Complexity of Treatment Regimens and Patient Adherence in Individuals with Heart Failure in Yemen: A cross Sectional Study

https://doi.org/10.22146/farmaseutik.v20i4.96997

Ramez Abdullah(1), Fita Rahmawati(2*), Anna Wahyuni Widayanti(3)

(1) Magister of Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada
(2) Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy Universitas Gadjah Mada
(3) Faculty of Pharmacy, Universitas Gadjah Mada
(*) Corresponding Author

Abstract


Various studies have consistently found that increased complexity in medication regimens leads to poorer adherence. Recognizing the growing global prevalence of heart failure and the specific challenges it presents, especially in low-resource settings, this study aims to investigate the influence of complexity of treatment regimens on adherence levels among Individuals with heart failure in Yemen. Through a cross-sectional observational study conducted at three major hospitals in Sana’a, structured questionnaires were employed to assess self-reported medication adherence and regimen complexity. The findings reveal a significant negative association between higher regimen complexity and adherence with regression coefficient (B = -0.150; P value 0.020). Moreover, socioeconomic factors such as income (B = 2.753; P value 0.000) and employment status (B = -1.380; P value 0.006) were found to exert considerable influence on adherence levels. This study underscores the imperative for simplified medication regimens and improved patient education to enhance adherence rates among heart failure patients in developing nations.


Keywords


Heart failure; Medication adherence; Medication regimen complexity; Yemen

Full Text:

PDF


References

Abdelbary, A., Kaddoura, R., Balushi, S. A., Ahmed, S., Galvez, R., Ahmed, A., Nashwan, A. J., Alnaimi, S., Al Hail, M., & Elbdri, S. (2023). Implications of the medication regimen complexity index score on hospital readmissions in elderly patients with heart failure: A retrospective cohort study. BMC Geriatrics, 23(1), 377. https://doi.org/10.1186/s12877-023-04062-2

Advinha, A. M., de Oliveira-Martins, S., Mateus, V., Pajote, S. G., & Lopes, M. J. (2014). Medication regimen complexity in institutionalized elderly people in an aging society. International Journal of Clinical Pharmacy, 36(4), 750–756. https://doi.org/10.1007/s11096-014-9963-4

Aksoy, N., Ozturk, N., Okuyan, B., & Sancar, M. (2023). Validation of the Arabic Version of Medication Regimen Complexity Index Among Older Patients—Validation of the “MRCI-Arabic.” Sudan Journal of Medical Sciences, 18(3), Article 3.

Al-Qerem, W., Al Bawab, A. Q., Abusara, O., Alkhatib, N., & Horne, R. (2022). Validation of the Arabic version of medication adherence report scale questionnaire and beliefs about medication -specific questionnaire: A factor analysis study. PloS One, 17(4), e0266606. https://doi.org/10.1371/journal.pone.0266606

Al-Zaazaai, A.-Z. E. A. A. A. M., Al-Amrani, M. A., Alakhali, K. M., & Aljaber, N. (2019). EVALUATION OF MEDICATION COMPLIANCE IN PATIENTS WITH CONGESTIVE HEART FAILURE IN YEMEN. International Journal of Pharmacy and Pharmaceutical Sciences, 93–97. https://doi.org/10.22159/ijpps.2019v11i4.29988

Amininasab, S., Lolaty, H., Moosazadeh, M., & Shafipour, V. (2018). Medication adherence and its predictors among patients with heart failure. Nursing and Midwifery Studies, 7, 81. https://doi.org/10.4103/nms.nms_9_17

Beezer, J., Al Hatrushi, M., Husband, A., Kurdi, A., & Forsyth, P. (2022). Polypharmacy definition and prevalence in heart failure: A systematic review. Heart Failure Reviews, 27(2), 465–492. https://doi.org/10.1007/s10741-021-10135-4

Bernell, S., & Howard, S. W. (2016). Use Your Words Carefully: What Is a Chronic Disease? Frontiers in Public Health, 4, 159. https://doi.org/10.3389/fpubh.2016.00159

Choudhry, N. K., Fischer, M. A., Avorn, J., Liberman, J. N., Schneeweiss, S., Pakes, J., Brennan, T. A., & Shrank, W. H. (2011). The implications of therapeutic complexity on adherence to cardiovascular medications. Archives of Internal Medicine, 171(9), 814–822. https://doi.org/10.1001/archinternmed.2010.495

Claxton, A. J., Cramer, J., & Pierce, C. (2001). A systematic review of the associations between dose regimens and medication compliance. Clinical Therapeutics, 23(8), 1296–1310. https://doi.org/10.1016/S0149-2918(01)80109-0

Cobretti, M. R., Page, R. L., Linnebur, S. A., Deininger, K. M., Ambardekar, A. V., Lindenfeld, J., & Aquilante, C. L. (2017). Medication regimen complexity in ambulatory older adults with heart failure. Clinical Interventions in Aging, 12, 679–686. https://doi.org/10.2147/CIA.S130832

Ferreira, J. M., Galato, D., & Melo, A. C. (2015). Medication regimen complexity in adults and the elderly in a primary healthcare setting: Determination of high and low complexities. Pharmacy Practice, 13(4), 659. https://doi.org/10.18549/PharmPract.2015.04.659

Fröhlich, S. E., Zaccolo, A. V., da Silva, S. L. C., & Mengue, S. S. (2010). Association between drug prescribing and quality of life in primary care. Pharmacy World & Science: PWS, 32(6), 744–751. https://doi.org/10.1007/s11096-010-9431-8

George, J., Phun, Y.-T., Bailey, M. J., Kong, D. C. M., & Stewart, K. (2004). Development and validation of the medication regimen complexity index. The Annals of Pharmacotherapy, 38(9), 1369–1376. https://doi.org/10.1345/aph.1D479

Goldstein, C. M., Gathright, E. C., Gunstad, J., A. Dolansky, M., Redle, J. D., Josephson, R., Moore, S. M., & Hughes, J. W. (2017). Depressive symptoms moderate the relationship between medication regimen complexity and objectively measured medication adherence in adults with heart failure. Journal of Behavioral Medicine, 40(4), 602–611. https://doi.org/10.1007/s10865-017-9829-z

Hajjar, E. R., Cafiero, A. C., & Hanlon, J. T. (2007). Polypharmacy in elderly patients. The American Journal of Geriatric Pharmacotherapy, 5(4), 345–351. https://doi.org/10.1016/j.amjopharm.2007.12.002

Hassan, M. (2015). Gulf CARE: Heart failure in the Middle East. Global Cardiology Science & Practice, 2015(3), 34. https://doi.org/10.5339/gcsp.2015.34

Hirsch, J. D., Metz, K. R., Hosokawa, P. W., & Libby, A. M. (2014). Validation of a patient-level medication regimen complexity index as a possible tool to identify patients for medication therapy management intervention. Pharmacotherapy, 34(8), 826–835. https://doi.org/10.1002/phar.1452

Irshaidat, S., Gustafsson, M., & Norberg, H. (2023). Self-Reported Medication Adherence Among Older People Admitted to Hospital: A Descriptive Study. Drugs - Real World Outcomes, 10(1), 23–29. https://doi.org/10.1007/s40801-023-00352-8

Jarab, A. S., Al-Qerem, W. A., Hamam, H. W., Alzoubi, K. H., Abu Heshmeh, S. R., Mukattash, T. L., & Alefishat, E. (2023). Medication Adherence and Its Associated Factors Among Outpatients with Heart Failure. Patient Preference and Adherence, 17, 1209–1220. https://doi.org/10.2147/PPA.S410371

Jarrah, M., Khader, Y., Alkouri, O., Al-Bashaireh, A., Alhalaiqa, F., Al Marzouqi, A., Qaladi, O. A., Alharbi, A., Alshahrani, Y. M., Alqarni, A. S., & Oweis, A. (2023). Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study. Medicina (Kaunas, Lithuania), 59(5), 960. https://doi.org/10.3390/medicina59050960

Kardas, P., Lewek, P., & Matyjaszczyk, M. (2013). Determinants of patient adherence: A review of systematic reviews. Frontiers in Pharmacology, 4. https://doi.org/10.3389/fphar.2013.00091

Khan, M. S., Shahid, I., Fonarow, G. C., & Greene, S. J. (2022). Classifying heart failure based on ejection fraction: Imperfect but enduring. European Journal of Heart Failure, 24(7), 1154–1157. https://doi.org/10.1002/ejhf.2470

Lin, C.-Y., Ganji, M., Griffiths, M. D., Bravell, M. E., Broström, A., & Pakpour, A. H. (2020). Mediated effects of insomnia, psychological distress and medication adherence in the association of eHealth literacy and cardiac events among Iranian older patients with heart failure: A longitudinal study. European Journal of Cardiovascular Nursing, 19(2), 155–164. https://doi.org/10.1177/1474515119873648

Lin, C.-Y., Ou, H.-T., Nikoobakht, M., Broström, A., Årestedt, K., & Pakpour, A. H. (2018). Validation of the 5-Item Medication Adherence Report Scale in Older Stroke Patients in Iran. The Journal of Cardiovascular Nursing, 33(6), 536–543. https://doi.org/10.1097/JCN.0000000000000488

Lund, L. H., Pitt, B., & Metra, M. (2022). Left ventricular ejection fraction as the primary heart failure phenotyping parameter. European Journal of Heart Failure, 24(7), 1158–1161. https://doi.org/10.1002/ejhf.2576

Ma, X., Jung, C., Chang, H.-Y., Richards, T. M., & Kharrazi, H. (2020). Assessing the Population-Level Correlation of Medication Regimen Complexity and Adherence Indices Using Electronic Health Records and Insurance Claims. Journal of Managed Care & Specialty Pharmacy, 26(7), 10.18553/jmcp.2020.26.7.860. https://doi.org/10.18553/jmcp.2020.26.7.860

Mahler, C., Hermann, K., Horne, R., Ludt, S., Haefeli, W. E., Szecsenyi, J., & Jank, S. (2010). Assessing reported adherence to pharmacological treatment recommendations. Translation and evaluation of the Medication Adherence Report Scale (MARS) in Germany. Journal of Evaluation in Clinical Practice, 16(3), 574–579. https://doi.org/10.1111/j.1365-2753.2009.01169.x

Malih Radhi, M., Niazy, S. M., & Naser Abed, S. (2023). Individual-related factors associated with treatment adherence among hypertensive patients. Journal of Public Health in Africa, 14(6), 2466. https://doi.org/10.4081/jphia.2023.2466

Mansur, N., Weiss, A., & Beloosesky, Y. (2012). Looking beyond polypharmacy: Quantification of medication regimen complexity in the elderly. The American Journal of Geriatric Pharmacotherapy, 10(4), 223–229. https://doi.org/10.1016/j.amjopharm.2012.06.002

Masoudi, F. A., & Krumholz, H. M. (2003). Polypharmacy and comorbidity in heart failure. BMJ : British Medical Journal, 327(7414), 513–514.

Moaddab, F., Ghanbari, A., Taheri-Ezbarami, Z., Salari, A., & Kazemnezhad-Leyli, E. (2023). Clinical parameters and outcomes in heart failure patients based on gender differences. International Journal of Africa Nursing Sciences, 18, 100525. https://doi.org/10.1016/j.ijans.2022.100525

Mohamad Yahaya, A. H., Hassali, M., Awaisu, A., & Shafie, A. (2009). Factors associated with warfarin therapy knowledge and anticoagulation control among patients attending a warfarin clinic in Malaysia. Journal of Clinical and Diagnostic Research, 3, 1663–1670.

Okuboyejo, S. (2014). Non-adherence to medication in outpatient setting in Nigeria: The effect of employment status. Global Journal of Health Science, 6(3), 37–44. https://doi.org/10.5539/gjhs.v6n3p37

Pantuzza, L. L., Ceccato, M. das G. B., Silveira, M. R., Junqueira, L. M. R., & Reis, A. M. M. (2017). Association between medication regimen complexity and pharmacotherapy adherence: A systematic review. European Journal of Clinical Pharmacology, 73(11), 1475–1489. https://doi.org/10.1007/s00228-017-2315-2

Park, Y.-H., Kim, H., Jang, S.-N., & Koh, C. K. (2013). Predictors of adherence to medication in older Korean patients with hypertension. European Journal of Cardiovascular Nursing, 12(1), 17–24. https://doi.org/10.1016/j.ejcnurse.2011.05.006

Raffaa, H. S. M., Alasmari, B. A., Abadi, S. A., Al Metrek, M. A., Raffaa, H. S., Al Qarni, H. Z. M., Alhumayed, R. S., Al Hamad, F. H., Almakhluti, F. M., Al Mani, H. M., Al Halafi, F. M., Assiri, M. A., & Al Qahtani, S. M. (2020). Adherence of heart failure patients to heart failure medications and its determinants in the Aseer region, Southern Saudi Arabia. Journal of Family Medicine and Primary Care, 9(9), 5041–5045. https://doi.org/10.4103/jfmpc.jfmpc_904_20

Rezaei, S., Vaezi, F., Afzal, G., Naderi, N., & Mehralian, G. (2022). Medication Adherence and Health Literacy in Patients with Heart Failure: A Cross-Sectional Survey in Iran. Health Literacy Research and Practice, 6(3), e191–e199. https://doi.org/10.3928/24748307-20220718-02

Sabaté, E., & World Health Organization (Eds.). (2003). Adherence to long-term therapies: Evidence for action. World Health Organization.

Sadeghiazar, S., Mobasseri, K., Gholizadeh, L., Sarbakhsh, P., & Allahbakhshian, A. (2022). Illness acceptance, medication adherence and the quality of life in patients with heart failure: A path analysis of a conceptual model. Applied Nursing Research, 65, 151583. https://doi.org/10.1016/j.apnr.2022.151583

Savarese, G., Stolfo, D., Sinagra, G., & Lund, L. H. (2022). Heart failure with mid-range or mildly reduced ejection fraction. Nature Reviews. Cardiology, 19(2), 100–116. https://doi.org/10.1038/s41569-021-00605-5

Schoonover, H., Corbett, C. F., Weeks, D. L., Willson, M. N., & Setter, S. M. (2014). Predicting potential postdischarge adverse drug events and 30-day unplanned hospital readmissions from medication regimen complexity. Journal of Patient Safety, 10(4), 186–191. https://doi.org/10.1097/PTS.0000000000000067

Seid, M. A., Toleha, H. N., & Sema, F. D. (2023). Medication Nonadherence and Associated Factors among Heart Failure Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. International Journal of Chronic Diseases, 2023, 1824987. https://doi.org/10.1155/2023/1824987

Shojaee, A., Azimi, A. V., Naderi, N., Salaree, M. M., & Faizi, F. (2023). Predictions of Adherence to Treatment in Patients Referred to the Heart Failure Clinic of Shahid Rajaee Hospital in Tehran. Research in Cardiovascular Medicine, 12(1), 8. https://doi.org/10.4103/rcm.rcm_36_22

Stange, D., Kriston, L., von Wolff, A., Baehr, M., & Dartsch, D. C. (2013). Medication complexity, prescription behaviour and patient adherence at the interface between ambulatory and stationary medical care. European Journal of Clinical Pharmacology, 69(3), 573–580. https://doi.org/10.1007/s00228-012-1342-2

Tinoco, M. S., Groia-Veloso, R. C. de S., Santos, J. N. D. dos, Cruzeiro, M. G. M., Dias, B. M., & Reis, A. M. M. (2021). Medication regimen complexity of coronary artery disease patients. Einstein (São Paulo), 19, eAO5565. https://doi.org/10.31744/einstein_journal/2021AO5565

Wu, J.-R., Moser, D. K., Lennie, T. A., & Burkhart, P. V. (2008). Medication Adherence in Patients Who Have Heart Failure: A Review of the Literature. Nursing Clinics of North America, 43(1), 133–153. https://doi.org/10.1016/j.cnur.2007.10.006



DOI: https://doi.org/10.22146/farmaseutik.v20i4.96997

Article Metrics

Abstract views : 2 | views : 0

Refbacks

  • There are currently no refbacks.


Majalah Farmaseutik Indexed by:

   
 
Creative Commons Licence
 
 
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.