Abstract
Background Non communicable diseases (NCDs) require continued use of medications for life. Medication adherence is an important factor for successful achievement of therapeutic goal. Objectives (1) To synthesize knowledge from projects in the upstream, midstream, and downstream phases of the Medication Adherence Research Network for Rational Drug Use in Thailand. (2) To develop an integrated medication adherence community model for patients (3) To examine the efficacy of a new integrated medication adherence model for improving medication adherence in patients with non communicable chronic disease. Methods: This study is a mixed method research consisting of: (1) a qualitative method to synthesize knowledge from upstream, midstream, and downstream research results of a series of medication adherence projects; (2) data analysis of knowledge shared in exchange meetings with providers, patients, and caregivers to develop the drafted prototype; and (3) the application of a cross-over randomized clinical trial. Study sample size was calculated to include 72 patients who did not adhere to medication use and attended the clinics of non communicable diseases at Wangthong hospital. Group 1 examined the prevalence rate of patients with medication adherence before and after receiving the new service system model in a group of 36 patients. This group of patients attended a current service model for 1 month, then were assigned to a new service model for another 1 month, and Group 2 examined duration of continued effect from the new service model in another group of 37 patients. This group of patients were assigned the new service system model for 1 month, then attended the current service model for another 1 month The Medication Adherence Questionnaire 20 items (MAQ-20) was a tool for evaluating medication adherence and data was collected through patient interviews. The data was analyzed using McNemar Test and Wilcoxon Signed Ranks Test to compare the two related groups and Mann Whitney U Test to compare the differences between the two independent groups, via SPSS version 21. Results Experts reached a consensus on the definition and meanings of medication adherence consistent with the 6 steps of medication self-management according to Bailey et al. (2013). This covers activities along the patient service path in the hospital. Proportion of patients who adhere to medication use was significantly higher after receiving a new service model in overall process of medication use p < 0 0001) and especially in the step of organizing medication p 0 046)), the step of taking medication p < 0 0001). The effect of the new service model continued for at least 1 month after returning to the current service model judging from the proportion of patients with medication adherence remained the same during and after receiving the new service model. p value = 0 063)). Comparison of the effect of these 2 systems for each time period was also performed. During the first month, a statistically significant difference in medication adherence between the new system and the routine system was observed. (p-value < 0.001). The proportion of patients with medication adherence in the new system was higher than that in the routine system. During the second month, a statistically significant difference in medication adherence between the group that switched to the new system and the group that switched to the routine system was also observed. (p-value < 0.002). The proportion of patients with medication adherence in the group that switched to the new system in 2nd month increased compared to that in this group when receiving the routine system in 1st month. In contrast, the proportion of patients with medication adherence in the group that switched to the routine system in 2nd month decreased compared to that in the group when receiving the new system in 1st month. Conclusions The new service model helped to improve medication adherence in patients with non communicable diseases and the new service model had continued effect on medication adherence for at least 1 month. In the future, implementation of this new service model should be tested in other hospital settings.
