Patients’ Adherence to Anti-Diabetic Medications in a Hospital at Ajman, UAE

Background: Anti-diabetic medications are integral for glycemic control in diabetes. Non-adherence to drugs can alter blood glucose levels, resulting in complications. Adherence to anti-diabetic medications reported by patients and the factors associated with medication adherence among adult patients with diabetes mellitus were explored. Methods: This cross-sectional study was carried out among patients with type II diabetes mellitus attending the Internal Medicine Department of a hospital in the United Arab Emirates. Consecutive patients were selected, and data regarding their medication adherence were collected using a questionnaire. Data analysis was carried out using SPSS-20. The chi-square test was performed to examine the associations between categorical variables; a two-sided P Value < 0.05 was considered significant. Results: A total of 132 patients participated in the study (63 males; 69 females). The mean age (standard deviation) of the respondents was 54 years (SD 10.2). The self-reported adherence rate to anti-diabetic drugs was 84%. The most common reason for non-adherence was forgetfulness, and the adherence rate was similar in both genders. Patients with Bachelor’s and Master’s degree reported greater adherence rate to anti-diabetic medication in comparison to the secondary school educated. Conclusion: The self-reported adherence rate to anti-diabetic medications was 84%, and forgetfulness was the most common reason for non-adherence. Future studies on strategies to improve adherence rate should be considered.

Use of antihypertensive medications in patients with diabetes in Ajman, UAE

Optimal reduction in blood pressure with antihypertensive agents helps to prevent diabetic microvascular and macrovascular complications. The objective of the study was to evaluate the current utilization pattern of antihypertensive medications among patients with diabetes and co-existent hypertension as per the JNC 7th Report guidelines. A cross sectional survey was carried out among patients with diabetes attending the Outpatient Department of Internal Medicine at a tertiary care hospital in Ajman. Medical records of the patients were used to obtain diagnostic, demographic and drug use information. Unvariate analysis was performed using Chi square and t-test followed by logistic regression to compute independent predictors. Of 132 patients with diabetes, uncomplicated hypertension [HTN] was coexistent in 107 [81%] patients. Males constituted 49.5% of the total. The mean age of patients with HTN was [55.1 +/- 10.1], which was higher than that in those without HTN [49.6 +/- 9.9] [p<0.05]. 51.4% of patients with HTN were between 45-60 years of age. A higher number of patients with HTN had duration of diabetes < 5 years than those >5 years [p<0.05]. While adjusting the significant factors, only the duration of diabetes [adjusted OR 1.06; CI [1.003-1.116]] was statistically significant among patient with HTN. 68 [62.6%] prescriptions contained one antihypertensive drug, 29 [30%] two drugs and 8 [7.4%] no anti-hypertensive drug. Angiotensin converting enzyme inhibitors/ angiotensin receptor blockers [ACEI/ ARBs] followed by diuretics were commonly prescribed. ARBs with diuretics were the most frequent two drug combination. The antihypertensive utilization pattern was similar in both gender and age groups. The results represent the current prescribing trend for anti-hypertensive agents among patients with diabetes, which is in accordance with JNC-7 recommendations

dilemma of polypharmacy: nurses perceptions of health care professionals' contribution in polypharmacy in Ajman, UAE

Health care professionals do not pay sufficient attention to polypharmacy which is a slowly growing phenomenon. Physician-related factors which contribute to polypharmacy include the use of multiple medications in management of co-morbid illnesses, symptomatic treatment, and the treatment of the adverse effects of drugs. The present study aimed to identify nurses' perceptions of health care professionals' role in polypharmacy. This cross sectional study was conducted among nurses in Gulf Medical College Hospital and Research Centre, Ajman, United Arab Emirates from March to May 2011. A structured self-administered close-ended pilot-tested questionnaire was used as a study instrument. Association between socio-demographic characteristics and items were analyzed using Chi-square test and p<0.05 was considered statistically significant. A total of 92 female and 13 male nurses were included. The most common physician factors identified by nurses were prescribing medications for every symptom [78 [74%]], not conducting medication review [74 [70.5%]], not simplifying medication regimens [62 [59%]] and the influence of pharmaceutical companies 58 [55.2%]. Regarding the pharmacist related factors, nurses opined that inadequate pharmacist-doctor communication [71 [67.6%]] and lack of effective patient counseling [65 [61.9%]] influence polypharmacy. On comparing physician related factors between nurses of different years of experience and also between the genders, prescribing medications for every symptom, and not conducting a medication review with the patient scored the highest in all the groups. A higher number of male nurses [statistically significant at p<0.05] in comparison to female nurses opined that inadequate knowledge of clinical pharmacology [7 [53.8%]], and lack of time to review medications [6 [46%]] contributed to polypharmacy. Healthcare professionals need to be aware of the increase in polypharmacy. Regular assessment of prescribed medications should be carried out to avoid the administration of inappropriate drugs

Nurses' views on patient factors associated with polypharmacy in Ajman, UAE

The specter of polypharmacy is an ever-increasing problem faced by the healthcare professionals. Nurses need to be aware of the several patient related factors that contribute to polypharmacy. This study evaluated the views of nurses regarding patient-related factors associated with polypharmacy. Nurses working in Gulf Medical College Hospital and Research Centre in Ajman, United Arab Emirates participated in the study during March to May 2011. The fourteen item questionnaire regarding patient factors was used as the research tool. Association between socio-demographic characteristics and items were analysed using Chi-square test [p<0.05 considered statistically significant]. Of 105 nurses included, 92 were females and 13 males. The most commonly identified patient factors were lack of awareness of polypharmacy [94.3%], seeing multiple physicians [82.9%], use of self medications [79%], ordering of refills without follow up [78%], and not reporting all the medications they are currently on [78%]. On comparing male and female nurses, the lack of awareness of polypharmacy was the most commonly stated patient factors by both groups. Male nurses gave a higher ranking for increased awareness of treatment options among patients in comparison to female nurses. Nurses with 5-10 years of experience had given a high score for ineffective doctor-patient communication and increased awareness of treatment options among patients in comparison to other groups. Nurses are aware of the patient factors contributing to polypharmacy. They should be trained to implement this knowledge in reducing polypharmacy especially while counseling patient regarding medications

Reducing the burden of multiple medications: nurses' views on strategies to prevent polypharmacy in Ajman, UAE

Polypharmacy is often used to imply a negative situation involving unnecessary or inappropriate use of medications. Nurse can contribute significantly in reducing the number of medications prescribed. The study was planned to identify the nurses' opinions on different strategies that could be used to prevent polypharmacy. This cross section study was conducted during March to May 2011 among nurses who are working in a tertiary care hospital in Ajman, UAE. In addition to socio-demographic characteristics the pilot-tested self-administered, questionnaire contained 20 items to collect information. Chi-square test was used to compare percentages by socio-demographic characteristics using PSAW software. The significance level for all analyses was p

Age and gender-based utilization pattern of anti-diabetic drugs in Ajman, UAE

Diabetes is a chronic multi-system metabolic disease associated with morbidity and mortality and cost to the society. Pharmacotherapy is an integral part of the management of diabetes. Factors like age, gender, Body Mass Index [BMI] and coexisting illnesses determine the prescription. The objective of the study was to evaluate the drug usage pattern of anti-diabetic drugs in different age groups and gender. A cross sectional epidemiological survey of all prescriptions of patients with diabetes attending the Outpatient department of Internal Medicine of Gulf Medical College Hospital and Research Centre, Ajman was conducted for a duration of 3 months. The socio-demographic and drug information was obtained by researchers with the help of a questionnaire. 54.8% patients were males and 45.2% were females. The mean age of patients with diabetes was 54.09 +/- 10.24 years. 128 patients were type 2 diabetes. Metformin combinations were the commonly prescribed anti-diabetic drug. Insulin prescription was noted in 14 patients, the commonest being Human Insulin. Metformin combinations were commonly prescribed in both genders. For patients below 45 years and those between 45-60 years of age metformin combinations were the commonest prescribed, while among patients above 60 years of age sulfonylureas were the most commonly prescribed. The utilization pattern of anti diabetic drugs varied among different age groups and gender. Metformin combination with newer antidiabetic medications were commonly utilized

Patients' adherence to anti-diabetic medications and factors associated with adherence

Anti-diabetic drug therapy plays a pivotal role in the glycemic control patients with diabetes. Patient with chronic diseases such as diabetes often discontinue their medications for various reasons which could lead to ineffective control of blood glucose levels. The objective of the study was to assess the patient adherence of anti-diabetic drug therapy and explore the reasons for non-adherence. This was a cross sectional survey of patients with diabetes attending the Outpatient department of Internal Medicine of Gulf Medical College Hospital and Research Centre, Ajman carried out over a period of three months. Data on patient adherence, knowledge of anti-diabetic drugs and patient-provider relationship were collected with the help of a researcher-administered questionnaire. A total of 132 patients were included [63 males and 69 females]. The mean age of the subjects was 54.09 +/- 10.24 years. Patient adherence rate to anti-diabetic drugs was 84%. Adherence was similar among male and female patients. Based on the educational status, patients with schooling showed non-adherence. The most common reason for non-adherence was forgetfulness. Only 2.3% of the patients took self-medication and alternative therapies in addition to the medications prescribed. The majority of the patients had good patient-physician relationship. The patients had good knowledge of diabetes and anti-diabetic medications, received from their doctor or as self-learned. It is crucial that health providers assess adherence of patients to drug therapy in the event of poor glucose control and presumed failure of the prescribed therapeutic regimen. Additionally, the health care providers should practice patient counseling on medication adherence for effective management of diabetes