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Table 3 Summary of findings

From: Factors associated with medication adherence of hypertensive patients in the Philippines: a systematic review

First author (year of study)

Measure of medication adherence

Independent variables tested

Medication adherence of Filipino sample

Statistically significant findings

Calano (2019) [31]

HB-HCT [20]

Not applicable

Pre-test 1.40 (8.56)

Post-test 17.98 (5.74)

Community-based health program (P-value = 0.03) F-value = 5.00) [31]

Coyoca (2013) [21]

SSQ-10 [21]

1. Age

2. Gender

3. Religion

4. Civil status

5. Educational attainment

6. Work status

7. Family monthly income

8. Social support system

9. Length of diagnosis

10. Blood sugar level

11. Awareness of the disease

12. Relationship towards their doctors

13. Availability and accessibility to healthcare services

14. Consultation with consultation in public clinics

Values cannot be determined.

1. Gender (P-value = 0.033), female has higher adherence [21].

2. Civil status (P-value = 0.016), married has higher adherence [21].

3. Work status (P-value = 0.037), working patients has higher adherence [21].

4. Social support system (Spearmen rho P-value = 0.028) – direct relationship [21]

5. Accessibility to health care services (Spearman rho P-value = 0.000) – direct relationship [21]

6. Consultation with consultation in public clinics (P-value = 0.016) – direct relationship [21]

7. Health care provider-patient relationship (P-value = 0.016) – direct relationship [21]

8. Health awareness (Spearman rho P-value = 0.000)- direct relationship (26)

de Guzman (2013) [11]

MMAS-8 [22]

1. Social support

2. Medication belief

3. Follow-up visits

4. Consultation satisfaction,

5. Memory task

6. Trust with physician

7. Perceived stress

8. Memory strategies

9. Memory load

10. Depression

11. Length of time taking the medications

12. Number of conditions

13. Self-efficacy

Low adherence 41.54% (n = 135)

Medium adherence 39.69% (n = 129)

High adherence 18.15% (n = 59)

1. Trust with physician (β = 1.168) – direct [11]

2. Consultation satisfaction (β = − 0.215) – inverse [11]

3. No. of conditions (β = 0.693) – direct [11]

4. No. of medication (β = − 0.151) – inverse [11]

5. Event-based memory(β = − 0.329) – inverse [11]

6. External memory strategy (β = − 0.186) – inverse [11]

7. Depression (β = 0.215) – direct [11]

Dror (2005) [34]

Compliance (binary question taking drugs prescribed)

 

Uninsured chronically ill not taking drugs is 32.6% while insureds is lower at 20.2%.

Insured persons reported better drug compliance among chronically ill (P-value = 0.0015) [34].

Ea (2018) [35]

MAOSS [24]

1. Acculturation

2. Acculturative stress

3. Hypertension self-efficacy

4. Patient activation

 

1. Self-efficacy (by self-efficacy scale) (P-value = 0.003) (β = 270) – direct

2. Patient activation P-value = 0.024) (β = 205) – direct

Encabo (2017) [23]

Adapted MMA8 [23]

1. Age

2. Gender

3. Marital status

4. Employment

5. History of hypertension

6. Presence of other diseases

7. Medication

14.5 (SD = 13.6), with scores ranging from 0 to 44 (scores of 22 to 44 is non adherent)

77.7% (n = 73) patients were adherent and 22.3% (n = 21) are non-adherent.

Use of maintenance drugs (P = 0.016) based on odds ratio (OR)

Juarez (2013) [14]

PDC [14]

1. Years of adherence

2. Healthcare utilization

Mean years of adherence for antihypertensive medication is 2.17 years.

1. Age older was significantly associated with greater adherence 1.33 (1.26, 1.42) [14].

2. Female sex was significantly associated with fewer years of adherence 0.9 (0.89, 0.99) [14].

3. Ethnicity Filipino negatively associated with adherence. OR 0.90 (080–1.00) [14]

4. Comorbidities history of either coronary artery disease 1.19 (1.11, 1.28) or congestive heart failure 1.20 (1.09, 1.32) was significantly associated with more years of adherence to antihypertensive medications [14].

5. Poly pharmacy being on lipid-lowering 1.38 (1.28, 1.49) and antidiabetic medications 1.34 (1.26, 1.43) increased adherence on antihypertensive.

Ku (2015) [25]

Binary [25]

1. Age

2. Knowledge

3. Attitudes

4. Perceptions of support

5. Perception of self-efficacy

6. Obesity/adiposity

7. Specialty clinic

8. Body mass index (BMI)

9. Waist circumference, and waist–hip ratio

 

1. Age (P = 0.002) older more adherent [25]

2. Specialty clinic had better adherence [25] (Fisher’s exact test P < 0.001) [25].

3. Knowledge (P = 0.007) higher more adherent [25]

4. Positive attitude (P < 0.001) higher more adherent [25]

5. Perception of support (P < 0.001) higher more adherent [25]

6. Perception of self-efficacy (P = 0.004) higher more adherent

Mamangon (2018) [26]

MAQ [26] and MMAS-8 [22]

1. Presence of comorbidities

2. Illness perception

3. Patient-doctor relationship

4. Health literacy

51.06% were non adherent to antihypertensive medication, 61.70% have forgotten to take antihypertensive medicine during the last two weeks.

1. Age aged 25–59 years old were non-adherent to antihypertensive medication [26].

2. Patient-doctor relationship (PR, 1.6; 95% confidence interval [CI], 0.96–2.75) associations but not statistically significant [26].

3. Comorbidity (PR, 1.15; 95% CI, 0.66–2.01) associations but not statistically significant [26].

4. Illness perception associations but not statistically significant (PR, 1.61; 95% CI, 0.50–5.17) [26].

5. Health literacy (PR, 1.96; 95% CI. 0.90–4.27) associations but not statistically significant [26].

Pablo (2018) [36]

Adapted MMAS-8 [23]

1. Attitude towards complementary and alternative medicine (CAM)

2. Medication adherence seminar

Mean score pre-intervention period is 2 (mean = 1.8939; SD = 0.86164) equivalent to “Sometimes” non-adherent to their medication.

1. Post-seminar intervention (P = 0.000), increase in the medication adherence of patients [36]

2. A significant negative correlation between medication adherence and CAM Attitude Pearson correlation r value = − 0.730, P-value = 0.049), increase in medication adherence if low CAM attitude. Inverse relationship [36]

Palileo-Villanueva (2011) [27]

ASRQ [27]

1. Socioeconomic factors

a. Sex

b. Age

c. Employment status

d. Economic status

2. Condition related

a. Chronicity of hypertension

b. Blood pressure (BP)

c. BP control

d. Number of comorbidities

e. Comorbidities

3. Therapy related

a. Number of medications

b. Number of anti

c. Class of antihypertensive medications

d. Cost – weekly cost of antihypertensive medications

1. Patient factors

a. Educational attainment

b. Knowledge scores

Adherence is 72% in a specialty clinic.

1. Number of maintenance medications increasing has more adherence increase in the number of drugs a patient has, the odds of being more adherent increases by 1.15 times (P = 0.05) [27].

2. Financial support from children, patients that were being supported by their children were twice more likely to be adherent (P = 0.002) [27].

Taira (2006) [15]

MPR [28] and binary

1. Age

2. Gender

3. Ethnicity

4. Morbidity level, health plan type

5. Isle of residence

6. Comorbidities

7. Year of treatment

8. Physician ethnicity

Adherence rates were less than 65% among all racial/ethnic groups.

1. Ethnicity Filipino patients were least adherent, compared to whites (P < 0.001) [15].

2. Age lower adherence in younger age (P < 0.001) [15]

3. Educational attainment. Adherence improved with increase (P < 0.001) [15].

4. Patients seeing cardiologists or other specialists were less adherent than patients seeing primary care doctors (P < 0.001) [15].

5. Patients seeing female physicians were less adherent than those seeing male physicians (P < 0.001) [15].

6. Patients seeing Filipino physicians tended to be less adherent than patients seeing white physicians (P < 0.001) [15].

7. Patients with a history of diabetes tended to be more adherent (P < 0.001) [15].

8. History of heart disease has lower adherence (P < 0.001) [15].

9. Adherence to be highest for beta blockers and calcium channel blockers, followed by Angiotensin receptor blocker and Angiotensin converting enzyme inhibitors. Adherence to all these therapeutic classes was significantly higher than adherence to thiazide diuretics (P < 0.001) [15].

Taira (2007) [16]

MPR [28]

1. Copayment level

2. Age

3. Ethnicity

4. Morbidity level

5. Therapeutic class

Age low compliance, age 40 years (42.5% compliance), 40 to 64 years were nearly twice as likely to be compliant with medications [16].

Ethnicity low compliance, Filipino ethnicity (58.7% compliance) [16]

1. Low compliance members wit Health maintenance organization coverage (59.7% compliance). Members of HMOs had lower compliance than members of preferred provider organization [16].

2. Copayment level, independent of other determinants, was found to be a strong predictor of compliance with antihypertensive medications (P < 0.05) [16].

3. Greater compliance seen among patients filing pharmacy claims for drugs that required lower copayments [16].

4. Compliance was lower for drugs in less preferred tiers [16].

5. Lower medication compliance was seen in those patients with high morbidity (i.e., indicating the presence of other comorbid conditions) compared with patients with low comorbidity [16].

6. Best compliance observed for angiotensin receptor blockers, followed by calcium channel blockers, [beta] adrenergic receptor antagonists ([beta]-blockers), angiotensin-converting enzyme inhibitors, and last, thiazide diuretics [16].

7. Filipino patients were more likely than other ethnic groups to have received tier 3 (for medications with a $20 to $165 copayment most expensive) medications (13.4% vs. 12%) [16].

Ursua (2014)

HB-HCT [20]

 

Pre-test 11.15 (2.73)

Post-test 11.54 (2.15)

CHW intervention significant changes were exhibited for systolic and diastolic BP, weight, and BMI (P < 0.01) but not significant for medication adherence.

Ursua (2018)

HB-HCT [20]

 

Pre-test intervention 3.6 (0.5) vs. control 3.6 (0.5) P-value = 0.867

Post-test intervention 3.8 (0.5) vs. control 3.7 (0.3)

1. Community-based intervention delivered by CHWs improve BP and related factors [38].

2. Adjusted odds of controlled BP for the treatment group was 3.2 times the odds of the control group (P < 0.001) and individuals in the treatment group showed significant changes in appointment keeping [38].

3. Weight, and BMI improvement (P < 0.01) [38]

  1. HB-HCT, Hill-Bone high blood pressure compliance scale; SSQ-10, Self-structured questionnaires (ten items); PR, Prevalence ratio; MMAS-8, Morisky Medication Adherence Scale; MAOSS, Medical Outcomes Study Specific Adherence Scale; SD, standard deviation; PDC, proportion of days covered; MAQ, Medication Adherence Questionnaire; ASRQ, Adherence Self-Report Questionnaire; MPR, Medication Possession ratio; CHW, community health worker