, A., Manias, E., & Walker, R. G. (2008). Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. Journal of Advanced Nursing, 63(2), 132–143. https://doi.org/10.1111/j.1365-2648.2008.04656.x
- Wu, J. R., Lennie, T. A., Chung, M. L., Frazier, S. K., Dekker, R. L., Biddle, M. J., & Moser, D. K. (2012). Medication adherence mediates the relationship between marital status and cardiac event-free survival in patients with heart failure. Heart & Lung, 41(2), 107–114. https://doi.org/10.1016/j.hrtlng.2011.09.009
- Xu, J., Zhao, M., Vrosgou, A., Yu, N., Liu, C., Zhang, H., Ding, C., Roth, N. W., Pan, Y., Liu, L., Wang, Y., & Bettger, J. P. (2021). Barriers to medication adherence in a rural-urban dual economy: a multi-stakeholder qualitative study. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06789-3