Medication Regimen Complexity, Medication Adherence and Health-Related Quality of Life Among Patients with Multimorbidity Treated at University of Gondar Comprehensive Specialized Hospital, Northwestern Ethiopia

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