Development of tools to measure prescription quality and medication compliance in adult hypertensive patients
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Date
2008
Authors
Hassan, Norul Badriah
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Abstract
The objectives of this thesis were to develop and validate new tools to measure
prescription 9uality, medication compliance, and psychosocial factors contributing to
non-compliance. These tools are to be used as quality measurement from the perspectives
of clinicians, pharmacists and patients.
The Prescription Quality Index (PQI) was developed based on three separate surveys and
piloted in 120 patients with chronic illnesses and 240 patients with hypertension. The
Medication Compliance Questionnaire (MCQ), Patient Satisfaction with Health Care
Questionnaire (PSHC) and Psychosocial Questionnaire (PQ) were developed and
validated in two separate pilot studies of 60 hypertensive patients each. A cohort study
was then conducted for six months in patients with hypertension. Prescriptions were rated
retrospectively and questionnaires were self-administered by patients. Results were
analyzed using SPSS version 12.0.1.
The PQI displayed Cronbach's alpha of 0.60 and range of intra-rater and inter-rater
reliability were 0.28 to 0.97 (average: 0.76) and 0.22 to 0.82 (average: 0.52) respectively.
The Cronbach's alpha for the MCQ were 0.67 and 0.84 with test-retest values of 0.78 and
0.93. For the PSHC, the Cronbach's alpha ranged from 0.76 to 0.91 and test-retest ranged
from 0.54 to 0.70. The Cronbach's alpha for the PQ ranged from 0.42 to 0.87 with testretest
value of0.53 to 0.77.
A total of 184. patients completed the study with seven patients lost to follow-up.
Tertiary education (OR=O.ll; 95% CI:0.03 to 0.43; p=O.OOI), number of drugs
(OR=l.96; 95% CI:l.46 to 2.64; p<O.OOI), duration of hypertension (OR=l.Ol; 95%
CI:l.OO to 1.01; p=0.009), and patients' lifestyle (OR=0.96; 95% Cl:0.93 to 0.99;
p=0.004) have been identified as significant and independent factors associated with
prescription quality.
Patients' tertiary education (OR=0.22; 95% CI:0.06 to 0.86; p=0.029), overall satisfaction
with health care (OR=0.95; 95% CI:0.91 to 0.98; p=0.006), medication barrier (complex
regime, cost, and effectiveness) (OR=0.92; 95% CI:0.86 to 0.97; p=0.006), and logistic
and transportation barrier (OR=1.03; 95% CI:l.Ol to 1.05; p=0.017), were identified as
independent and significant factors associated with medication non-compliance.
In conclusion, this thesis has generated four new tools with moderate to good
psychometric properties to be used in patient care and for clinical or epidemiological
studies. Factors associated with good prescription quality were higher education, lesser
number of drugs, shorter duration of hypertension and healthier lifestyle. Psychosocial
predictors of medication non-compliance were patient education, patient satisfaction,
medication barrier, and logistic and transportation barrier. Future studies in other disease
states and populations are highly recommended.
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Keywords
Prescription quality , Hypertensive patients