AUCTORES
Globalize your Research
Review Article | DOI: https://doi.org/10.31579/2642-9756/136
Abdul Kader Mohiuddin, Alumni, Faculty of Pharmacy, Dhaka University
*Corresponding Author: Abdul Kader Mohiuddin, Alumni, Faculty of Pharmacy, Dhaka University
Citation: Abdul Kader Mohiuddin (2023), Adherence to Medication and Treatment Guidelines: Most Important but Mostly Avoided. J. Women Health Care and Issues. 6(2); DOI:10.31579/2642-9756/136
Copyright: © 2023 Abdul Kader Mohiuddin, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 11 November 2022 | Accepted: 15 December 2022 | Published: 11 January 2023
Keywords: patient compliance ; healthcare denials; medication adherence; elderly patient care; treatment failure
To cure any disease, proper use of medicine or taking medicine in the correct order is required. Even patients from developed countries struggle to maintain their drug compliance. There is an odd parallel between underdeveloped, emerging nations and the so-called developed world in the West when it comes to improper medicine use. The understanding and perception of the disease is the most important factor influencing whether patients stick to their treatment plan.
Proper use of medicine or taking medicine in correct order is essential to cure any disease. According to the WHO, lack of adherence to treatment regimens leads to major problems among patients, mostly with chronic illnesses. "Right administration" depends on at least 5 right factors--right patient, right drug, right time, right dose and right route [1]. "Medicines won't work if you don't take it right"--This simple fact is not understood by most people in the world, as a result still more than half of the patients with chronic diseases in the developed world do not take their medicine correctly-says WHO [2]. Patients with chronic diseases may find it especially difficult to adhere because their medications must frequently be taken for an extended period of time, sometimes for the rest of their lives. There are a variety of reasons why patients may struggle to stick to treatment regimens, and the CDC estimates that medication noncompliance accounts for 30 to 50% of chronic disease treatment failures. Poor adherence may result in treatment outcomes not being met, symptoms worsening, and health deterioration [3].
Non-Adherence in the so-called Developed Countries
In the UK, up to 50% of medicines are not taken as intended and 60% of NHS patients failed to receive the right treatment within 18 weeks [4-6]. Lack of medication adherence leads to poorer health outcomes, higher healthcare expenditures, increased hospitalizations, and even higher mortality rates in patients with chronic diseases [7]. Medication non-adherence alone accounts for at least 10% of hospitalizations in US, 250,000 hospitalizations in Australia and 1.1 million hospital days in France [8-10]; induces $300 billion in annual medical costs in US, and $125 billion in EU; causes more than 1,25,000 premature deaths in the US and 2,00,000 deaths in EU [8, 11, 12]. Also, two-thirds of medication-related hospital admissions in Australia are potentially preventable [9]. A recent Canadian study found that 30% of patients stop taking their medication before it is instructed, and 25% patients do not fill their prescription or take less than prescribed [13]. Among patients with at least one preventable encounter, medication non-adherence was associated with $679-$898 increased preventable spending [14]. However, pharmaceutical companies around the globe lost $637 billion in potential sales annually due to non-adherence, with $250 billion lost for the same in the U.S. alone last year [15].
Misuse of Antibiotics
More than half of the antibiotics worldwide are sold without a prescription and CDC stated, 30-50% of antibiotics prescribed in hospitals are inappropriate or unnecessary [16, 17]. A recent study published by The Lancet, funded by the Bill & Melinda Gates Foundation, Wellcome Trust, states that nearly 5 million deaths worldwide in 2019 were related to bacterial resistance, which is expected to double by 2050 [18]. In south Asia, about 70% of hospitalized patients have been administered a minimum of one or more antibiotics, whereas 100% of ICU patients received antibiotics [19, 20]. However, 70% to 80% of COVID-19 patients got different types of antibiotics for their COVID-19 treatment [21-23]. The most frequently prescribed antibiotics were azithromycin, ceftriaxone, amoxicillin, metronidazole, and amoxicillin-clavulanic acid [24]. In addition, it has been reported that about 90% of patients with COVID-19 are being unnecessarily treated with antibiotics and close to 100% of these prescriptions were empiric [25].
Abuse of NSAIDs in patients with COVID-19, Dengue, and Chikungunya
Globally, NSAIDs are responsible for at least 650,000 hospitalizations and 165,000 deaths and 30% of ADR related hospital admissions around the globe annually [26, 27]. Overuse of this class of drugs can cause kidney injury, and their side effects can be 3 to 4 times higher in kidney compromised patients [28]. Many studies have reported widespread misuse of these drugs in Dengue, Chikungunya and Covid-19 patients. Especially in Dengue or Covid-19 patients, it is more important to maintain the hydration level of the body than to bring down the fever with the pain killers. In children, the use of excess Paracetamol syrup or suppositories may cause stomach irritation, which hampers digestion and led to vomiting and ended up with hospitalization. Most hospitalizations or ICU admissions among those patients could be prevented, with few exceptions, simply by preventing dehydration at home with saline and fruit juice or simply by drinking more water [29].
More or less 40% of Covid-19 patients report sleep disturbances–use of Benzodiazepines in Covid-19 patients increases the incidence of delirium, depresses the system in patients with compromised respiratory functions, and contraindicated with some anti-viral medications [30, 31]. Surprisingly, between 2020-2021, a huge increase in benzodiazepine dispensing is reported in Canada and abuse of similar drugs doubled in Italy [32]. Around 300 metric tons of morphine-type painkillers are used worldwide each year, less than 1% of which distributed to low-and-middle income countries, says the American Journal of Public Health [33]. So their misuse and related side effects are also retained by the developed world. Prior to the US midterm elections, an announcement from authorities on "simple possession of cannabis" to thousands of convicted citizens exploded recreational drug abuse in both the US and the EU [34, 35].
Negative Attitude towards Covid-19 Vaccine
A cross-sectional study of 259 school leaders in Hong Kong carried out during the COVID-19 pandemic between April 2021 and February 2022 shows that more than 50% of participants had limited health literacy, which was strongly associated with a negative attitude towards vaccination, confusion about COVID-19-related information and secondary symptoms [36]. Earlier, a US-based study in 2020 concluded that two-thirds of the Americans will not get the COVID-19 vaccine when it is first available, while 25% report that they do not have any intention to get vaccinated at any time [37]. In India, vaccine hesitancy was high in Tamil Nadu, more than 40% and willingness for vaccine uptake was found to be close to 90% in Kerala [38, 39]. Another vaccine hesitancy survey by University College London, UK finds mistrust among 16% respondents, and 23% were confused [40].
Medical Cost and Low-Health-Literacy: The Two Major Barriers of Adherence among Diabetes Patients
A strange similarity can be found in under-developed, developing countries and the so-called developed world in the West or the Middle-East when it comes to not taking medicine properly. According to a WHO report, only half of patients in developed countries adhere to treatment guidelines for chronic diseases, which is much less in developing countries [41]. Several studies among diabetic patients in South Asian countries have shown that nearly half of patients do not adhere to their prescribed medication and are at risk of acute and long-term complications, resulting in increased hospitalization rates and medical costs [42, 43]. “Medical costs are barriers to adherence to proper clinical guidelines for chronic diseases in poor countries”-- although discussed in many forums but forgetfulness, confusion about the duration required for medication use and mistrust about the overall efficacy of medication are among the reasons for non-adherence to diabetes management protocols in Middle Eastern countries [44]. Health literacy and medication adherence are strongly associated. Poor glycemic control due to low-health-literacy among diabetes patients reported to both South-East Asian and Middle Eastern countries [45-51].
Humanitarian crisis: Poor BP Control among Cardiac Patients
A recent study by the American Heart Association revealed that patients with high blood pressure do not follow treatment guidelines because of--(a) suboptimal dosing or prescribing the wrong medication (b) lack of insurance or lack of health care access and (c) patient failure to comply prescribed medication or other lifestyle guidelines [52]. Among hypertensive patients, less than 50% have persistent control over BP, even though more patients have received treatment over time. Furthermore, inadequate BP control was reported among those with elevated total cholesterol, LDL, and uric acid levels in both high, low and middle income countries [53]. Humanitarian crisis is associated with increased short-term and long-term cardiac morbidity and mortality and increases in BP [54]. For example, hypertensive patients with diabetes mellitus were twice as likely to exhibit poor BP control, found in war-torn Palestine [55]. Also, a US-based survey on re-settled Rohingya refugees from Myanmar shows a higher trend of chronic diseases like diabetes, hypertension and obesity [56].
Superstitions: An Elephant in the Room
Epilepsy and schizophrenia still seen in most countries of the world as an evil spirit --although two-thirds of patients can become seizure-free with adequate treatment, poor adherence to proper guidelines is a major problem for effective recovery [57, 58]. In a study conducted in India, 60% of the patients believed in luck and superstition with regard to illnesses [59]. Superstitions also reported in close to 40% men and 70% women in Northern Germany [60]. In Africa, 70% of people turn to indigenous treatments such as charms and witchery to treat their illness [61]. Surprisingly, more than 40% of Americans believe in spiritual treatments and researchers found that 73% of addiction treatment programs in the USA include a spirituality-based element [62, 63]. Phobia was the cause of insulin refusal among 60% diabetic patients, despite physician recommendations—found in a study conducted in South Iran [64].
Pediatric and Geriatric Complications to Non-Adherence
Three-quarters of elderly patients worldwide are unable to adhere to appropriate long-term treatment regimens—due to multiple physical complications and additional medication burden [65]. Elderly patients taking at least 5 medications are at increased risk of mild cognitive impairment, dementia, falls, frailty, disability, and mortality, while ADRs are estimated to be 5% to 28% of acute geriatric medical admissions [66, 67]. For children, common non-adherences are related to family routines, child-raising issues, and to social issues such as poverty. Long-term disease conditions like asthma, cystic fibrosis, HIV, diabetes, IBD and juvenile arthritis—are attributable to around 60% of non-adherence among children [68-70].
| Exhibit 1. Several identified reasons for non-adherence to treatment guidelines for chronic diseases [7, 71-73] | ||
| No. | Status | Factors |
| Patient's socio-economic status | Low health literacy, lack of family or social support network, unstable living or homelessness, financial insecurity | |
| Treatment-related | Complexity and duration of treatment procedures, frequent changes in medication regimen, lack of immediate results, real or perceived unpleasant side effects, interference with lifestyle | |
| Health system-related | High treatment costs, limited health system for patient education and follow-up, doctor-patient relationship, patient trust in health care, long waits, lack of patient information materials | |
| Patient-related | Visual-hearing and cognitive impairment, mobility and dexterity, psychological and behavioral factors, perceived risk of disease susceptibility, superstitions and stigmatization by disease, etc | |
Finally, it can be said that patients' knowledge and perception of the disease is the main driving force in determining their adherence to the treatment regimen. Health care providers should explore providing more effective health-education to identify patients' attitudes toward disease, trust in medications, psychological stressors, and increase medication adherence.
Adverse Drug Reactions (ADR)
Blood Pressure (BP)
Non-steroidal anti-inflammatory drugs (NSAIDs)
The Centers for Disease Control and Prevention (CDC)
World Health Organization (WHO)
Financial Disclosure or Funding: N/A
Conflict of Interest: The author declares that he has no competing interests.
Informed Consent: N/A
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
