Journal of Research in Pharmacy Practice

Adherence to prescribed medications of Iranian traditional medicine in a group of patients with chronic disease

Authors

. Fataneh Hashem Dabaghian 1
. Maryam Rassouli 2
. Jila Sadighi 3
. Roshanak Ghods 4

1 Department of Research, Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran

2 School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran

4 Iranian Traditional Medicine, Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran

Abstract
Objective: The extent to which a person’s health‑related behavior corresponds with 
medical instructions (adherence) is an important modifier of health system effectiveness. 
This study was designed to determine the patients’ adherence to Iranian traditional 
medicine in a group of patients with chronic disease.
Methods: Convenience sampling was used to enroll 320 patients with chronic diseases 
from January 2014 to January 2015 in clinics of traditional medicine affiliated with 
medical universities in Tehran. Morisky Medication Adherence Scale (MMAS) was 
used to measure the adherence. After describing the variables and the frequency of 
adherence, logistic regression analysis was used to determine the influencing factors.
Findings: Mean age was 40.8 (standard deviation [SD] =13) years. The mean of the 
duration of disease was 54.6 (SD = 56.1) months and mean of the duration of referring to 
the clinics 6.5 (SD = 6.9) months. Total score of MMAS was zero in 33 (10.3%) of patients 
(high adherence), one or two in 128 (40%) of patients (moderate adherence), and more 
than two in 159 (49.7%) of patients (low adherence). Forgetfulness, bad taste, not 
availability, and the high cost of the drugs were the most commonly reported causes of 
non‑adherence. Adherence was associated with age(odds ratio[OR] =1.05, 95% confidence 
interval [95% CI] 1–1.1), marriage (OR = 10.8, 95% CI 2.05–57.6), number of prescribed 
drugs (OR = 0.05, 95% CI 0.02–0.14), and duration of disease (OR = 1.01, 95% CI 1–1.02).
Conclusion: Considering the low adherence in users of medications of Iranian traditional 
medicine, health care practitioners need to be trained in adherence and the influencing 
factors and also to use some interventions to increase the adherence.

Keywords

Adherence
compliance
Iran
traditional medicine
  1. Sabaté E. Adherence to Long‑Term Therapies; Evidence for 
    Action. Geneva: World Health Organization; 2003. p. 3, 28.
  2. 2. Bani Asad MH, Pana MV, Hemmati M. Studying the belief of 
    borderline personality disorder patient about the necessity of 
    medication and the role of demographic factors in adherence 
    to treatment. Am J Appl Psychol 2014;2:104‑8.
    3. Morisky DE, Ang A, Krousel‑Wood M, Ward HJ. Predictive 
    validity of a medication adherence measure in an outpatient 
    setting. J Clin Hypertens (Greenwich) 2008;10:348‑54.
    4. Burnier M, Santschi V, Favrat B, Brunner HR. Monitoring 
    compliance in resistant hypertension: An important step in 
    patient management. J Hypertens Suppl 2003;21:S37‑42.
    5. Lagi A, Rossi A, Passaleva MT, Cartei A, Cencetti S. 
    Compliance with therapy in hypertensive patients. Intern 
    Emerg Med 2006;1:204‑8.
    6. Nuesch R, Schroeder K, Dieterle T, Martina B, Battegay E. 
    Relation between insufficient response to antihypertensive 
    treatment and poor compliance with treatment: A prospective 
    case‑control study. BMJ 2001;323:142‑6.
    7. Smith WE. Role of a pharmacist in improving rational drug 
    therapy as part of the patient care team. Ann Pharmacother 
    2007;41:330‑5.
    8. DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient 
    adherence and medical treatment outcomes: A meta‑analysis. 
    Med Care 2002;40:794‑811.
    9. Cunico C, Picheth G, Correr CJ, Scartezini M. Assessing 
    the adherence to and the therapeutic effectiveness of 
    hypolipidemic agents in a population of patients in Brazil: 
    A retrospective cohort study. Pharm Pract (Granada) 
    2014;12:378.
    10. Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki 
    RT, Varney J, et al. A meta‑analysis of the association between 
    adherence to drug therapy and mortality. BMJ 2006;333:15.
    11. Mar J, Rodríguez‑Artalejo F. Which is more important for the 
    efficiency of hypertension treatment: Hypertension stage, type 
    of drug or therapeutic compliance? J Hypertens 2001;19:149‑55.
    12. Horne R, Weinman J. Patients’ beliefs about prescribed 
    medicines and their role in adherence to treatment in chronic 
    physical illness. J Psychosom Res 1999;47:555‑67.
    13. Dunbar‑Jacob J, Erlen JA, Schlenk EA, Ryan CM, Sereika SM, 
    Doswell WM. Adherence in chronic disease. Annu Rev Nurs 
    Res 2000;18:48‑90.
    14. Morisky DE, Green LW, Levine DM. Concurrent and 
    predictive validity of a self‑reported measure of medication 
    adherence. Med Care 1986;24:67‑74.
    15. Cramer JA. A systematic review of adherence with medications 
    for diabetes. Diabetes Care 2004;27:1218‑24.
    16. Barreto Mda S, Reiners AA, Marcon SS. Knowledge about 
    hypertension and factors associated with the non‑adherence 
    to drug therapy. Rev Lat Am Enfermagem 2014;22:491‑8.
    17. Heydari A, Ziaee ES, Gazrani A. Relationship between 
    awareness of disease and adherence to therapeutic regimen 
    among cardiac patients. Int J Community Based Nurs 
    Midwifery 2015;3:23‑30.
    18. Shalansky SJ, Levy AR, Ignaszewski AP. Self‑reported Morisky 
    score for identifying nonadherence with cardiovascular 
    medications. Ann Pharmacother 2004;38:1363‑8.
    19. Erickson SR, Coombs JH, Kirking DM, Azimi AR. Compliance 
    from self‑reported versus pharmacy claims data with 
    metered‑dose inhalers. Ann Pharmacother 2001;35:997‑1003.
    20. Al‑Qazaz HK, Hassali MA, Shafie AA, Sulaiman SA, Sundram 
    S, Morisky DE. The eight‑item Morisky Medication Adherence 
    Scale MMAS: Translation and validation of the Malaysian 
    version. Diabetes Res Clin Pract 2010;90:216‑21.
    21. Sakthong P, Chabunthom R, Charoenvisuthiwongs R. 
    Psychometric properties of the Thai version of the 8‑item 
    Morisky Medication Adherence Scale in patients with type 2 
    diabetes. Ann Pharmacother 2009;43:950‑7.
    22. Wang Y, Lee J, Toh MP, Tang WE, Ko Y. Validity and reliability 
    of a self‑reported measure of medication adherence in patients 
    with type 2 diabetes mellitus in Singapore. Diabet Med 
    2012;29:e338‑44.
    23. Tzeng JI, Chang CC, Chang HJ, Lin CC. Assessing analgesic 
    regimen adherence with the Morisky Medication Adherence 
    Measure for Taiwanese patients with cancer pain. J Pain 
    Symptom Manage 2008;36:157‑66.
    24. Osterberg L, Blaschke T. Adherence to medication. N Engl J 
    Med 2005;353:487‑97.
    25. Hashem Dabaghian F, Karbakhsh M, Soheilikhah S, Sedaghat 
    M. Drug compliance in type 2 diabetic patients. Payesh 
    2006;4:103‑11.
    26. Gottlieb S, Behar S, Schwartz R, Harpaz D, Shotan A, Zahger D, 
    et al. Age differences in the adherence to treatment guidelines 
    and outcome in patients with ST‑elevation myocardial 
    infarction. Arch Gerontol Geriatr 2011;52:118‑24.
    27. Tiv M, Viel JF, Mauny F, Eschwège E, Weill A, Fournier C, et 
    al. Medication adherence in type 2 diabetes: The ENTRED 
    study 2007, a French population‑based study. PLoS One 
    2012;7:e32412.
    28. Donnan PT, MacDonald TM, Morris AD. Adherence to 
    prescribed oral hypoglycaemic medication in a population 
    of patients with type 2 diabetes: A retrospective cohort study. 
    Diabet Med 2002;19:279‑84.
    29. Sohi H, Sultana Y, Khar RK. Taste masking technologies in 
    oral pharmaceuticals: Recent developments and approaches. 
    Drug Dev Ind Pharm 2004;30:429‑48.
    30. Fairman K, Motheral B. Evaluating medication adherence: 
    Which measure is right for your program? J Manag Care 
    Pharm 2000;6: 499-506.
    31. Grymonpre RE, Didur CD, Montgomery PR, Sitar DS. Pill 
    count, self‑report, and pharmacy claims data to measure 
    medication adherence in the elderly. Ann Pharmacother 
    1998;32:749‑54.
    32. Gordis L, Markowitz M, Lilienfeld AM. The inaccuracy in 
    using interviews to estimate patient reliability in taking 
    medications at home. Med Care 1969;7:49‑54.
    33. Anonymous. Just what the doctor ordered; a system approach 
    to assessing patient adherence. USA: Pfizer Medical Education 
    Group; 2008. Available from: http://www.ipmameded.org/
    media/46347/adherence.pdf.
    34. Ravi S, Nasiri Toosi M, Karimzadeh I, Ahadi‑Barzoki M, 
    Khalili H. Adherence to chronic hepatitis C treatment 
    regimen: First report from a referral center in Iran. Hepat Mon 
    2013;13:e11038.
    35. Nieuwkerk PT, Oort FJ. Self‑reported adherence to 
    antiretroviral therapy for HIV‑1 infection and virologic 
    treatment response: A meta‑analysis. J Acquir Immune Defic 
    Syndr 2005;38:445‑8.
Journal of Research in Pharmacy Practice
Volume 5, Issue 1
Winter 2016
Pages 52-57

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