Capítulo 2. Revisión de la literatura.
3.1. Cuadro de Mando Integral (CMI)
3.1.6. Metas, Indicadores y Programas Estratégicos y su vinculación con la
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SECTION D: OUT-PATIENTS’ ATTITUDE TOWARDS DRUG USE AND
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Figure 4: Patients’ affordability of prescribed drugs
Out of the 644 patients surveyed, 386(60.0%) were able to afford all the prescribed drugs all the time the dispensed drugs were in stock. Therefore, not having the dispensed drugs at any point in time was never as a result of cost for this proportion of patients.
0 10 20 30 40 50 60
All the time Sometimes Often Occassionally Rarely
Frequency (%)
Drug Affordability 60.0
21.2
11.6
4.7
2.5
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TABLE 30: Patients’ satisfaction with non drug encounter with prescribers
Of the 74 patients who accepted that they have had cause to consult a doctor and ended up not given any drug because his/her health condition required no drug treatment, 46(62.1%), said they felt quite satisfied with such consultations despite being given no drug. Ten (13.1%) however felt indifferent.
Satisfied Frequency Percent
Yes 46 62.1
No 18 24.8
Indifferent 10 13.1
Total 74 100.0
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TABLE 31: Patient’s most common reason for not keeping to prescribed drug dosage regimen
Reason given Frequency Percent
Forgot 46 44.2
Not convenient 40 38.5
Unclear instructions 10 9.8
Personal perception 8 7.5
Total 104 100.0
One hundred and four (16.2%) out of the 644 patients surveyed were not able to stick to their recommended dosage regimen for a number of reasons. Most frequent of these reasons was sheer forgetfulness 46(44.2%), followed by inconvenient drug dose and timing 40(38.5%). The least frequent reason was the patient’s personal perception or conviction about the ailment or the drug 8 (7.5%).
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TABLE 32: Patients’ most common reason for stopping prescribed drugs
Reason Frequency Percent
Complete required treatment 295 45.8
Feels well 158 24.5
Gets tired of the drugs 101 15.7
Cannot afford more drugs 90 14.0
Total 644 100.0
What will inform the stoppage of any dispensed drug by patients, will most frequently be completion of the required treatment duration 295(45.8%). Least of the instances, was when the patient could not afford to buy more drugs even though the treatment was supposed to continue 90(14%).
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TABLE 33: The fate of patient’s leftover drugs
Fate of leftover drugs Frequency Percent
Discard them 417 64.8
Keep them 180 27.9
Give them out 47 7.3
Total 644 100.0
In the very rare instances when patients may have leftover drugs after completing their required treatment duration, 417(64.8%) of the patients studied, said such drugs would rather be discarded. Very rarely 47(7.3%) they would give them out to other persons for use.
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TABLE 34: Patient’s commonest source of drug information
Information source Frequency Percent
Pharmacists 218 33.9
Hospital health talks 196 30.4
Friends and neighbours 124 19.3
Doctors 79 12.3
Mass media 13 2.0
Others 8 1.2
Seminars outside hospital 6 0.9
Total 644 100.0
There were many sources of drug information for the patients. However, most of the times 218(33.9%) they got their drug information from pharmacists in and around the hospital. Only 6(0.9%) of them got their drug information from seminars outside the hospital.
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Figure 5: Patients' preferred route of drug administration
Largely the preferred route of drug intake by the patients surveyed was the oral route 525(81.5%), while 89(13.8%) preferred parenteral route of administration. Only 30(4.7%) said they would prefer topical medications.
Oral 81%
Parenteral 14%
Topical 5%
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TABLE 35: Patient’s sharing of prescribed drugs with others.
Drug sharing Frequency Percent
Yes 169 26.2
No 475 73.8
Total 644 100.0
It was shown that 169 (26.2%) of the patients have had cause to share their prescribed drugs with family members or friends at one time or the other. While the others 475(73.8%) had not.
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TABLE 36: Most important factor in patient’s drug choice
Factor Frequency Percent
Cost 247 38.4
Efficacy 123 19.1
Peer influence 89 13.8
Dosage form/route of admin. 70 10.9
Duration of treatment 70 10.9
Accessibility 34 5.3
Cultural belief 11 1.7
Total 644 100.0
Whenever patients had the opportunity to choose between any two drugs for the purpose of treatment, they more frequently 274(38.4%) considered the cost of the drugs before making their choices. Their cultural belief 11(1.7%) was considered least important in making their drug choices.
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TABLE 37: Patient’s basic expectations and needs met by service received (patient’s satisfaction)
Patient’s satisfaction Frequency Percent
Yes 544 84.5
No 100 15.5
Total 644 100.0
Five hundred and forty four (84.5%) of patients surveyed said they felt satisfied with the treatment and general services they had received in the health facility. While 100(15.5%) felt otherwise.
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TABLE 38: Patients’ view of the most important factor in drug compliance
Influencing factor Frequency Percent Accessibility of health facility 204 31.7 Prescribers’/dispensers’ attitude 121 18.8
Drug cost 121 18.8
Nature of the drug itself 60 9.3
Nature of the health facility 57 8.9
Cultural belief 51 7.9
Severity of illness 30 4.7
Total 644 100.0
Most frequently, 204(31.7%) patients felt that their level of compliance to medical instructions would depend more on how easily they could access services in the facility. Apart from this, the cost of drugs and prescribers’/dispensers’ attitude would play a greater role 121(18.8%) in determining their compliance level. Only 57(8.9%) of the patients surveyed felt their level of compliance would be influenced by nature of the health facility in terms of the state of infrastructure and general environmental hygiene of the hospital. Severity of the illness would influence the drug compliance of only 30(4.7%) of the patients.
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TABLE 39: Prescribers’ report of whether self medications by patients seen were rightly done or not
Right self medication Frequency Percent
Yes 33 22.6
No 113 77.4
Total 146 100.0
Majority of the prescribers surveyed, 113(77.4%) reported that from the history taken from their patients, the self medications were mostly wrongly done. While 33(22.6%) felt that their patients were often right in their self medications.
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TABLE 40: Educational status of patients and drug sharing with others
Drug sharing with others
Yes (%) No (%) Total (%)
Educational status of patient
None 21(26.3) 59(73.7) 80(100.0)
Primary 16(15.0) 91(85.0) 107(100.0)
Secondary 41(23.0) 137(77.0) 178(100.0)
Tertiary 91(32.6) 188(67.4) 279(100.0)
Total 169(26.2) 475(73.8) 644(100.0)
χ2 = 13.848 df = 3 p = 0.003
The highest proportion of patients who will not share their drugs with others was those with primary education 91(85.0%). Conversely, patients most likely to share their drugs with others were those with tertiary education 91(32.6%). The association between educational status of patients and their drug sharing habit was statistically significant. (p = 0.003)
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TABLE 41: Educational status and wrong timing of drug intake
Wrong timing of drug intake
Yes (%) No (%) Total (%)
Educational status of patient
None 18(22.5) 62(77.5) 80(100.0)
Primary 5(4.6) 102(95.4) 107(100.0)
Secondary 27(17.9) 151(82.1) 178(100.0) Tertiary 54(19.6) 225(80.4) 279(100.0) Total 104(16.2) 540(83.8) 644(100.0) χ2 = 15.826 df = 3 p = 0.001
Patients who had primary education were less likely to take their prescribed drugs at the wrong time 105(95.4%), while, those with no formal education were more likely to take their drugs at the wrong time 18(22.5%). There was statistically significant
association (p = 0.001) between patients’ educational status and wrong timing of drug intake.
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TABLE 42: Sex of patients and their wrong timing of drug intake.
Wrong timing of drug intake
Yes (%) No (%) Total (%) Sex of
patients
Male 44(16.6) 221 (83.4) 265(100.0)
Female 60 (15.8) 319(84.2) 379 (100.0)
Total 104(16.2) 540(83.8) 644 (100.0)
χ2 = 0.069 df = 1 p = 0.793
It was noted that males (16.6%) were more likely to take their prescribed drugs at the wrong time than females (15.8%). This association was not statistically significant
(p=0.793).
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TABLE 43: Patients’ occupation and factors influencing their drug compliance
Factors influencing drug compliance
Cultural belief(%) Acc. of health services(%) Severity of illness(%) Total(%)
Civil servant 6(3.6) 153(92.8) 6(3.6) 165(100)
Self employed 27(11.7) 197(85.7) 6(2.6) 230(100)
Unemployed 18(7.2) 213(85.6) 18(7.2) 249(100)
Total 51(7.9) 563(87.4) 30(4.7) 644(100)
χ2 = 14.900 df = 4 p = 0.005
Table 43 shows that accessibility of the health services provided in the various hospitals played a greater role in influencing patients’ drug compliance (87.4%) than any other factor irrespective of their occupations. The self employed included occupations like traders,
farmers, tailors, hair dressers, drivers etc, while the unemployed were applicants, students, full time housewives etc. The analysis showed that the association between influencing factors to patients’ drug compliance and their occupations was statistically significant (p=0.005).
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TABLE 44: Patients’ religion and factors influencing their drug compliance
Factors influencing drug compliance
Cultural belief(%) Acc. of health services(%) Severity of illness(%) Total(%)
Christianity 43(7.2) 517(87.7) 30(5.1) 590(100.0)
Islam 2(7.1) 26(92.9) 0(0.0) 28(100.0)
A. T. R. 6(60.0) 4(40.0) 0(0.0) 10(100.0)
Atheists 0(0.0) 16(100.0) 0(0.0) 16(100.0)
Total 51(7.9) 563(87.4) 30(4.7) 644(100.0)
χ2 = 25.602 df = 6 p = 0.000
It was shown here that accessibility of the health services provided in the various hospitals was the commonest factor that influenced the drug compliance of the Christians (87.7%), Muslims (92.9%) and the atheists, (100.0%). For the African traditional religion practitioners it was their cultural belief that mainly influenced their drug compliance (60.0%). The association between the factors that mainly influenced the drug compliance of patients and their religion was statistically significant
(p=0.000).
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