AN INTERVENTION STUDY ON MEDICATION ADHERENCE AND CLINICAL OUTCOME AMONG TYPE 2 DIABETIC PATIENTS IN A TERTIARY HEALTH FACILITY NIGERIA
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ABSTRACT
Diabetes is one of the leading causes of morbidity and mortality in adults globally. Type 2 diabetes is a disease associated with a huge burden of medication non-adherence due to complex regimens leading to complications that further increase morbidity and mortality among this population. The aim of this study was to assess medication adherence and the impact of mobile phone short message service (SMS) reminders on clinical outcome among type 2 diabetic patients in IBB Specialist Hospital Minna, Niger State Nigeria. A prospective intervention study with a control arm comparing standard of care with standard of care plus SMS reminders was conducted. The sample consisted of 423 patients with type 2 diabetes that were randomly sampled and assigned to two groups; an intervention group (n=213) and the control group (n=210). Morisky 8-Medication Adherence Scale (MMAS) was used to assess the medication adherence of patients. The SMS reminders were sent by the principal investigator thrice weekly for three months; the control group did not receive any SMS reminders. For three successive months FBS levels were recorded for both the intervention and control groups and compared to baseline. The collected data was categorized, coded and analyzed using Statistical Package for Social Sciences (SPSS) version 20 (SPSS Inc, Chicago, Illinois, USA). Chi-square test was used to ascertain associations between adherence to diabetic medication and patient related, medication related and disease related factors. Paired t-test was used to compare baseline and post intervention FBS levels. A P-value of less than 0.05 was considered statistically significant for this study. The result of the study showed that only about 15% of patients had good adherence to medication, the others range between the poor (10.7%) and non-adherent (74.3%) categories. The intervention group had significant reduction in FBS levels (P < 0.05) with a mean reduction of 1.3mmol/l compared to the control group in which there was no reduction in ix FBS (P > 0.05). It was concluded that medication adherence among type 2 diabetic patients in this study setting was suboptimal and intervention using mobile phone short message service (SMS) reminders slightly improves clinical outcome (FBS).
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