Patient satisfaction and medication adherence assessment amongst patients at the diabetes medication therapy adherence clinic

Patient satisfaction and medication adherence assessment amongst patients at the diabetes medication therapy adherence clinic

Accepted Manuscript Title: Patient Satisfaction and Medication Adherence Assessment Amongst Patients at the Diabetes Medication Therapy Adherence Clin...

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Accepted Manuscript Title: Patient Satisfaction and Medication Adherence Assessment Amongst Patients at the Diabetes Medication Therapy Adherence Clinic Author: Zanariah Abu Bakar Mathumalar Loganathan Fahrni Tahir Mehmood Khan PII: DOI: Reference:

S1871-4021(16)30002-9 http://dx.doi.org/doi:10.1016/j.dsx.2016.03.015 DSX 588

To appear in:

Diabetes & Metabolic Syndrome: Clinical Research & Reviews

Received date: Accepted date:

10-1-2016 5-3-2016

Please cite this article as: http://dx.doi.org/10.1016/j.dsx.2016.03.015 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Zanariah Abu Bakar,1 Mathumalar Loganathan Fahrni 1,2 & Tahir Mehmood Khan 3 Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam Campus, 42300, Kuala Selangor, Selangor, Malaysia. 2 Pharmaceutical & Life Sciences, Communities of Research, Universiti Teknologi MARA (UiTM), 40450 Shah Alam, Selangor Darul Ehsan, Malaysia 3 School of Pharmacy, Monash University, Bandar Sunway 45700, Selangor Malaysia.

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Corresponding author

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Tahir Mehmood Khan, BPharm, MClinPharm, PhD Address: Academic School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia E-mail: [email protected] Tel: +6012-3223273

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Patient Satisfaction and Medication Adherence Assessment Amongst Patients at the Diabetes Medication Therapy Adherence Clinic

Competing interest: All authors have no conflict of interest

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Abstract

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Aims: To determine the satisfaction and current adherence status of diabetes mellitus patients at the diabetes MTAC (DMTAC) and its between patient satisfaction and adherence. Methods: This cross-sectional descriptive study was carried out at three government hospitals in the state of Johor, Malaysia. Patients satisfaction was measured using the Patient Satisfaction with Pharmaceutical Care Questionnaire (PSPCQ); medication adherence was measured using the eight-item Morisky Medication Adherence Scale (MMAS). Results: of n= 165 patients, 87.0% of patients were satisfied with DMTAC service (score 60100) with mean scores of 76.8. On the basis of MMAS, 29.1% had a medium rate and 26.1% had a high rate of adherence. Females are 3.02 times more satisfied with the pharmaceutical service compared to males (OR 3.03, 95% CI 1.12-8.24, p<0.05) and non-Malays are less satisfied with pharmaceutical care provided during DMTAC compared to Malays (OR 0.32, 95% CI 0.12-0.85, p<0.05). Older patients age group ≥60 years have 3.29 times the odds to highly adhere to medications (OR 3.29, 95% CI 1.10-9.86, p<0.05). Females were the most adherence to medications compared to male (OR 2.33, 95%CI 1.10-4.93, p<0.05) and patients with secondary level of education were 2.72 times more adherence to medications compared to those in primary school and no formal education (OR 2.72, 95%CI 1.13-6.55, p<0.05). There is a significant (p<0.01), positive fair correlation (r=0.377) between the satisfaction and adherence. Conclusion: Patients were highly satisfied with DMTAC service; while their adherence levels were low. There is an association between patient satisfaction and adherence.

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Worldwide, about 347 million people have diabetes and by the year 2030, it is predicted to

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become the 7th leading cause of death.[1] The prevalence of type 2 diabetes mellitus (T2DM)

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is increasing and has become the major concern in Malaysia. This rising epidemic with an

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alarming statistic reported on the latest National Health and Morbidity Survey showed that

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the overall prevalence of diabetes for those aged over 18 years old is a staggering 15.2%.[2]

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Introduction

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Keywords: patient satisfaction; adherence; Morisky Medication Adherence Scale; DMTAC

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Medication use is undoubtedly important in the management of T2DM. The

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effectiveness of diabetes treatment is largely dependent on patient level of adherence to

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medications prescribed.[3] Adherence is important in chronic disease that needs long term

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therapy for a better outcome.[4,5] In Malaysia, study showed that more than 50% T2DM

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patients did not adhere to treatment.[6] In that respect, one of the initiatives taken by

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Pharmaceutical Services Department to increase patient adherence towards medications was

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the initiation of Medication Therapy Adherence Clinic (MTAC).[7] As highly trained and

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easily reached health care professionals, pharmacist can contribute well in the diabetes

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adherence program.

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86 MTAC

MTAC has been introduced in 2004 as one of the clinical pharmacy component in

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ambulatory care. The objective of this service is to increase patient adherence towards

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medications.7 DMTAC is one of the ambulatory care services which are run by pharmacists

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in collaboration with physicians. It intended to assists diabetic patients in improving their

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adherence to medication and also their glycaemic control (MOH Pharmaceutical Services

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Division, 2010). DMTAC patients will be recruited by pharmacists according to the criteria

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of DMTAC protocol or also can be referred by physicians.[8] Patients will undergo series of

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drug knowledge and compliance assessment, resolving any pharmaceutical care issues,

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managing drug related problems, clinical outcome assessment and the whole loads of

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education outlined according to number of visits. Patients will be follow up to a maximum of

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8 visits.[8] At each meeting or at the earliest opportunity, pharmaceutical review will need to

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be done by the DMTAC pharmacist. Drug therapy problem identification, resolving patient

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drug therapy problem such as what is the best therapeutic alternatives for patients and

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considering patient related factors such as social and financial needs when establishing action

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plan, monitoring patients’ drug therapy and lastly offering feedback on patient progress,

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discussion on patient case according to action plan and outcome and where necessary,

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making appropriate recommendations.

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Measuring patient satisfaction

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Pharmaceutical care provided during MTAC needs to be assessed to ensure its

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effectiveness and benefits to patients. For patients’ aspect, satisfaction to the pharmaceutical

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care provided is one of the measures that can be assessed. Patient satisfaction is now

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becoming one of the well-known indicators for health care services quality and healthcare

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related behaviour. Assessing the degree of patient satisfaction to health services provided is

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pertinent clinically as patients that are satisfied to be expected to conform to treatment.[9] It

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is especially important for chronic disease like diabetes.[10] Satisfaction studies on T2DM

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are important as satisfaction might affect adherence. Hence, by knowing the satisfaction level

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and what factors affecting it, intervention to enhance patient satisfaction level for the

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pharmaceutical care provided during diabetes MTAC can be devised so that the adherence

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level can be improved.

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Thus, the objective of this study is to determine the satisfaction and current adherence

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status of diabetes mellitus patients at the diabetes MTAC (DMTAC) and its association with

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socio-demographic characteristics and to determine the relationship between patient

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satisfaction and adherence.

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Material and Methods

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Study design and patient selection

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This cross-sectional descriptive study was conducted between September 2014 and

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November 2014 at DMTAC in three government hospitals in the state of Johor, Malaysia.

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Approval to perform the study was obtained from National Institute of Health and the

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Medical Research and Ethics Committee, Ministry of Health Malaysia. T2DM patient age 18

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years old and above, have attended DMTAC counselling at least once and able to

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communicate and read in Malay was included in the study. Patients were asked for their

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agreement to participate in the study and the study protocol was explained accordingly. A set

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of patient information sheet, consent form and questionnaires were given before the

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recruitment. Interested patients were asked to complete the consent form. All the

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questionnaires were guided administered by the researcher.

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135 Assessment and measures

The instrument used in this study consisted of three parts: Part one elicited socio-

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demographic characteristics; part 2 was satisfaction to pharmaceutical care test; and part 3

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was a medication adherence test. All sections contain Malay version only. Patient satisfaction

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was determined using the Malay version of the validated PSPCQ.[11] PSPCQ consists of 20

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items measuring two main dimensions: Friendly Explanation which covered eleven items

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aspects of service such as staff’s professional conduct, service promptness, pharmacy

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appearance, patient’s relationship with pharmacist, how well pharmacist answered questions,

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explained on drug indication and its administration ways. The other nine items cover another

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dimension termed Managing Therapy which includes pharmacist’s interest on patient’s

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health, pharmacist’s management and responsibility for drug therapy, pharmacist’s

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determinations to ensure medication work as intended, ability to solve drug-related problems

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and to improve patient’s health.[12] Each question was scored on a Likert-type response from

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1 to 5 (poor, fair, good, very good, and excellent). The score of 100 indicates the highest

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satisfaction towards pharmaceutical care. Higher scores denoted higher satisfaction level.

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Medication adherence was tested using the Malay version of the validated 8-item

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MMAS.[13] The Malay version of the MMAS is an 8-item questionnaire with seven yes/no

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questions and one question answered on a 5-point Likert scale. The scoring system for the

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MMAS indicates that 8=high adherence, 6 to <8 = medium adherence, and <6 = low

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adherence. Patients who had a score of low and medium were considered non-adherent.

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Data analysis The results for the socio-demographic criteria, patient satisfaction and medication

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adherence scores were presented descriptively. The categorical variables were presented in

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frequencies and percentage while continuous variables were shown in mean and standard

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deviation. Association between categorical variables was determined using Chi-square or

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Fisher’s exact test whenever appropriate. Multiple logistic regression was applied to

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determine associated factors of categorical dependant variable patient satisfaction/high

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adherence (Yes/No) (outcomes) with multiple categorical independent variables (predictors).

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Backward and forward stepwise logistic regression was used for the variable under interest

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(satisfied/dissatisfied and high adherence: Yes/No) which was binary. The final model was

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obtained using the likelihood ration based on maximum likelihood estimate. Model fitness for

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final model was checked by using the Hosmer-Lemershaw test, over all classification of

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correct outcome and area under the receiver operating characteristic (ROC) curve. For

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multivariate analysis, results were presented with adjusted odds ratios with 95% CI,

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likelihood ratio test statistics and p-value. All statistical analyses were conducted using the

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statistical package, SPSS version 18.0 for Windows (SPSS Inc. Chicago, IL, 2009). The

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conventional 5% significance level was used throughout the study.

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Results

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There was almost equal participation from male and female patients. Overall, majority of the

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patients were Malay 120(72.7%), and most of the patients were from age group more than 50

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years. Further details about patient’s education and income status are shown in Table 1. Out

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of 165 patients, majority were satisfied with the service (86.7%) while 13.3% of them were

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not satisfied. The mean score for patient satisfaction was 76.8 (SD 13.8). Among the two

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dimensions, Friendly Explanation showed higher mean score (3.87 ± 0.67) compared to

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Managing Therapy (3.80 ± 0.75) (Figure 1). The mean for total PSPCQ score was 76.8 ± 13.8

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with the maximum and minimum total score of 100 and 42 respectively.

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Initial bivariate analysis showed that Malays, those who are not currently employed and those

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with no income were more satisfied to the pharmaceutical services provided during DMTAC

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(p<0.05) . However, multiple logistic regressions found that only gender and race of patients

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were associated with satisfaction to the pharmaceutical services provided during DMTAC

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(Table 2). It appears from figure 2 that majority of patients were in the group of “Low

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Adherence” (44.8%), followed by “Medium Adherence” (29.1%) and “High Adherence”

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(26.1%). Further classification was done whereby the scale of “Medium Adherence” and

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“Low Adherence” were merged into “Not High Adherence” while the “High Adherence”

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scale was retained for inferential analysis purpose (Pearson Chi-Square and Logistic

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Regression) as a dependant categorical variable.

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Initial bivariate analysis showed that none of the factors were associated with patient

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adherence (p<0.05). However, when multivariate modelling (logistic regression analysis) was

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done (Table 3), only age group, gender and education level were significantly associated with

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patient satisfaction (p<0.05).Yet, as the result showed, counselling on adherence and measure

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that can be taken to improve it should be focused on patient with primary education and no

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formal education. There is a significant (p<0.01), positive fair correlation (r=0.377) between

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the satisfaction and adherence (Table 4). The link concerning better adherence and higher

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treatment satisfaction is well documented

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Discussion The gender proportion report in this study corresponds with the gender proportion

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reported in the data from the National Diabetes Registry Record.[14] Most of the patients fall

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in age group of ≥ 60 years with the mean age of 55.5 years and it was similar as study

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presented by Ahmad et al., (2013). Prevalence of known diabetes according to the age group

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from the report of National Health and Morbidity survey also reported similar outcome of 60-

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64 years and 65-69 years of age.[2] This result was similar to the data from the National

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Diabetes Registry Record and the status of diabetes control in Malaysia.[14,15]

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Satisfaction to pharmaceutical care service delivered in DMTAC

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Overall, patients satisfaction towards pharmaceutical service provided during

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DMTAC is high with 87% patients reported feeling satisfied. The mean score was high which

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were 76.8. This is in line with other study in Malaysia in HIV patients whereby more than

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half of patients (82%) were satisfied with the pharmaceutical service provided to them during

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MTAC and scored a high mean satisfaction score of 73.65 while another study reported

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scores of patients satisfaction above average.[11,16] Satisfaction study with other chronic

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disease such as hypertension and those on long term therapy for chronic disease such as

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warfarin also reported patient satisfaction good.[17,18]

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An abundance amount of evidence as stated above showed that patient satisfaction

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score was indeed above average or high in various chronic disease. In patient satisfaction

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research area, it is not an uncommon sight where the scores are high and patients feel

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satisfied.[19] One of the oldest theories by influential sociologist Talcott Parsons on health

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and sickness which is sick role explained that generally patients tend to be quite passive and

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acquiescent unless there is some intolerable or startling circumstances occurred.[19] bivariate 8 Page 8 of 17

analysis revealed that Malay female patients were more satisfied with the DMTAC. It is

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proven that This is due to the fact that female are more sensitive to illness in which have

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greater concern for diabetes and more willing to seek medical advice besides make greater

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use of diabetes services offered to discuss medical problems.[20,21] These differences might

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lead to female being more satisfied than male. Non-Malays were also less satisfied with the

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pharmaceutical care compared to Malays (OR 0.32, 95%CI 0.12 - 0.85, p<0.05). This is in

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line with other study.[22] A study reported that majority races are more satisfied than the

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minority races.[23] However, race is not a significant predictor in other study.[16,24] This

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prompt needs to identify if there was any barriers presence in terms of language, race or

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religion that might hamper satisfaction.

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From this study, we could see that the satisfaction levels were high; only a small

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portion of patients were dissatisfied. Though not all association between satisfaction and

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socio-demographic characteristics were significant, though research showed that usually

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factors like older patients and lower education level appear to be more satisfied, this could

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always be explained by the fact that satisfaction also were determined by psychosocial

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influence.[19,25] Patient reported greater satisfaction than they actually feel as they fear that

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if they give negative feedback, they will face adverse consequences.[25]

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Adherence to antidiabetic medications

It appears that the maximum total MMAS score was 8 and the minimum score was

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1.25. The mean for total score was 5.99 ± 1.76. This result is alike to that stated in the

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literature and suggests that non-adherence to medications is a problem in chronic disease

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patients in Malaysia.[26,27] The mean score for MMAS was 5.99 while the median was 6.00

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which was comparable to study by Al-Qazaz et al. [28] Previous study showed that

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characteristics related to adherence and non-adherence tends to vary. Generally, race and

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gender have not been consistently associated with adherence level.[29,30] Then again,

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education level has been described to affect adherence to medication.[29] Likewise, in this

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study, socio-demographic characteristics such as race, marital status, employment status and

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monthly income did not define adherence level.

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Patients from the age group ≥60 years have 3.29 times the odds to highly adhere to

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medications compared to younger patients less than 50 years old (OR 3.29, 95% CI 1.10-

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9.86, p<0.05). This is consistent with another study in the country whereby patients aged ≥60

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years were significantly more compliant to treatment than younger age group.[6] It also

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reported that a decrease in age by a year increased the possibility of non-adherence by 3.4.[6]

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Another study also reported significant positive correlation between age and adherence.[31]

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Thus, adherence needs to be emphasized more in younger age group patients. Females were

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more likely to achieve high adherence to medications compared to male and this is similar

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with other studies on adherence in hypertensive patients in Malaysia.[29] Thus, attention on

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adherence to medications needs to be directed more towards male patients during DMTAC.

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Lastly, patients with secondary level of education were 2.72 times more adherence to

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medications compared to those in primary school and no formal education. This is similar in

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study with HIV patients.[16] However, other study in Malaysia showed that there was no

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significant association between education level and adherence.[32] However, those with low

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level of education they may need extra counselling support to improve their practice and

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perception towards the disease. This will assist in further improving the patient satisfaction

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and adherence to diabetic therapy. [33–35] Medication adherence is associated with higher

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treatment satisfaction.[35] Thus, this finding of significant correlation between total score of

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satisfaction and adherence support this result.

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In general, the patients were satisfied with DMTAC service provided by the

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pharmacist according to the PSPCQ score. However, majority of the patients were not highly

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adhered to their diabetes medications measured by MMAS scale. There is a need to improve

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on the area whereby patient scored were not favoured. Even though the association and

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relationship between patient satisfaction and medication adherence were only fair, it is still

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significant. It is important to incorporate satisfaction in the element of quality management

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reports about quality of the service and quality of care provided to patients.

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Acknowledgements

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The authors would like to thank the patients that participated in the study and the team

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of Diabetes Medication Therapy Adherence Clinic in all three hospitals involved. Special

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thanks to the Ministry of Higher Education Malaysia (Research Acculturation Grant Scheme)

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and UiTM for funding this project.

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References

303 304

1.

World Health Organization. 10 facts about diabetes. 2014. Available at: http://www.who.int/features/factfiles/diabetes/en/. Accessed August 3, 2014.

305 306

2.

Institute for Public Health (IPH). National Health and Morbidity Survey 2011 (NHMS 2011). Non- Commun Dis. 2011;II:188 pages.

307 308

3.

A.H.P. Paes, Bakker A, Soe-Agnie CJ. Measurement of patient compliance. Pharm World Sci. 1998;20(2):73-77.

309 310

4.

Sokol MC, Mcguigan KA, Verbrugge RR. Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost. Med Care. 2005;43(6):521-530.

311 312 313

5.

DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40(9):794-811. doi:10.1097/01.MLR.0000024612.61915.2D.

314 315 316

6.

Ahmad NS, Ramli A, Islahudin F, Paraidathathu T. Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia. Patient Prefer Adherence. 2013;7:525-530.

317 318 319 320

7.

MOH Pharmaceutical Services Division. Perkhidmatan Medication Therapy Adherance Clinic. 2013. Available at: http://www.pharmacy.gov.my/v2/ms/entri/perkhidmatan-medication-therapyadherance-clinic-mtac.html.

321 322

8.

MOH Pharmaceutical Services Division. Protocol Medication Therapy Adherence Clinic : Diabetes. First Edit.; 2010:1-24.

323 324

9.

Guldvog B. Can patient satisfaction improve health among patients with angina pectoris ? Int J Qual Heal Care. 1999;11(3):233-240.

325 326 327

10.

Biderman A, Noff E, Harris SB, Friedman N, Levy A. Treatment satisfaction of diabetic patients: what are the contributing factors? Fam Pract. 2009;26(2):102-8. doi:10.1093/fampra/cmp007.

328 329 330 331

11.

Lua Pei Lin, Ahmad Kashfi Abdul Rahman, Farah Nadia Sulaiman, Rohana Hassan, Ahmad Bakhtiar Abdul Aziz, Nor Samira Talib. The HIV MTAC: Association of Drug Adherence and Satisfaction towards Pharmaceutical Care Services. 16th Malaysian Conf Psychol Med 22-23 July 2011 Abstr Free Pap Poster Present. 2011;07(July).

332 333

12.

Larson LN, Rovers JP, Mackeigan LD. Patient Satisfaction With Pharmacuetical Care : Update of a Validated Instrument. J Am Pharm Assoc. 2002;42(1):44-50.

334 335 336 337

13.

Harith Kh. Al-Qazaz, Mohamed A. Hassali, Asrul A. Shafie SAS, Shameni Sundram DEM. The eight-item Morisky Medication Adherence Scale MMAS: Translation and validation of the Malaysian version. Diabetes Res Clin Pr. 2010;90(2):216-221. doi:10.1016/j.diabres.2010.08.012.The.

Ac ce pt e

d

M

an

us

cr

ip t

302

12 Page 12 of 17

14.

Non-Communicable Disease Section Disease Control Division. National Diabetes Registry Report.; 2012:1-48.

340 341

15.

Mafauzy M, Hussein Z, Chan SP. The Status of Diabetes Control in Malaysia : Results of DiabCare 2008. Med J Malaysia. 2011;66(3):175-181.

342 343 344

16.

Siti Noor Adila Binti Talhah. Patient satisfaction and medication adherence evaluation in HIV Medication Therapy Adherence Clinic (MTAC) Hospital Sungai Buloh. 2014:128 pages.

345 346 347 348

17.

Zyoud SH, Al-Jabi SW, Sweileh WM, Morisky DE. Relationship of treatment satisfaction to medication adherence: findings from a cross-sectional survey among hypertensive patients in Palestine. Health Qual Life Outcomes. 2013;11(1):191. doi:10.1186/1477-7525-11-191.

349 350

18.

Rodin NAK. Patient satisfaction and adherence toward warfarin therapy at warfarin medical therapy adherence clinic (MTAC) of hospitals around Klang valley. 2012.

351 352

19.

Sitzia J, Wood N. Patient satisfaction: a review of issues and concepts. Soc Sci Med 1997 Dec;45(12)1829-43. 1997;45(12):1829-43.

353 354

20.

Green K. Common illness and self-care. J Community Heal 1990; 15 329-338. 1990;15:329-338.

355 356 357

21.

Anderson R, Fitzgerald J, Oh M. The relationship between diabetes- related attitudes and patient’s self-reported adherence. 1993; 19(4): 287-29. Diabetes Educ. 1993;19(4):287-29.

358 359 360

22.

Hasyimah R, Aniza I, J AT, Jamsiah M, A AN. Factors affecting outpatients ’ satisfaction at University Kebangsaan Malaysia Medical Centre ( UKMMC ). Malaysian J Public Heal Med. 2014;14(2):77-85.

361 362 363

23.

Campbell J, Ramsay J, Green J. Age Gender socioeconomic and ethnic differences in patients assessments of primary health care Campbell 2001. Qual Health Care. 2001;10:1-6.

364 365

24.

Nora’i M, Tahir A, Nuraimy A. Does Putrajaya health clinic meet their clients expectations? Malaysian J Heal Manag. 2008;4(1):27-35.

366 367 368

25.

Hall JA, Dornan MC. Patient sociodemographic characteristics as predictors of satisfaction with medical care: A meta-analysis. Soc Sci Med. 1990;30:811-818. doi:10.1016/0277-9536(90)90205-7.

369 370

26.

Cramer JA. A Systematic Review of Adherence With Medications for Diabetes. Diabetes Care. 2004;27(August 2003):1218-1224.

371 372

27.

World Health Organization (WHO). Adherence to Long-Term Therapies - Evidence for action. WHO Libr Cat Data. 2003.

Ac ce pt e

d

M

an

us

cr

ip t

338 339

13 Page 13 of 17

28.

Kh H, Sulaiman ASA, Hassali MA. Diabetes knowledge , medication adherence and glycemic control among patients with type 2 diabetes. Int J Clin Pharm. 2011;33(6):1028-35. doi:10.1007/s11096-011-9582-2.

376 377 378

29.

Ramli A, Ahmad NS, Paraidathathu T. Medication adherence among hypertensive patients of primary health clinics in Malaysia. Patient Prefer Adherence. 2012;6:613622.

379 380 381

30.

Misra R, Lagerb J. Ethnic and gender differences in psychosocial factors, glycemic control, and quality of life among adult type 2 diabetic patients. J Diabetes Complicat. 2009;23(1):54-64.

382 383 384

31.

Jamous RM, Sweileh WM, Abu-Taha AS, Sawalha AF, Zyoud SH, Morisky DE. Adherence and satisfaction with oral hypoglycemic medications: a pilot study in Palestine. Int J Clin Pharm. 2011;33(6):942-8. doi:10.1007/s11096-011-9561-7.

385 386

32.

Chua SS, Chan SP. Medication adherence and achievement of glycaemic targets in ambulatory type 2 diabetic patients. J Appl Pharm Sci. 2011;01(04):55-59.

387 388 389

33.

Blonde L, Dey J, Testa MA, Guthrie RD. Defining and measuring quality of diabetes care. Prim Care - Clin Off Pract. 1999;26:841-855. doi:10.1016/S00954543(05)70134-2.

390 391

34.

Finkel ML. The importance of measuring patient satisfaction. Empl Benefits J. 1997;22:12-15.

392 393 394

35.

Franciosi M, Pellegrini F, De Berardis G, et al. Correlates of satisfaction for the relationship with their physician in type 2 diabetic patients. Diabetes Res Clin Pract. 2004;66:277-286. doi:10.1016/j.diabres.2004.03.009.

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Table 1: Patient socio-demographics information n (%)

Gender

Male Female

81 (49.1) 84 (50.9)

<40 40-49 50-59 ≥60

17 (10.3) 20 (12.1) 62 (37.6) 66 (40.0)

Malay Chinese

120 (72.7) 39 (23.6)

Age group

Race

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Indian Others

5 (3.0) 1 (0.6)

Married Single

151 (91.5) 14 (8.5)

Education level No formal education Primary Secondary College/University

11 (6.7) 43 (26.1) 91 (55.2) 20 (12.1)

Employment status Employed Unemployed

72 (43.6) 93 (56.4)

us

cr

ip t

Marital Status

d Ac ce pt e

401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416

61 (37.0) 87 (52.7) 14 (8.5) 3 (1.8)

M

No income <3000 3000-5000 >5000

an

Monthly income

Table 2: Factors associated with patient satisfaction, using multivariate analysis (N=165) Variable

Crude ORa (95% CI)

Adjusted ORb (95% CI)

Wald statisticsb (df)

p-valueb

1 3.03 (1.12, 8.24)

4.739 (1)

0.029*

Gender

Male 1 Female 2.50 (0.96, 6.50)

Race

417

Malay 1 1 5.257 (1) 0.022* Others 0.39 (0.16, 0.98) 0.32 (0.12, 0.85) a simple log regression b multiple log regression *p-value is significant at the 0.05 level

418 419 15 Page 15 of 17

420 421 422

Table 3: Factors associated with adherence to medications, using multivariate analysis Variable

Crude ORa (95% CI)

Adjusted ORb (95% CI)

1 2.11 (0.75, 5.93) 2.09 (0.75, 5.81)

1 2.75 (0.94, 8.03) 3.29 (1.10, 9.86)

1 1.92 (0.94, 3.93)

2.33 (1.10, 4.93)

Wald statisticsb (df)

p-valueb

3.422 (1)

0.064

≥60 Gender Male Female

0.028*

an

M d Table 4: Spearman Rank Order Correlations between two dimensions of patient satisfaction and MMAS total score Dimension

Friendly Explanation Managing Therapy

435 436 437

4.853 (1)

1 1 0.025* 5.019 (1) 2.72 1.86 (1.13, 6.55) (0.82, 4.22) 0.1 2.703 (1) 2.85 1.89 College/University (0.82, 9.93) (0.58, 6.12) a simple log regression b multiple log regression *p-value is significant at the 0.05 level

Ac ce pt e

423 424 425 426 427 428 429 430 431 432 433 434

0.033*

us

Education level None or primary Secondary

4.537 (1)

cr

<50 50-59

ip t

Age group

Total score MMAS Spearman’s rho, r 0.363 0.370

p 0.00 0.00

*Correlation is significant at the 0.01 level

16 Page 16 of 17

ip t cr us

an

Fig. 1. Mean satisfaction score for PSPCQ dimension.

445 446 447 448

Ac ce pt e

d

M

438 439 440 441 442 443 444

Fig. 2. Distribution of patients based on adherence level.

17 Page 17 of 17