Abstract:
Abstract
Introduction: Assessing the medication regimen complexity, treatment adherence, and healthrelated
quality of a patient is important to better tailor health and social care services, and
thereby improve the functioning and well-being of patients living with multimorbidity.
Objective: To assess medication regimen complexity, level of medication adherence, and healthrelated
quality of life among patients with multimorbidity treated at the University of Gondar
Comprehensive Specialized Hospital.
Method: A Hospital-based cross-sectional study was conducted from May 01 to June 30, 2021.
A systematic random sampling technique was used. Statistical Package for Social Sciences
(SPSS) version 25 was used to analyze data. Descriptive statistics such as mean, percent, and
frequency were used to summarize patients' demographic and clinical characteristics. To identify
associations between variables; ordinal logistic regression, simple linear regression analysis,
Pearson chi-square test, and Post-hoc comparison using the Analysis of variance tests were
performed. The Adjusted Odds Ratio (AOR) with 95% (CI) was reported for potential
determinant factors of adherence level and for multiple linear regression analysis, the variable
entry criterion was set to 0.05, to explore the variables that were significantly associated with
HRQoL.
Result: From the total of 416 study participants, the mean (SD) age was 56.12 years (± 13.75).
In the majority of the participants, the patient-level medication regimen complexity
index(MRCI) score was classified as medium (n=169, 40.6 %) and high (n=238,57%).
According to the Chronic Disease Adherence Scale, nearly half of the patients (n=205, 49%)
were poorly adhering to their treatment regimens. The patients' quality of life on EuroQol's
mean utility index and Visual Analogue scale scores were 0.76±0.15, and 77±.021, respectively.
In the multivariable ordinal regression analysis, number of medication (AOR = 0.63([0.41,
0.97],), income level (AOR=4.59, 95% CI [2.14,9.83],), follow up duration (AOR=2.31(1.09,
4.86) and Charlson comorbidity index(AOR=0.36, [0.16,0.83],)were significantly associated
with low level of adherence. In the multivariable linear regression analysis, number of
multimorbidity (?=-0.027,P= 0.015),number of drugs (?=-0.023, P<0.001), Charlson
comorbidity index (?=-0.012,P= 0.022), income(? =0.105 ,P<0.001) , exercise (?=-0.062,p=
0.004), residence (?=-0.035 ,p=0.016) and paid for health care(? = 0.056,P<0.001 )were the
identified factors associated with health-related quality of life .
Conclusion: Medication regimens for patients with multimorbidity were high and complex.
Almost half of the study populations were classified as non-adherent. Anxiety/Depression and
Pain/Discomfort dimensions show the highest disutility score. Even though the utility index and
visual analog scale indicated equivalent health status, adherence to routinely prescribed
medicines was poor. Hence, health care professionals and other stakeholders should seek
interventions aimed at simplifying drug regimens complexity, improving adherence, and
enhancing the quality of life.
Keywords: medication regimen complexity, multimorbidity, Adherence, Quality of life, Gondar
