Drug therapy problems, medication adherence and treatment satisfaction among diabetic patients on follow-up care at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Autoři: Gebre Teklemariam Demoz aff001;  Alemseged Beyene Berha aff002;  Minyahil Alebachew Woldu aff002;  Helen Yifter aff003;  Workineh Shibeshi aff002;  Ephrem Engidawork aff002
Působiště autorů: Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Aksum University, Aksum, Ethiopia aff001;  Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia aff002;  Department of Internal Medicine, School of Medicine, College of Health, Sciences Addis Ababa University, Addis Ababa, Ethiopia aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222985



Patients with diabetes are at high risk of drug therapy problems (DTPs), as they are receiving multiple medications. To date, studies regarding DTPs in patients with diabetes in Ethiopia are limited. The aim of this study was to assess prevalence of DTPs, medication adherence and treatment satisfaction of patients with diabetes at Tikur Anbessa Specialized Hospital (TASH).


A cross-sectional study was conducted on randomly selected 418 participants who fulfilled the inclusion criteria. Data were collected using structured questionnaire and patients’ chart review. Cipolle’s classification system was used to determine DTPs. Modified Morisky’s Adherence Scale (MMAS-8) was used to measure patients’ adherence to their medication. Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) patient satisfaction assessment questionnaire was used to assess patients’ treatment satisfaction.


A total of 207 DTPs in 177 (42.3%) of participants were identified. Commonly identified DTPs were dosage too low (58, 28.0%), ineffective drug therapy (54, 26.1%), and need additional drug therapy (52, 25.1%). Factors associated with DTPs were female gender (Adjusted Odds Ratio [AOR] = 2.31,95% CI:1.30–4.12); ≥3comorbidities (AOR = 3.61, 95% CI:1.19–10.96); ever married (AOR = 2.58,95% CI:1.23–5.48); type 2 diabetes (AOR = 5.62, 95% CI:1.21–26.04); non-adherence (AOR = 5.26,95% CI:2.51–11.04) and residence out of Addis Ababa (AOR = 0.30, 95% CI:0.12–0.73). Twenty four percent of participants were non-adherent to their drug therapies. Factors associated with non-adherence were diabetes complications (AOR = 2.00, 95% CI: 1.2–3.32), the female gender (AOR = 1.67, 95%CI: 1.01–2.8) and level of education (AOR = 0.42, 95%CI: 0.18–0.96). Eighty one percent of participants were satisfied with the current treatment.


A significant proportion of patients were satisfied with their treatment and a quarter of the study participants were non-adherent to their medications at TASH diabetic clinic. However, DTPs were considerably higher among the study participants. Hence, future interventions targeting prevention and resolution of DTPs deemed to be necessary.

Klíčová slova:

Adverse reactions – Drug adherence – Drug therapy – Drugs – Ethiopia – Insulin – Regression analysis


1. WHO (2006) Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. World Hearth Organization.

2. ADA (2017) American Diabetes Association standards of medical care in Diabetes-2017. Diabetes Care:The journal of clinical and applied research and Education 40.

3. IDF (2017) IDF Diabetes atlas Eighth edition. IDF: International Diabetes Federation.

4. WHO (2016) World Health Organizatio: Global Report On Diabetes: World Health Day 2016.

5. WHO (2009) World Health Organization: Global health risks: mortality and burden of disease attributable to selected major risks.

6. WHO (2016) World Health Organization–Diabetes country profiles, 2016.

7. Europe PCN (2017) PCNE Classification for Drug-Related Problems V8.01. http://wwwpcneorg/working-groups/2/drug-related-problem-classification:1-3.

8. Cipolle RJ, Strand L, Morley P (2012) Drug therapy problems. Pharmaceutical Care Practice: The Patient-Centered Approach to Medication Management 3rd edition McGraw-Hill: 156–169.

9. Huri HZ, Ling LC (2013) Drug-related problems in type 2 diabetes mellitus patients with dyslipidemia. BMC public health 13: 1.

10. Huri HZ, Wee HF (2013) Drug related problems in type 2 diabetes patients with hypertension: a cross-sectional retrospective study. BMC endocrine disorders 13: 1.

11. Haugbolle LS, Sorensen EW (2006) Drug-related problems in patients with angina pectoris, type 2 diabetes and asthma—interviewing patients at home. Pharm World Sci 28: 239–247. doi: 10.1007/s11096-006-9023-9 17066246

12. Ogbonna B, Ezenduka C, Opara C, Ahara L (2014) Drug Therapy Problems in Patients with Type-2 Diabetes in a Tertiary Hospital in Nigeria. International Journal of Innovative Research and Development|| ISSN 2278–0211 3.

13. Cipolle R, Strand L, Frakes M (2013) Diabetes: co-morbidities and drug therapy problems in patients with diabetes. Medication Management Systems, Inc: 1–10.

14. Mamunuwa N, Jayamanne S, Coombes J, De Silva, A Lynch C, Wickramasinghe D (2016) Drug related problems among patients with diabetes; a descriptive analysis of data from an urban hospital in Sri Lanka. International Postgraduate Research Conference 2016—University of Kelaniya 244 FACULTY OF GRADUATE STUDIES–UNIVERSITY OF KELANIYA IPRC 16.

15. Fugate AR, Kadam A, Ganachari M (2015) Prospective Study of Medication Adherence Pattern in Chronic Obstructive Pulmonary Disease and Asthma Patient’s in Tertiary Care teaching Hospital. Indian Journal of Pharmacy Practice 8: 79.

16. Shamkuwar CA, Kumari N, Meshram SH, Dakhale GN, Motghare VM (2016) Evaluation of Knowledge, Attitude and Medication Adherence among Asthmatics Outpatients in Tertiary Care Teaching Hospital-A Questionnaire Based Study. Journal of Young Pharmacists 8: 39.

17. David P (2015) The Effectiveness of Educational Methods on Medication Adherence.

18. Price D, Harrow B, Small M, Pike J, Higgins V (2015) Establishing the relationship of inhaler satisfaction, treatment adherence, and patient outcomes: a prospective, real-world, cross-sectional survey of US adult asthma patients and physicians. World Allergy Organization Journal 8: 26. doi: 10.1186/s40413-015-0075-y 26417397

19. Sabaté E, Sabaté E (2003) Adherence to long-term therapies: evidence for action: World Health Organization.

20. Biderman A, Noff E, Harris SB, Friedman N, Levy A (2009) Treatment satisfaction of diabetic patients: what are the contributing factors? Family practice 26: 102–108. doi: 10.1093/fampra/cmp007 19254969

21. Wagner EH, Austin BT, Von Korff M (1996) Organizing care for patients with chronic illness. The Milbank Quarterly: 511–544. 8941260

22. Black Lion Specialized Hospital E, AMECA (2017) http://ameca.org.uk/directory/listing/black-lion-specialized-hospital-ethiopia#.

23. Morisky DE, Green LW, DM L (1986) Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 24.

24. Rejas J, Ruiz M, Pardo A, Soto J (2013) Detecting changes in patient treatment satisfaction with medicines: the SATMED-Q. Value in Health 16: 88–96. doi: 10.1016/j.jval.2012.08.2224 23337219

25. Mickey RM, Greenland S (1989) The impact of confounder selection criteria on effect estimation. Am J Epidemiol 129: 125–137. doi: 10.1093/oxfordjournals.aje.a115101 2910056

26. Bursac Z, Gauss CH, Williams DK, Hosmer DW (2008) Purposeful selection of variables in logistic regression. Source code for biology and medicine 3: 17. doi: 10.1186/1751-0473-3-17 19087314

27. Rejas J, Ruiz MA, Pardo A, Soto J (2011) Minimally important difference of the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q). BMC medical research methodology 11: 142. doi: 10.1186/1471-2288-11-142 22014277

28. Adepu R, Adusumilli PK, BR Jk (2013) Assessment of drug related problems (DRP) in prescriptions received by patients suffering from chronic diseases dwelling in a South Indian rural community. Value in Health 16

29. Al-Taani GM, Al-Azzam SI, Alzoubi KH, Darwish Elhajji FW, Scott MG, Alfahel H et al. (2017) Prediction of drug-related problems in diabetic outpatients in a number of hospitals, using a modeling approach. Drug Healthc Patient Saf 9: 65–70. doi: 10.2147/DHPS.S125114 28814901

30. Odili V, Egiebor B, Oparah A (2011) Identification of drug therapy problems in patients with diabetes treated in a secondary care facility in Benin city. Nigerian Journal of Pharmaceutical Research 9.

31. Fowler MJ (2008) Microvascular and macrovascular complications of diabetes. Clinical diabetes 26: 77–82.

32. IDF (2017) IDF Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care. IDF: ISBN: 978-972-930229-930285-930220.

33. Turner RC, Cull CA, Frighi V, Holman RR, Group UPDS (1999) Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). Jama 281: 2005–2012. doi: 10.1001/jama.281.21.2005 10359389

34. Tooke J (2000) Possible pathophysiological mechanisms for diabetic angiopathy in type 2 diabetes. Journal of diabetes and its complications 14: 197–200. 11004428

35. Dahal P, Venkataraman R, Fuloria PC (2013) Assessment of clinical pharmacist intervention in tertiary care teaching hospital of southern India. Asian J Pharm Clin Res 6: 258–261.

36. Shareef J, Fernandes J, Samaga L (2016) Assessment of clinical pharmacist interventions in drug therapy in patients with diabetes mellitus in a tertiary care teaching hospital. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 10: 82–87.

37. Wong I (2017) Improving Medication Safety and Diabetes Management in Hong Kong–A Multi-disciplinary Approach. Hong Kong Medical Journal.

38. Al Hamid A, Aslanpour Z, Aljadhey H, Ghaleb M (2016) Hospitalisation Resulting from Medicine-Related Problems in Adult Patients with Cardiovascular Diseases and Diabetes in the United Kingdom and Saudi Arabia. Int J Environ Res Public Health 13.

39. Claydon-Platt K, Manias E, Dunning T (2012) Medication-related problems occurring in people with diabetes during an admission to an adult teaching hospital: a retrospective cohort study. Diabetes research and clinical practice 97: 223–230. doi: 10.1016/j.diabres.2012.03.003 22541634

40. Koyra HC, Tuka SB, Tufa EG (2017) Epidemiology and Predictors of Drug Therapy Problems among Type 2 Diabetic Patients at Wolaita Soddo University Teaching Hospital, Southern Ethiopia American Journal of Pharmacological Sciences 5: 40–48.

41. Lester FT (1984) The Clinical Pattern of Diabetes Mellitus in Ethiopians. DIABETES CARE 7: 6–11. doi: 10.2337/diacare.7.1.6 6705667

42. Kautzky-Willer A, Kosi L, Lin J, Mihaljevic R (2015) Gender-based differences in glycaemic control and hypoglycaemia prevalence in patients with type 2 diabetes: results from patient-level pooled data of six randomized controlled trials. Diabetes Obes Metab 17: 533–540. doi: 10.1111/dom.12449 25678212

43. Asfaw AA, Mamo NM, Anshabo AT, Hawaze S (2014) Assessment of type II diabetes mellitus drug therapy in diabetes clinic of a tertiary care teaching hospital in Addis Ababa. Archives of Pharmacy Practice 5: 113.

44. Yigazu DM, Desse TA (2017) Glycemic control and associated factors among type 2 diabetic patients at Shanan Gibe Hospital, Southwest Ethiopia. BMC Research Notes 10: 597. doi: 10.1186/s13104-017-2924-y 29141693

45. Gebel E (2011) How Diabetes Differs for Men and Women. Diabetes Forcast Megazine: The healthy living megazine: Diabets Forcast.

46. Kautzky-Willer A, Harreiter J, Pacini G (2016) Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocrine Reviews 37: 278–316. doi: 10.1210/er.2015-1137 27159875

47. IDF (2017) IDF-WDD(world Diabetes Day), 2017 event.

48. Sajith M, Pankaj M, Pawar A, Modi A, Sumariya R (2014) Medication adherence to antidiabetic therapy in patients with type 2 diabetes mellitus. Young 18: 7.

49. Gelaw BK, Mohammed A, Tegegne GT, Defersha AD, Fromsa M, Tadesse E et al. (2014) Nonadherence and contributing factors among ambulatory patients with antidiabetic medications in Adama Referral Hospital. Journal of Diabetes Research 2014.

50. Abebe SM, Berhane Y, Worku A (2014) Barriers to diabetes medication adherence in North West Ethiopia. Springerplus 3: 195. doi: 10.1186/2193-1801-3-195 24834373

51. Teklay G (2013) Patients at Jimma University Specialized Hospital, Southwest. J Med Sci 13: 578–584.

52. Jemal A, Abdela J, Sisay M (2017) Adherence to Oral Antidiabetic Medications among Type 2 Diabetic (T2DM) Patients in Chronic Ambulatory Wards of Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: A Cross Sectional Study. J Diabetes Metab 8 18–40.

53. Kassahun A, Gashe F, Mulisa E, Rike WA (2016) Nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital, Oromia Region, Ethiopia. Journal of Pharmacy & Bioallied Sciences 8: 124.

54. Tadele K, Abebe A, Teklebirhan T, Desalegn S (2017) Assessment of Adherence to Insulin Self-Administration and Associated Factors Among Type I Diabetic Patients at Jimma University Specialized Hospital, Ethiopia. Endocrinology & Diabetes Research 2017.

55. TessemaTsehay (2014) Assessment of antidiabetic medication adherence and its effect on glycemic control in ambulatory patients with type 2 diabetes at Tikur Anbessa Specialized Hospital: Addis Ababa University, Addis Ababa, Ethiopia. 75 p.

56. Ali M, Alemu T, Sada O (2017) Medication adherence and its associated factors among diabetic patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia. BMC Res Notes 10: 676. doi: 10.1186/s13104-017-3025-7 29202857

57. Bagonza J, Rutebemberwa E, Bazeyo W (2015) Adherence to anti diabetic medication among patients with diabetes in eastern Uganda; a cross sectional study. BMC Health Services Research 15: 168. doi: 10.1186/s12913-015-0820-5 25898973

58. Wabe NT, Angamo MT, Hussein S (2011) Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia. North American Journal of Medical Sciences 3: 418. 22362451

59. Mastewal Abebaw, Anteneh Messele, Mignote Hailu, Fisseha Z (2016) Adherence and Associated Factors towards Antidiabetic Medication among Type II Diabetic Patients on Follow-Up at University of Gondar Hospital, Northwest Ethiopia. Advances in Nursing 2016.

Článek vyšel v časopise


2019 Číslo 10
Nejčtenější tento týden