CHAPTER ONE
INTRODUCTION
1.1 Background
Medication non-compliance defined here as the failure to take medications as prescribed, is
arguably one of the largest behavioral challenges facing the health care system today
(Osterberg and Blaschke, 2005). Currently, the most commonly used approaches of
determining medication non-compliance include self-report, pill counts, biological drug
levels, pharmacy refill data, and electronic pill bottles, each of which has shortcomings
(Osterberg and Blaschke, 2005). Although self-reports of medication non-adherence can be
easily to obtained, both informally or through use of standardized instruments such as the
Morisky scale (Morisky et al., 2008), the accuracy of this approach is often questioned due to
significant underreporting (Ho et al., 2009; Mann et al., 2010). Pill counting, a more objective
measure, tends to be more time consuming and fails to capture nuances of medication taking
behavior (Cramer et al., 1989; Osterberg and Blaschke, 2005). Biological surrogates, such as
blood and urine drug levels or intermediate indices like serum cholesterol or glycosylated
hemoglobin that reflect the target of medications, are more costly and have limited
applicability to the broad range of medications that are commonly used (Osterberg and
Blaschke, 2005; Parris et al., 2005).
In recent years, the availability of large databases of insurance claims and pharmacy refills
has given rise to new methods for detecting non-adherence. These include measures such as
the medication possession ratio, calculated by dividing the total number of doses dispensed by
the total number of doses that should have been taken during the days monitored (Taira et al.,
2006; Chan et al., 2010). To date, however, there exist considerable infrastructural barriers in
applying this methodology to individual patients, given that closed pharmacies and
centralized electronic medical records are only available in a limited number of integratedhealthcare systems (Ho et al., 2009). A more promising approach is the use of devices such as
electronic pill bottles, which are able to capture each instance of medication taking behavior
and allow the analysis of processes by which behavioral tendencies to adhere or not are
established (Osterberg and Blaschke, 2005; Rieckmann et al., 2006). Although the
effectiveness of this method is now well-proven in research settings, issues of cost, ease of
use, and patient acceptance remain barriers for more wide-spread clinical
application.medications for specific conditions, there should also be more emphasis on
elucidating potential behavioral patterns of nonadherence that persist across medication
classes. Medication noncompliance results in approximately 125,000 preventable deaths a
year globally (Jimmy, Jose 2011).
Medication compliance in medical management of cardiovascular disease is vital. Patients
with acute coronary syndrome who do not adhere to their medication have threefold the
likelihood of death of patients who adhere to prescriptions (Ruppar, Cooper, Mehr, Delgado,
Dunbar‐Jacob 2016). Poor compliance with heart failure drugs is associated with an increased
number of cardiovascular-related emergency-department visits and inpatient hospital days.
Heart Failure and poor medication adherence are often associated with high morbidity and
mortality and poor quality of life. An 80% compliance rate is needed for optimal therapeutic
efficacy. However, with chronic medication, compliance is around 50% (Wu, Lennie, Chung,
et al.,2012). This is mainly due to poor access to medication, poor health-care services, and
lack of knowledge of medication and diagnosis(Van See Wal, Jaarsma, et al.,2005). In Africa,
medication nonadherence is reported as high at 62.5%. The prevalence of non-adherence to
Antiretroviral therapy was 22.5% based on the Community Program for Research on AIDS
index and 34.9% based on the Centre for Adherence support Evaluation index, Independent
determinants of diagnosed non-adherence were as follows: being a remunerated employee
(odds ratio 95%), Pentecostal Christianity, alcohol consumption.
1.2 Problem Statement
Medication non-compliance has led to death in many patients. Patients who don’t have
adequate knowledge on medication non-compliance may be at risk of resistance for the drugs
through their choices. Factors affecting noncompliance with medication: scarcity of
knowledge, patients’ negative attitudes, poor family support, financial constraints,
forgetfulness, irregular clinic attendance, heavy alcohol use, and alternative treatment vs
pharmaceutical medication. Noncompliance with medication in cardiac patients contributes to
worsening cardiac disease and premature deaths. For factors related to noncompliance,
awareness can be raised in clinics for patients to realize the effects of noncompliance and
provide ways to improve compliance. Providing professional counseling services for all
patients would greatly help in increasing compliance with medication.
1.3 Rational
This study aims to explore medication-taking decisions that may underpin intentional
medication non-adherence behaviour amongst a hospital sample and the relative importance
of medication specific factors and patient background characteristics contributing to those
decisions.
1.4. Research Questions
1. What knowledge do patients have about the consequences of medication non
compliance in the Solidarity Clinic Molyko
2. What challenges do patients face towards medication compliance in the Solidarity
Clinic Molyko 1.5. Objectives of The Research
1.5.1 General Objective
To asses the knowledge of patients on the consequences of medication non-compliance in the
solidarity clinic Buea
1.5.2. Specific Objectives
1. To assess patient’s knowledge on the consequences of medication non-compliance
2. To determine the challenges face by patients towards medication compliance
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