FREQUENCY AND FACTORS ASSOCIATED WITH MEDICATION NON-ADHERENCE AMONG PATIENTS OF CARDIOVASCULAR DISEASES IN SELECTED PUBLIC AND PRIVATE TERTIARY CARE HOSPITALS OF PESHAWAR

Introduction: Cardiovascular diseases are on the rise and one of the major causes of deaths worldwide. Medications can greatly lower the mortality rate by delaying the progression of the disease. These patients have the problem of non‐adherence to their medications due to many factors. Successful management of treatment depends on adequate self‐care and knowledge of patients about their disease and medications which indirectly affects medication adherence behavior. The objectives of the study were to find the frequency of medication non-adherence in two public and private tertiary care hospitals of Peshawar and the factors which determine non-adherence. Materials & Methods: A comparative cross-sectional study was conducted in the months of April-May 2016 at Hayatabad Medical Complex (HMC) and Rehman Medical Institute (RMI) Peshawar, which together treat a sizable proportion of cardiovascular disease patients of this region. A calculated sample of 168 patients was selected for the study (84 per hospital) based on convenience sampling; the 8-item Morisky Scale (MMAS-8), validated in patients with Diabetes Mellitus, Heart Failure, and Coronary Artery Diseases was used to assess adherence. Factors affecting medication non-adherence were documented with an indigenous questionnaire which was developed after a pilot study done in both the hospitals. Data analysis was done by SPSS 16.0 for descriptive statistics, while comparison of hospitals was done by the Chi Square test; multinomial regression analysis was done for factors affecting adherence levels. A p≤0.05 was considered significant. Results: Of the 168 patients from both hospitals, 107(63.7%) were males, and 61(36.3%) were females. The ages of the participants ranged from 19-84 years with a mean age of 55.33±10.61 years. Medication adherence calculated for both hospitals showed high adherence of 20.2%, medium adherence of 22.6%, and low adherence of 57.1%. Income per month (p=0.006), co-morbidities (p=0.002) and fear of getting addicted to the medication (p=0.048) were found to be the main factors affecting medication adherence; hospitals were significantly associated with adherence levels (p<0.001). Conclusion: Income, education status, cost of healthcare, and co-morbidities are factors leading to low medication adherence among cardiovascular disease patients, more so in the public tertiary care sector. Keywords: Medication Adherence; Cardiovascular Diseases; Self Care; Health Care Costs; Drug Costs.