Date of Conferral

2022

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Pelagia Melea

Abstract

Pharmacotherapy is a significant component of chronic disease management; its efficacy depends on long term, correct, and consistent use; however, medicine adherence rates remain low. The cost of medicines is considered a significant barrier to adherence, especially in low-income settings. This quantitative cross-sectional study was conducted using data from Cimas Medical Aid Society collected between 2015 and 2019. The purpose of the study was to determine the extent of the association between medicine adherence, complication development, and cost of care among diabetic and hypertensive patients while controlling for age and gender on a population that does not experience cost barriers to medicine access. The sample consisted of 23,303 diabetic and hypertensive patients above the age of 16 who purchased chronic medicines through medical aid. The chi-square test bivariate analysis showed a significant association between medicine adherence and complication development in hypertension (p < 0.001) and no association in diabetic patients. Binary logistic regression indicated that nonadherent patients were more likely to develop hypertension complications (OR = 1.428, p < 0.001) in females and older age groups. In diabetes patients, it showed no significant association between adherence and complication development (OR = 0.993, p = 0.841). The claims ratio was higher in nonadherent diabetes (OR = 8.301, p < 0.001) and hypertensive (OR = 2.516, p < 0.001) patients. The implications for positive social change include the findings being used to improve interventions for lowering non-cost barriers to medicine adherence, to reduce complication development, and lower the cost of care for diabetes and hypertension patients.

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