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      Patient Preference and Adherence (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on the growing importance of patient preference and adherence throughout the therapeutic process. Sign up for email alerts here.

      34,896 Monthly downloads/views I 2.314 Impact Factor I 3.8 CiteScore I 1.14 Source Normalized Impact per Paper (SNIP) I 0.629 Scimago Journal & Country Rank (SJR)

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      Determinants of medication adherence among adults with type 2 diabetes mellitus in three Malaysian public health clinics: a cross-sectional study

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          Abstract

          Medication adherence (MA) in adults with type 2 diabetes mellitus (T2D) is associated with improved disease control (glycated hemoglobin, blood pressure, and lipid profile), lower rates of death and diabetes-related complications, increased quality of life, and decreased health care resource utilization. However, there is a paucity of data on the effect of diabetes-related distress, depression, and health-related quality of life on MA. This study examined factors associated with MA in adults with T2D at the primary care level. This was a cross-sectional study conducted in three Malaysian public health clinics, where adults with T2D were recruited consecutively in 2013. We used the 8-item Morisky Medication Adherence Scale (MMAS-8) to assess MA as the main dependent variable. In addition to sociodemographic data, we included diabetes-related distress, depressive symptoms, and health-related quality of life as independent variables. Independent association between the MMAS-8 score and its determinants was done using generalized linear models with a gamma distribution and log link function. The participant response rate was 93.1% (700/752). The majority were female (52.8%), Malay (52.9%), and married (79.1%). About 43% of patients were classified as showing low MA (MMAS-8 score <6). Higher income (adjusted odds ratio 0.90) and depressive symptoms (adjusted odds ratio 0.99) were significant independent determinants of medication non-adherence in young adults with T2D. Low MA in adults with T2D is a prevalent problem. Thus, primary health care providers in public health clinics should focus on MA counselling for adult T2D patients who are younger, have a higher income, and symptoms of depression.

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          Assessing psychosocial distress in diabetes: development of the diabetes distress scale.

          William H. Polonsky, Lawrence Fisher, Jay Earles … (2005)
          The purpose of this study was to describe the development of the Diabetes Distress Scale (DDS), a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples. In consultation with patients and professionals from multiple disciplines, a preliminary scale of 28 items was developed, based a priori on four distress-related domains: emotional burden subscale, physician-related distress subscale, regimen-related distress subscale, and diabetes-related interpersonal distress. The new instrument was included in a larger battery of questionnaires used in diabetes studies at four diverse sites: waiting room at a primary care clinic (n = 200), waiting room at a diabetes specialty clinic (n = 179), a diabetes management study program (n = 167), and an ongoing diabetes management program (n = 158). Exploratory factor analyses revealed four factors consistent across sites (involving 17 of the 28 items) that matched the critical content domains identified earlier. The correlation between the 28-item and 17-item scales was very high (r = 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high (r = 0.82), but the pattern of interscale correlations suggested that the subscales, although not totally independent, tapped into relatively different areas of diabetes-related distress. Internal reliability of the DDS and the four subscales was adequate (alpha > 0.87), and validity coefficients yielded significant linkages with the Center for Epidemiological Studies Depression Scale, meal planning, exercise, and total cholesterol. Insulin users evidenced the highest mean DDS total scores, whereas diet-controlled subjects displayed the lowest scores (P < 0.001). The DDS has a consistent, generalizable factor structure and good internal reliability and validity across four different clinical sites. The new instrument may serve as a valuable measure of diabetes-related emotional distress for use in research and clinical practice.
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            Predictive validity of a medication adherence measure in an outpatient setting.

            Donald E. Morisky, Alfonso Ang, Marie Krousel-Wood … (2008)
            This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension. The authors also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care, and complexity of the medical regimen. A total of 1367 patients participated in the study; mean age was 52.5 years, 40.8% were male, 76.5% were black, 50.8% graduated from high school, 26% were married, and 54.1% had income <$5,000. The 8-item medication adherence scale was reliable (alpha=.83) and significantly associated with blood pressure control (P<.05). Using a cutpoint of <6, the sensitivity of the measure to identify patients with poor blood pressure control was estimated to be 93%, and the specificity was 53%. The medication adherence measure proved to be reliable, with good concurrent and predictive validity in primarily low-income, minority patients with hypertension and might function as a screening tool in outpatient settings with other patient groups.
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              The Patient Health Questionnaire-9 for measuring depressive symptoms among the general population in Hong Kong.

              Xiaonan Yu, Wilson W. S. Tam, Paul Wong … (2012)
              The Patient Health Questionnaire-9 (PHQ-9) assesses depressive symptoms by self-report, is brief, and was developed to correspond to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depression. This article presents information regarding its reliability and validity and the distribution of scores in a Chinese community sample in Hong Kong. A total of 6028 participants 15 years or older were recruited using random household sampling. They completed the Chinese version of the PHQ-9, the Happiness Scale, the Chinese Health Questionnaire, and the Short-Form 12-Item Health Survey (SF-12). Information was also gathered on health and health service use. Exploratory factor analysis and confirmatory factor analysis supported a single factor with strong loadings for all 9 items. Multiple-group analyses demonstrated that the structure can be generalized across sex and age groups (ie, adolescents, adults, and individuals 65 years or older). The internal consistency of the PHQ-9 was 0.82. The test-retest reliability over a 2-week interval was 0.76. As expected, the total score of the PHQ-9 was significantly associated with the Chinese Health Questionnaire (r = 0.49) and the Happiness Scale (r = -0.41). In addition, as expected, the relationship with the physical component subscale of the SF-12 was significantly weaker (r = -0.27) than for the mental component subscale of the SF-12 (r = -0.60). Participants with higher scores on the PHQ-9 were more likely to report having been diagnosed with depression by a physician, having chronic illness, using medicine, and using inpatient and outpatient health services. Almost 40% of participants did not report any depressive symptoms (score, 0). Self-reported symptoms at a level that would qualify for a diagnosis of major depressive disorder were provided by 1.7% of the participants. Our data support the reliability and validity of the PHQ-9 in assessing depressive symptoms among the general population in Hong Kong. Its validity against diagnostic interview for major depressive disorder and its sensitivity and specificity should be determined in future studies. Copyright © 2012 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Patient Prefer Adherence
                Journal ID (iso-abbrev): Patient Prefer Adherence
                Journal ID (publisher-id): Patient Preference and Adherence
                Title: Patient preference and adherence
                Publisher: Dove Medical Press
                ISSN (Electronic): 1177-889X
                Publication date Collection: 2015
                Publication date (Electronic): 06 May 2015
                Volume: 9
                Pages: 639-648
                Affiliations
                [1 ]Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
                [2 ]Klinik Kesihatan Dengkil, Ministry of Health, Universiti Putra Malaysia, Serdang, Malaysia
                [3 ]Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
                Author notes
                Correspondence: Boon-How Chew, Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia, Tel +60 3 8947 2520, Fax +60 3 8947 2328, Email chewboonhow@ 123456gmail.com
                Article
                Publisher ID: ppa-9-639
                DOI: 10.2147/PPA.S81612
                PMC ID: 4427255
                PubMed ID: 25999699
                SO-VID: 04bf79e5-0793-4a07-bd5a-5012426f1eae
                Copyright © © 2015 Chew et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License
                License:

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Medicine
                Keywords: medication adherence,type 2 diabetes mellitus,quality of life,distress,depression,primary care
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: medication adherence, type 2 diabetes mellitus, quality of life, distress, depression, primary care

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