Perceived Medication-Related Burden, Adherence and Associated Factors among Diabetes Mellitus Patients Attending the Outpatient Clinic at Felege Hiwot Compressive and Specialized Hospital, North-west Ethiopia

Abstract

Abstract Background: Medication related burden is the overall workload imposed on the patients resulting from all aspects of utilizing healthcare. It can lead to non-adherence and poor clinical outcomes, as well as affecting patient satisfaction, psychological well-being, social functioning, and quality of life. Even though studying medication related burden is essential to measure the impact of medicines use from the patient’s perspective and important as a key step to designing and delivering minimally disruptive medicine to diabetes patients, it is less well defined and less researched. Objective: The aim of this study was to investigate perceived medication-related burden, adherence and associated factors in diabetes mellitus patients attending the outpatient clinic at Felege Hiwot Compressive and Specialized Hospital, North-west Ethiopia, 2020. Method: A cross-sectional study was conducted on a total of 423 systematically randomly selected patients with a diagnosis of diabetes mellitus, attending the outpatient clinic at Felege Hiwot Compressive and Specialized Hospital. The Living with Medicines Questionnaire Version-3 (LMQ-3) and the Visual Analog (VAS) scale data collection tool was used to assessed perceived medication related burden after pretest was done. Adherence to prescribed medication was measured using Adherence to Refills and Medications Scale (ARMS). Data was entered using EpiData version 4.6.0.0 and analyzed using SPSS version 21 software. Linear regression was used to identify factors associated with medication-related burden. To identify factors associated with adherence, logistic regression model was used. P-value<0.05 was considered as statistically significant and reported as 95% confidence interval (CI). Results: The mean (±SD) LMQ-3 score was 126.52 (17.397) and majority of the participants 58.9% (95 CI: 53.9-63.7) experienced moderate degree of burden. Higher medication related burden was found in diabetes patients with uncontrolled D.M (P=0.003), non-adherences to prescribed medication (P<0.001) and high global burden (P<0.001). The mean (±SD) VAS score was 3.83(1.07) and majority of participants 60% (95 CI: 55-65.6)) were perceived high global burden. The median (IQR) ARMS score was 13(3). Almost 44.9% (95% CI: 39.9-49.7) of the study participants were non-adherent to their prescribed medications. Patients who had high LMQ3 score

were 12 times likelihood non adherence (P?0.001, (AOR= 12.45; 95%CI: 3.38--45.76). Participants who lived in rural area were two times more likely to be non-adherent to prescribed xi

medications than those who lived in urban area, (P-value= 0.014, (AOR= 2.26; 95%CI: 1.184.33)).

Also, participant with more than 4 years of duration of DM diagnosis had non-adherent than less than 4-year duration of diagnosis (P-value= 0.012, (AOR= 2.49; 95%CI: 1.22-5.09)). Having high perceived global burden were almost six times more likely non-adhered to prescribed medication than low perception (P?0.001, (AOR= 6.71; 95%CI: 3.65-12.33)) Conclusion: The vast majority of diabetes mellitus patients (85.1%) suffered from moderate to high degree of burden. Adherence level (ARMS score), perceived global burden (VAS score) and Fasting blood glucose (FBS) were the predictor of medication related burden in diabetes patients. The overall ARMS score were higher in patients with which lived in rural, more than 4 years of D.M diagnosis’s, had high LMQ-3 score, and high perceived global burden. Significant number of diabetes patients were suffer from both high medication related burden and non-adherence to long term medicine. This study underscore the need for multidimensional intervention to decrease medication related burden and to upgrade adherence to increase patient’s quality of life. Keywords: Medication related burden, Adherence, Perceived global burden, Diabetes mellitus, Felege Hiwot Compressive and Specialized Hospital, Ethiopia