Type-2 diabetes mellitus and evaluation of medication adherence in chronic disease care

Objectives: Diabetes is one of the oldest chronic disease that causes major morbidity and mortality in developed and developing countries. When considering the increased risk of morbidity and mortality; it is seen that chronic disease care has an important role in health care delivery in primary care. Therefore, various models have been developed for the management of chronic diseases in primary care. Especially, according to Chronic Care Model that recommended for primary health care; evaluation from the patient perspective is an important part of the health care. Low medication adherence in long-term treatment of chronic diseases is a big and increasing problem worldwide. Also, it is the most common reason of not achieving the potential benefits of the drug. In our study, we aimed to assess chronic disease care and medication adherence from the patient perspective in patients with Type 2 Diabetes Mellitus. Material and Methods: A total of 150 patients with type 2 diabetes included to our study who were admitted to polyclinics of Ankara Atatürk Education and Research Hospital between in November 2015 and October 2015 and these patients were receiving medical treatment for at least 6 months. A survey designed to check the status and sociodemographic characteristics and drug use, Care for Chronic Disease Assessment Scale ( Turkish version of PACIC ) and Morisky Medication Adherence Scale(MMAS-8) was administered to the included patients. The data obtained from this study were analyzed using SPSS 20 software package. Student t test, chi-square test, One Way ANOVA test, Mann-Whitney U test, Pearson correlation analysis, Spearman correlation analysis was applied for evaluating the data. p<0.05 was taken for the level of significance during the interpretation outcomes. Results: Sociodemographic characteristics of our study group includes 56% female and 44% male. The mean age of the patients was 57.27±11,5, 78% of the patients are married and 37,3% are not paid. The average duration of diabetes was 8,9±7,7 years. 42.7% of the patients have diabetes check-ups every three months and 33,3% have diabetes check-ups every six months. 52.7% of the patients had not received any training related to diabetes from health personnel. PACIC average total score was 2.91±1. As in the most similar studies, the highest score has been reached in decision support subscale (3,09±1,2) and the lowest score has been reached in follow-up/coordination subscale (2,74±1). MMAS-8 average score was 5,53±2,1. When patients are examined individually, we reached the conclusion that 24% of patients have high medication adherence, 31,3% of patients have medium medication adherence, and 44,7% of patients have the low medication adherence. Medication adherence was reduced when the frequency of daily insulin use increases. No correlation was found between the total scores of patients' PACIC and MMAS-8. Conclusion: According to the results of the tools (PACIC, MMAS-8) we used in this study; chronic disease care and the medication adherence is not sufficient. We believe that both patients and the medical staff should pay more attention to the absence of adequate levels of medication adherence and chronic disase care. The assessment of chronic disease care and medication adherence in patients with diabetes is significant and previously not investigated issue and it seems to be clear that more studies are needed to clarify the matter. Keywords: Type 2 Diabetes Mellitus, Chronic Care Model, Medication adherence, Family Medicine