Abstract
Background
Adherence to medication has an important role in the long-term management of diabetes. The Indonesian Endocrinologist Association found that of the 50% of the entire population who have been diagnosed with diabetes, two-thirds are undergoing therapy and only one-third have been achieving the intended outcomes of the drug therapy. This study aimed to identify patients’ adherence behavior and the root causes of non-adherence.
Methods
This study used a non-experimental mixed-methods approach. A total of 40 patients with type 2 diabetes mellitus (T2DM), who were part of the referral program of the National Health Care Security System (BPJS Kesehatan) were recruited by purposive sampling from 17 primary health care centers in Surabaya, Indonesia.
Results
The adherence behavior assessment revealed non-adherence among 80% of the patients. The highest instances of non-adherence based on the percentage scores involved the following: patients forgot to take the medications (38.23%), patients preferred not to take the medications (20.59%) and the drug products were not available for the patient (14.71%). The factors influencing non-adherence included the complex instructions for taking medication, the absence of a reminder, the unwanted side effects of the drug, the feeling of repetition, the feeling that drugs were ineffective and the concern for the drug’s effects on the kidney.
Conclusions
The high rates of non-adherence identified in this study encourage pharmacists to implement better medication therapy management for chronic diseases. The patients’ understanding of drug therapy indications and regimens is very important in increasing the expectations of achieving effective treatment, awareness and concern for medication safety and treatment compliance.
Appendix
The Adherence Behavior Questionnaire.
| No | Adherence behavior | Yes | No |
|---|---|---|---|
| 1 | I need help from other people every time I read the instructions for use of my medicine | ||
| 2 | The information written on the label is unclear, I use my own rules | ||
| 3 | I don’t always use my medicine on time | ||
| 4 | I am not sure how to use my medicine correctly (*) | ||
| 5 | I don’t redeem medicine that are prescribed to be purchased at other pharmacies (if you have never experienced them, no need to answer) | ||
| 6 | I replace my medicine with another drugs (herbs or alternative therapies) | ||
| 7 | I save on the use of my medicine so that it is enough to use | ||
| 8 | I only take my medicine when I feel my blood sugar level is high/rising | ||
| 9 | When I feel dizzy, weak or unhealthy, I decide not to use my medicine without checking my blood sugar level | ||
| 10 | I feel that my medicine caused a negative change to me, so I don’t use it | ||
| 11 | I feel my condition does not improve with medication, so I stop it | ||
| 12 | I am worried that my medicine will affect the kidneys, so I don’t use it regularly | ||
| 13 | I often feel uncomfortable when using my medicine, so I don’t use it regularly | ||
| 14 | I sometimes forget to use my medicine, because I get more than 1 drug with different instructions for use | ||
| 15 | I sometimes forget to use my medicine, because my activities are crowded | ||
| 16 | I sometimes forget to use my medicine, because nobody reminds me | ||
| 17 | I sometimes forget to use my medicine because I fall asleep | ||
| 18 | Prescription medicine are not available at the Primary Health Center, so I don’t use the medicine | ||
| 19 | Sometimes the medicine at the Primary Health Center is lacking, I don’t go back to the Primary Health Center to get the rest of my medicine | ||
| 20 | When my medicine is running out, I don’t buy my medicine myself at the pharmacy | ||
| 21 | I have difficulty using medicine, because I cannot swallow or use the medicine |
(*) If you have a special drug, show how to use it after filling out the questionnaire.
Acknowledgments
The authors would like to thank The Ministry of Research, Technology and Higher Education of Indonesia for providing grants for the implementation of this research. The authors are also grateful for the support of the heads of the Surabaya City Health Office who have given us permission to carry out this research.
Research funding: A doctoral dissertation grant from The Ministry of Research, Technology and Higher Education of Indonesia.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, gifts, or honoraria.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: This research has obtained permission from the Surabaya City Health Office with a permit number for research: 072/20362/436.7.2/2018.
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