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      Adherence to oral anti-diabetic drugs among patients attending a Ghanaian teaching hospital Translated title: Adherencia a antidiabéticos orales entre pacientes que visitan un hospital universitario en Gana

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          Abstract

          Background: The burden of diabetes mellitus, especially Type-2, continues to increase across the world. Medication adherence is considered an integral component in its management. Poor glycemic controls due to medication nonadherence accelerates the development of long-term complications which consequently leads to increased hospitalization and mortality. Objective: This study examined the level of adherence to oral antidiabetic drugs among patients who visited the teaching hospital and explored the probable contributory factors to non-adherence. Methods: A cross-sectional descriptive study using systematic sampling to collect quantitative data was undertaken. Questionnaires were administered to out-patients of the medical department of a teaching hospital in Ghana. Logistic regression was performed with statistical significance determined at p<0.05. Results: A total of 200 diabetic patients participated in the study. Using the Morisky Medication Adherence scale, the level of adherence determined was 38.5%. There were significant correlations between level of adherence and educational level [(OR)=1.508; (CI 0.805- 2.825), P=0.019), and mode of payment [(OR)=1.631; (CI 0.997- 2.669), P=0.05). Conclusion: Adherence in diabetic patients was low among respondents and this can be improved through education, counseling and reinforcement of self-care. There were several possible factors that contributed to the low adherence rate which could benefit from further studies.

          Translated abstract

          Antecedentes: La carga de la diabetes mellitus, especialmente de la tipo 2, continúa creciendo en todo el mundo. La adherencia a la medicación se considera un componente integral de su manejo. El mal control de la glicemia debido a la no adherencia a la medicación acelera el desarrollo de complicaciones a largo plazo lo que lleva consecuentemente a aumento de hospitalización y mortalidad. Objetivo: Este estudio examinó los niveles de adherencia a los antidiabéticos orales entre pacientes que visitaron el hospital universitario y exploró los factores probablemente contribuyentes a la no adherencia. Métodos: Se realizó un estudio transversal descriptivo usando una muestra sistemática para recoger datos cualitativos. Se administraron cuestionarios a pacientes ambulatorios del departamento médico de un hospital universitario de Gana. Se realizó una regresión logística con significación estadística en p<0,05. Resultados: Un total de 200 pacientes diabéticos participaron en el estudio. Usando la escala de adherencia de medicación de Morisky, el nivel de adherencias determinado fue del 38,5%. Hubo correlación significativa entre el nivel de adherencia y el nivel educativo [(OR)=1,508; (95%CI 0,805 - 2,825), P=0,019), y el modo de pago [(OR)=1,631; (95%CI 0,997 - 2,669), P=0,05). Conclusión: La adherencia en pacientes diabéticos fue baja entre los respondentes y esto puede mejorarse mediante educación, consejo y refuerzo de los auto-cuidados. Había varios posibles factores que contribuyeron a la baja adherencia que podrían beneficiarse de estudios posteriores.

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          Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.

          The goal of this study was to estimate the prevalence of diabetes and the number of people of all ages with diabetes for years 2000 and 2030. Data on diabetes prevalence by age and sex from a limited number of countries were extrapolated to all 191 World Health Organization member states and applied to United Nations' population estimates for 2000 and 2030. Urban and rural populations were considered separately for developing countries. The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people >65 years of age. These findings indicate that the "diabetes epidemic" will continue even if levels of obesity remain constant. Given the increasing prevalence of obesity, it is likely that these figures provide an underestimate of future diabetes prevalence.
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            Concurrent and predictive validity of a self-reported measure of medication adherence.

            Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P less than 0.01).
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              Economic costs of diabetes in the U.S. In 2007.

              (2008)
              The prevalence of diabetes continues to grow, with the number of people in the U.S. with diagnosed diabetes now reaching 17.5 million. The objectives of this study are to quantify the economic burden of diabetes caused by increased health resource use and lost productivity, and to provide a detailed breakdown of the costs attributed to diabetes. This study uses a prevalence-based approach that combines the demographics of the population in 2007 with diabetes prevalence rates and other epidemiological data, health care costs, and economic data into a Cost of Diabetes Model. Health resource use and associated medical costs are analyzed by age, sex, type of medical condition, and health resource category. Data sources include national surveys and claims databases, as well as a proprietary database that contains annual medical claims for 16.3 million people in 2006. The total estimated cost of diabetes in 2007 is $174 billion, including $116 billion in excess medical expenditures and $58 billion in reduced national productivity. Medical costs attributed to diabetes include $27 billion for care to directly treat diabetes, $58 billion to treat the portion of diabetes-related chronic complications that are attributed to diabetes, and $31 billon in excess general medical costs. The largest components of medical expenditures attributed to diabetes are hospital inpatient care (50% of total cost), diabetes medication and supplies (12%), retail prescriptions to treat complications of diabetes (11%), and physician office visits (9%). People with diagnosed diabetes incur average expenditures of $11,744 per year, of which $6,649 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures that are approximately 2.3 times higher than what expenditures would be in the absence of diabetes. For the cost categories analyzed, approximately $1 in $5 health care dollars in the U.S. is spent caring for someone with diagnosed diabetes, while approximately $1 in $10 health care dollars is attributed to diabetes. Indirect costs include increased absenteeism ($2.6 billion) and reduced productivity while at work ($20.0 billion) for the employed population, reduced productivity for those not in the labor force ($0.8 billion), unemployment from disease-related disability ($7.9 billion), and lost productive capacity due to early mortality ($26.9 billion). The actual national burden of diabetes is likely to exceed the $174 billion estimate because it omits the social cost of intangibles such as pain and suffering, care provided by nonpaid caregivers, excess medical costs associated with undiagnosed diabetes, and diabetes-attributed costs for health care expenditures categories omitted from this study. Omitted from this analysis are expenditure categories such as health care system administrative costs, over-the-counter medications, clinician training programs, and research and infrastructure development. The burden of diabetes is imposed on all sectors of society-higher insurance premiums paid by employees and employers, reduced earnings through productivity loss, and reduced overall quality of life for people with diabetes and their families and friends.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                pharmacy
                Pharmacy Practice (Granada)
                Pharmacy Pract (Granada)
                Centro de Investigaciones y Publicaciones Farmacéuticas (Redondela )
                1885-642X
                March 2015
                : 13
                : 1
                : 0
                Affiliations
                [1 ] Korle Bu Teaching Hospital Ghana
                [2 ] Korle Bu Teaching Hospital Ghana
                [3 ] University of Ghana Ghana
                Article
                S1885-642X2015000100009
                30e818d1-ab7b-4227-82a8-c2c94eef8de3

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                PHARMACOLOGY & PHARMACY

                Pharmacology & Pharmaceutical medicine
                Medication Adherence,Diabetes Mellitus,Type 2,Risk Factors,Logistic Models,Ghana,Cumplimiento de la Medicación,Diabetes Mellitus Tipo 2,Factores de Riesgo,Modelos Logísticos,Gana

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