Appropriateness of chronic asthma management and medication adherence in patients visiting ambulatory clinic of Gondar University Hospital: a cross-sectional study

Abstract

BackgroundAlthough asthma cannot be cured, appropriate management can ensure adequate control of the disease, prevent disease progression and even reverse the illness, enabling people to enjoy good quality of life. Predisposing factors for inappropriate asthma management, including limited diagnostic options and inadequate supply of medications, are features of health institutions in developing countries like Ethiopia. This study was launched to determine the appropriateness of asthma management in patients visiting ambulatory clinic of the Gondar University Hospital.MethodsCross-sectional study was conducted on asthmatic patients who were on chronic follow-up at Gondar University Hospital. Data were collected by review of patients’ medical records and through a semi-structured questionnaire. The Global Initiative for Asthma guideline was used as a reference for determining the appropriateness of asthma management whereas the eight-item Morisky medication adherence scale (MMAS-8) was used to collect data on patients’ adherence to asthma medications.ResultsThe study participants’ ages ranged from 20 to 80 years with a mean age of 49.3 ± 13.6 years. Mild asthma showed a slight predominance in frequency accounting for 38.7% of cases. Asthma management was found to be inappropriate in 52.0% of the patients. Inappropriateness of therapy is attributed to incorrect dosing of medications, addition of unnecessary medications and omission of necessary medications. Patients who had moderate asthma were more likely to receive appropriate treatment [AOR = 728: 63.2, 8386.06], whereas having a treatment regimen of beclomethasone with salbutamol was found to be predictor of inappropriate treatment [AOR = 0.004: 0.001, 0.07]. More than half (56.7%) of the study subjects reported to have high adherence to their medications. Having no formal education was a predictor of low adherence to asthma medications [AOR = 0.051: 0.003, 0.978] whereas, increased monthly income was found to have a positive association with adherence [AOR = 1.923: 1.037, 3.566].DiscussionHigh prevalence of inappropriate therapy in this study may be attributed primarily to limited accessibility of asthma medications, as 86% of the patients received medium dose beclomethasone with salbutamol for exacerbations despite being at different severity of asthma and level of control.ConclusionThe findings of the study showed more than half of asthmatic patients received inappropriate treatment. Nevertheless, a larger proportion of the patients claimed to be highly adherent to their medications.

Factors That Influence Adherence to Medication in Adults With Congenital Heart Disease (ACHD)

“…Adherence to medication has already been examined in chronic diseases and cardiac diseases other than congenital heart disease. In these studies, non-adherence was predicted by disease severity, lower education, smoking, and psychiatric comorbidities such as depression and anxiety disorders (17)(18)(19)(20)(21). However, in adults with congenital heart disease, non-adherence to medication has not been evaluated before.…”

Non-adherence to inhaled medications among adult asthmatic patients in Ethiopia: a systematic review and meta-analysis

“…Although several studies have been published on the prevalence and associated factors of non-adherence to inhaled medications among adult asthmatic patients in Ethiopia [18][19][20][21][22][23], the general prevalence remains unknown. Therefore, the primary purpose of this systematic review and meta-analysis is to determine the pooled national prevalence of non-adherence to inhaled medications among adult asthmatic patients in Ethiopia.…”

Adherence to anti-asthma medications among adult asthmatic patients in Eastern Ethiopia: A multi-center cross-sectional study

“…In Ethiopia, adherence to anti-asthmatic medication was reported to be 56.7% in Gondar town [ 12 ], and 49.4% in Addis Ababa City [ 13 ]. However, according to a recent systematic review and meta-analysis results, nearly 30% of asthmatic patients in Ethiopia have poor adherence to anti-asthmatic medications [ 14 ].…”

“…However, only a few studies elucidate the extent of adherence to anti-asthmatic medications among asthma patients. Furthermore, these studies only focused on a patient’s level of adherence to specific types of treatment regimens; inhalation medications [ 13 , 15 ], inadequate sample size and conducted at a single health facility [ 10 , 12 , 17 ] yielding unrepresentative data. Therefore, the current study was conducted at six different hospitals with adequate sample size, and includes all types of anti-asthmatic medications to assess the level of adherence to anti-asthmatic medications and associated factors among asthmatic patients attending governmental hospitals in Eastern Ethiopia.…”