Medication Adherence and Health Care Use in People with Diabetes, Chronic Kidney Disease and Cardiovascular Disease
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Purpose: To examine medication adherence and health care use in people with co-existing diabetes, chronic kidney disease and cardiovascular disease. Methods: Patients aged > 18 years with these comorbid conditions were recruited from nephrology and diabetes outpatients' clinics of two Australian metropolitan hospitals between 2008 and 2009. Participants were surveyed face-to-face by a research assistant (with interpreter assistance as required) using the 4-item Morisky Medicine Adherence scale (Morisky et al., 1986) and the 4-item Health Care Utilization scale (Lorig et al., 1996). Results: There were 128 participants with 30 (23.4%) born either in Australia or the UK, 38 (29.7%) born in Italy, and 17 (13.3%) born in Greece. Forty one (32.1%) participants indicated English as their first language and 90 participants (70.3%) spoke English well or very well. Based on the Morisky Medicine Adherence scale, those born in Australia or the UK were more likely to forget to take their medications (60.7%) compared to participants born in other countries (23.3%), (p=0.001), and also more likely to have a problem remembering to take their medications (56.6% vs 25.5%, p=0.001). Based on the Health Care Utilization scale, they also had less reported visits to their general practitioner (median 2 (IQR: 1-3) vs 3(IQR: 2-4), p=0.027). However this did not reach statistical significance when adjusted for participants' age, gender, level of education or English proficiency. Conclusion: Why English-speaking patients are more likely to self-report forgetting to take their medications requires deeper investigation. We cannot assume that English-speaking patients are able to manage their medications better than patients with non-English speaking backgrounds. It is possible that patients with Non-English speaking backgrounds report higher levels of medication adherence and medical consultations due to compliant behaviour and overt family concern. Nurses caring for people requiring multiple medications need to be aware of cultural issues affecting medication adherence.