Determinants of Treatment Adherence and Health Outcomes in Patients With Type 2 Diabetes and Hypertension in a Low-Income Urban Agglomerate in Delhi, India: A Qualitative Study

Abstract

BackgroundDiabetes and hypertension (HTN) are increasing threats to global public health. Despite evidence of effective management of diabetes and HTN by medications that help in the prevention and reducing mortality of the disease, a large proportion of people either remain undiagnosed or untreated, especially in low-resource countries. This study was conducted to explore the patient treatment pathway and their health-seeking behavior in a low-income urban area. MethodologyWe conducted 45 in-depth interviews of adult patients affected by type 2 diabetes mellitus (DM) and/or HTN on treatment for at least two years and attended the weekly clinic catering to an urban resettlement colony in the Northeast district of Delhi. Interviews were conducted and transcribed into Hindi and translated into English. Data analysis was done using Microsoft Excel. The patient treatment pathways were mapped, and their health-seeking behavior, treatment adherence, and experiences were described. ResultsMost patients reported taking treatment from the government primary health facilities due to optimal healthcare accessibility as the prescribed drugs for DM/HTN control were available free of cost at these healthcare facilities. Those who visited private facilities thought of shorter waiting times and the quality of drugs. Patients also had little knowledge of complications of diabetes and hypertensive disorders. Nearly 25% of patients had poor adherence to the medications, and lifestyle modification was rarely practiced by patients although they were aware of the same. ConclusionsExpanding the role of community health workers or volunteers in providing information on noncommunicable diseases might help improve patient treatment pathways to care.

Factors influencing medication adherence in co-morbid hypertension and diabetes patients: A scoping review

“… economic resources to travel for consultation, Have support from their families or close acquaintances, 43 N/A N/A N/A Positive beliefs about medication, stronger perceived medication-specific social support N/A 38 Pharmacist N/A Medication Therapy management None N/A 29 Provider patient relationship, frequency of visits, availability of medicine, medication cost N/A number of medicines, side effects, therapy duration inadequate knowledge about therapy. social support 30 Outpatient clinic visits, phone calls and emails, N/A Number of medications smoking status insurance product 39 N/A N/A N/A Male low income and employment 44 N /A N/A N/A Forgetfulness of therapy Family support through reminders 49 Attendance to a Health center Presence of comorbidities N/A Substance use, level of education Lack of financial resources (extreme poverty) 41 N/A N/A N/A higher education, tobacco use N/A 23 Nurses and physicians involved in home tele intervention and a certified diabetes educator. N/A N/A N/A N/A N/A: Not Available.…”

“…Patient related factors that impacted on medication adherence included sex of patient 36 , 37 , 39 , 40 , age of patient, 24 , 35 , 37 level of education, 13 , 36 , 37 , 40 , 41 mental health factors 42 , 43 , previous hospitalization 27 , belief of medication 14 , 43 ,substance and tobacco use, 13 , 30 , 41 forgetfulness of therapy 44 ,level of knowledge about their health condition and therapy 29 , 32 and perception of quality of life. 45 …”

“…Health insurance, 30 , 36 lack of financial resources 13 , 46 , employment status 39 , 40 , societal norms, 17 social support, 29 , 32 , 47 monthly expenditure on medications, 16 Medication Costs 29 ,mode of payment for medical bills 35 , low income 39 ,economic resources to travel for consultation, 32 have support from their families or close acquaintances, 32 family support through reminders 44 were the socio-economic factors associated with medication adherence among individuals with comorbid hypertension and diabetes.…”

“… 62.5 30 Characteristics of Patients with Primary Non-adherence to Medications for Hypertension, Diabetes, and Lipid Disorders United states of America Retrospective Cohort study proportion of days covered (PDC) Adherence was calculated using the proportion of days covered (PDC) 7% N/A We recommend that healthcare systems pursue directly linking orders with dispensed prescriptions 54.5 39 Factors Associated with Antihypertensive Medication Adherence among Diabetic Patients with Coexisting Hypertension in a Tertiary Care Centre from a Low Middle Income South Asian Country Sri Lanka Cross-sectional study Self-report modified MASES (Medication Adherence Self Efficacy Scale) questionnaire 53.3%(Males) 38.5%(Females) N/A Prescribers to consider patients socio demographic factors such as gender, income, and occupation when choosing the appropriate pharmaceutical agents to control hypertension. 75 44 Determinants of Treatment Adherence and Health Outcomes in Patients with Type 2 Diabetes and Hypertension in a Low-Income Urban Agglomerate in Delhi, India: A Qualitative Study India Qualitative study Self-report Morisky, Green and Levine Adherence 73% N/A Expanding the role of community health workers or volunteers in the prevention and treatment of NCDs and including information regarding nonpharmacological interventions in health promotion packages might help to improve treatment outcomes, adherence, and patient treatment pathways to care. 60 13 Magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Ethiopia during the COVID-19pandemic Ethiopia Cross-sectional study Self-report Morisky Medication Adherence Scale 28% N/A All concerned health authorities should take into account, and set multidisciplinary strategies to prevent impacts of the COVID-19 pandemic on medication adherence of patients with chronic illnesses.…”

Evaluation of adherence to pharmacological treatments by undocumented migrants with chronic diseases: a 10-year retrospective cohort study

“…On the basis of our observations, better PCC is needed to obtain better MA for patients belonging to the poorest segments of western countries populations as undocumented migrants. Since we can assume that they appreciate easily accessible consultations and free dispensations of appropriate treatments,43 in the absence of involvement by health authorities, it is advisable that voluntary healthcare providers involved in the cure of these patients make every effort to implement better PCC. These can include, for example, family assistance when a family is present,44 and bundle format interventions including patient education and follow-up phone calls which are known to be effective also for patients with mental disorders 45…”