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Orozco-Solano S, Silva-Castro MM, Machuca M. [Translated article] Medication experience and clinical interventions in patients receiving pharmaceutical care: A scoping review of pharmaceutical care practice. FARMACIA HOSPITALARIA 2023; 47:T230-T242. [PMID: 37659906 DOI: 10.1016/j.farma.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 04/04/2023] [Accepted: 04/26/2023] [Indexed: 09/04/2023] Open
Abstract
OBJECTIVE Analyze scientific literature on qualitative research that studies the medication experience-MedExp-and related pharmaceutical interventions that bring changes in patients' health. Through the content analysis of this scoping review, we intend to: (1) understand how pharmacists analyze the MedExp of their patients who receive Comprehensive Medication Management CMM and (2) explain which categories they establish and how they explain the individual, psychological, and cultural dimensions of MedExp. METHODS The scoping review followed recommendations from PRISMA Extension for Scoping Reviews. Medline (Pubmed), SCOPUS, Web of Science, and Psycinfo were used to identify research on MedExp from patients attended by pharmacists; and that they comply with quality standards, Standards for Reporting Qualitative Research. Articles published in English and Spanish were included. RESULTS 395 qualitative investigations were identified, 344 were excluded. In total, 19 investigations met the inclusion criteria. Agreement between reviewers, kappa index 0.923, 95% CI (0.836-1.010). The units of analysis of the patients' speeches were related to how they were progressing in their medications and how it was built through MedExp, the influence it has on the experience of becoming ill, the connection with socioeconomic aspects, and beliefs. Based on MedExp, the pharmacists raised cultural proposals, support networks, health policies, and provide education and information about medication and disease. Additionally, characteristics of the interventions were identified, such as a dialogic model, therapeutic relationship, shared decision-making, comprehensive approach, and referrals to other professionals. CONCLUSIONS The MedExp is an extensive concept, which encompasses people's life experience who use medications based on their individual, psychological, and social qualities. This MedExp is corporal, intentional, intersubjective, and relational, expanding to the collective because it implies beliefs, culture, ethics, and the socioeconomic and political reality of each person located in their context.
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Affiliation(s)
- Sofía Orozco-Solano
- Centro de Información de Medicamentos, Unidad de Optimización de la Farmacoterapia, Servicio de Farmacia, Hospital Dr. R.A. Calderón Guardia, San José, Costa Rica.
| | | | - Manuel Machuca
- Departamento de Ciencias Biológicas y de la Salud, Facultad de Ciencias de la Salud, Universidad Loyola, Dos Hermanas, Sevilla, Spain.
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Orozco-Solano S, Silva-Castro MM, Machuca M. Medication experience and clinical interventions in patients cared for by pharmacist: Scoping review of pharmaceutical care practice. FARMACIA HOSPITALARIA 2023; 47:230-242. [PMID: 37302918 DOI: 10.1016/j.farma.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 04/04/2023] [Accepted: 04/26/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE Analyze scientific literature on qualitative research that studies the medication experience -MedExp- and related pharmaceutical interventions that bring changes in patients' health. Through the content analysis of this scoping review, we intend to: 1) understand how pharmacists analyze the MedExp of their patients who receive Comprehensive Medication Management and 2) explain which categories they establish and how they explain the individual, psychological and cultural dimensions of MedExp. METHODS The scoping review followed recommendations from PRISMA Extension for Scoping Reviews. Medline (Pubmed), SCOPUS, Web of Science, and Psycinfo were used to identify research on MedExp from patients attended by pharmacists; and that they comply with quality standards, Standards for Reporting Qualitative Research. Articles published in English and Spanish were included. RESULTS 395 qualitative investigations were identified, 344 were excluded. In total, 19 investigations met the inclusion criteria. Agreement between reviewers, kappa index 0.923 95% CI (0.836-1.010). The units of analysis of the patients' speeches were related to how they were progressing in their medications and how it was built through MedExp, the influence it has on the experience of becoming ill, the connection with socioeconomic aspects, and beliefs. Based on MedExp, the pharmacists raised cultural proposals, support networks, health policies, and provide education and information about medication and disease. Additionally, characteristics of the interventions were identified, such as a dialogic model, therapeutic relationship, shared decision-making, comprehensive approach, and referrals to other professionals. CONCLUSIONS The MedExp is an extensive concept, which encompasses people's life experience who use medications based on their individual, psychological and social qualities. This MedExp is corporal, intentional, intersubjective and relational, expanding to the collective because it implies beliefs, culture, ethics and the socioeconomic and political reality of each person located in their context.
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Affiliation(s)
- Sofía Orozco-Solano
- Centro de Información de Medicamentos, Unidad de Optimización de la Farmacoterapia, Servicio de Farmacia, Hospital Dr. R.A. Calderón Guardia, San José, Costa Rica.
| | | | - Manuel Machuca
- Departamento de Ciencias Biológicas y de la Salud, Facultad de Ciencias de la Salud, Universidad Loyola, Dos Hermanas, Sevilla, España
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Upamali S, Rathnayake S. Perspectives of older people with uncontrolled type 2 diabetes mellitus towards medication adherence: A qualitative study. PLoS One 2023; 18:e0289834. [PMID: 37561681 PMCID: PMC10414664 DOI: 10.1371/journal.pone.0289834] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Better medication adherence among people with diabetes mellitus was found to be associated with improved glycaemic control. However, medication non-adherence is a significant concern in older people with uncontrolled type 2 diabetes mellitus. PURPOSE To explore the perspectives of older people with uncontrolled type 2 diabetes mellitus towards medication adherence. DESIGN A qualitative descriptive exploratory study. METHODOLOGY A purposive sample of older people with uncontrolled type 2 diabetes mellitus living in the community was recruited. Snowball sampling was applied in community recruitment. In-depth telephone interviews were conducted using a semi-structured interview guide. Interviews were transcribed verbatim. Thematic analysis was used in data analysis. The consolidated criteria for reporting qualitative research (COREQ) guidelines were followed. RESULTS The emerged six themes were: (a) impact of knowledge, attitudes and practices on medication adherence, (b) treatment-related barriers to medication adherence, (c) impact of age-related changes on medication adherence, (d) person-related barriers to medication adherence, (e) impact of COVID-19 on medication adherence and, (f) role of support systems in medication adherence. Knowledge of the disease process and medications, attitudes towards medication adherence, the practice of different treatment approaches, self-medication and dosing, negative experiences related to medications, polypharmacy, changes in lifestyle and roles, the influence of work-life, motivation, negligence, family support, support received from health workers, facilities available and financial capability are the main factors influence medication adherence. Age-related memory impairment, visual disturbances and physical weaknesses affect medication adherence in older people. Additionally, COVID-19-related guidelines imposed by the government and healthcare system-related issues during the COVID-19 pandemic also affected medication adherence. CONCLUSION Adherence to medications among older people is hampered by a variety of factors, including their knowledge, attitudes and practices, person and treatment-related factors and age-related changes. The COVID-19 pandemic has brought additional challenges. Individualised patient care for older people with uncontrolled type 2 diabetes mellitus to improve medication adherence is timely. Strengthening support mechanisms for the above population is essential.
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Affiliation(s)
- Sathma Upamali
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sarath Rathnayake
- Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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Kamarli Altun H, Özyildirim C, Koç Ş, Aksoy HN, Sağir B, Bozkurt MS, Karasu H. The factors associated with orthorexia nervosa in type 2 diabetes and their effect on diabetes self-management scores. Eat Weight Disord 2023; 28:22. [PMID: 36809582 PMCID: PMC9944002 DOI: 10.1007/s40519-023-01552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/10/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE This study aimed to determine the factors affecting the ORTO-R scores in individuals with T2DM and to investigate their effect on diabetes self-management. METHODS The study included 373 individuals with type 2 diabetes between the ages of 18-65 who applied to Akdeniz University Hospital Endocrinology and Metabolic Diseases Polyclinic between January and May 2022. A questionnaire including sociodemographic data, information about diabetes, and nutritional habits, and the ORTO-R and Type 2 Diabetes Self-Management Scales were used to collect data. Linear regression analysis was performed to determine the factors affecting ORTO-R. RESULTS The linear regression analysis showed that age, gender, education level, and duration of diabetes affected ORTO-R scores in patients with type 2 diabetes. Body mass index, comorbidities (cardiovascular diseases, kidney diseases and hypertension), diabetes-related complications, diabetes treatment method and dieting had no significant contribution to the model (p > 0.05). We also found that education level, comorbidities, diabetes-related complications, diabetes treatment method, dieting, and BMI can affect diabetes self-management. CONCLUSION It should be kept in mind that type 2 diabetes are at risk of orthorexia nervosa (ON) in terms of various aspects such as age, gender, education level and duration of diabetes. Since the factors affecting the risk of ON and the factors affecting diabetes self-management are intertwined, orthorexic tendencies should be kept under control while trying to increase self-management in these patients. In this respect, developing individual recommendations according to the psychosocial characteristics of patients may be an effective approach. LEVEL OF EVIDENCE Level V, cross-sectional study.
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Affiliation(s)
- Hülya Kamarli Altun
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Caner Özyildirim
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye.
| | - Şeyma Koç
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Hatice Nur Aksoy
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Beyza Sağir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Merve Sefa Bozkurt
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Hakan Karasu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
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Liu Y, Jiang J, You W, Gong D, Ma X, Wu M, Li F. Exploring facilitators and barriers to self-management engagement of Chinese people with type 2 diabetes mellitus and poor blood glucose control: a descriptive qualitative study. BMC Endocr Disord 2022; 22:294. [PMID: 36435767 PMCID: PMC9701421 DOI: 10.1186/s12902-022-01214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS To explore facilitators and barriers to self-management engagement of Chinese people with poorly controlled type 2 diabetes. METHODS Purposive sampling method was used for recruitment. Semi-structured interview and thematic analysis was used for data collection and analysis. RESULTS Twenty-six semi-structured interviews were conducted. Poor blood glucose control introduced awareness of susceptibility to complications, while mental disorders could be concomitant. General knowledge about healthy lifestyle and unhealthy habits impeded lifestyle management. Temporary remission of hyperglycemia and no perceived symptoms interfered engagement of medication therapy and regular blood glucose monitoring. Family and work environments could impact self-management engagement. Accessibility to reliable diabetes-related information influenced self-management engagement. CONCLUSIONS Awareness of susceptibility to complications motivated self-management engagement, while the awareness could cause mental disorders that need to be addressed. Customized lifestyle plans and behavior change technologies were crucial for lifestyle management. The progression of diabetes, importance of continuity of medication therapy, and the value of blood glucose monitoring should be clarified in diabetes education. Building diabetes-friendly social environments and providing reliable diabetes-related information were essential.
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Affiliation(s)
- Yuan Liu
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China.
| | - Jiajia Jiang
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China
| | - Wenjun You
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Dandan Gong
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Xiaoqing Ma
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Min Wu
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Feng Li
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
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Bekele BB, Bogale B, Negash S, Tesfaye M, Getachew D, Weldekidan F, Yosef T. Public health interventions on prescription redemptions and secondary medication adherence among type 2 diabetes patients: systematic review and meta-analysis of randomized controlled trials. J Diabetes Metab Disord 2021; 20:1933-1956. [PMID: 34900834 DOI: 10.1007/s40200-021-00878-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
Background Despite the inadequate filling of prescriptions among chronic care patients has been a problem, little is known about the intervention effect on it. Objective The aim of this systematic review and meta-analysis (SRMA) was to investigate the effectiveness of various public health interventions on primary and secondary medication adherence among T2DM patients. Methods Searching was done from the major databases; Cochrane Library, Medline/PubMed, EBSCOhost, and SCOPUS. A hand search was made to find grey works of literature. Articles focused on interventions to enhance primary and secondary medication among type 2 diabetes mellitus patients were included. After screening and checking eligibility, the methodological quality was assessed. Secondary medication adherence was synthesized descriptively due to measurement and definition variations across studies. Finally, a meta-analysis was made using the fixed effects model for primary medication adherence. Results 3992 studies were screened for both primary and secondary medication adherences. Among these, 24 studies were included in the analysis for primary (5) and secondary (19) medication adherence. Pooled relative medication redemption difference was RD = 8% (95% CI: 6-11%) among the intervention groups. Age, intervention, provider setting, and IDF region were determinant factors of primary medication adherence. About two-thirds of the studies revealed that interventions were effective in improving secondary medication adherence. Conclusion Both primary and secondary medications were enhanced by a variety of public health interventions for patients worldwide. However, there is a scarcity of studies on primary medication adherence globally, and in resource-limited settings for the type of adherences. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-021-00878-0.
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Affiliation(s)
- Bayu Begashaw Bekele
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.,Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia.,Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Biruk Bogale
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Samuel Negash
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Melkamsew Tesfaye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Dawit Getachew
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Fekede Weldekidan
- Department of Public Health, College of Health Science, Ethiopian Defence University, Addis Ababa, Ethiopia
| | - Tewodros Yosef
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
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Kvarnström K, Westerholm A, Airaksinen M, Liira H. Factors Contributing to Medication Adherence in Patients with a Chronic Condition: A Scoping Review of Qualitative Research. Pharmaceutics 2021; 13:pharmaceutics13071100. [PMID: 34371791 PMCID: PMC8309154 DOI: 10.3390/pharmaceutics13071100] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Medication adherence continues to be a significant challenge in healthcare, and there is a shortage of effective interventions in this area. This scoping review studied the patient-related factors of medication adherence. Methods: We searched Medline Ovid, Scopus, and Cochrane Library from January 2009 to June 2021 to find the most recent original qualitative studies or systematic reviews that addressed the patient-related factors of medication adherence in treating chronic conditions. We used the PRISMA-ScR checklist to ensure the quality of the study. Results: The initial search revealed 4404 studies, of which we included 89 qualitative studies in the scoping review. We inductively organized the patient-related factors causing barriers, as well as the facilitators to medication adherence. The studies more often dealt with barriers than facilitators. We classified the factors as patient-specific, illness-specific, medication-related, healthcare and system-related, sociocultural, as well as logistical and financial factors. Information and knowledge of diseases and their treatment, communication, trust in patient-provider relationships, support, and adequate resources appeared to be the critical facilitators in medication adherence from the patient perspective. Discussion and conclusions: Patients are willing to discuss their concerns about medications. Better communication and better information on medicines appear to be among the critical factors for patients. The findings of this scoping review may help those who plan further interventions to improve medication adherence.
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Affiliation(s)
- Kirsi Kvarnström
- HUS Pharmacy, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (A.W.); (M.A.)
- Correspondence:
| | - Aleksi Westerholm
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (A.W.); (M.A.)
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (A.W.); (M.A.)
| | - Helena Liira
- Department of General Practice, University of Helsinki, 00290 Helsinki, Finland;
- Unit of Primary Health Care, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland
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Jiraporncharoen W, Pinyopornpanish K, Junjom K, Dejkriengkraikul N, Wisetborisut A, Papachristou I, Hashmi A, Angkurawaranon C. Exploring perceptions, attitudes and beliefs of Thai patients with type 2 diabetes mellitus as they relate to medication adherence at an out-patient primary care clinic in Chiang Mai, Thailand. BMC FAMILY PRACTICE 2020; 21:173. [PMID: 32825811 PMCID: PMC7442984 DOI: 10.1186/s12875-020-01233-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
Background Within the sphere of diabetes self-management, much emphasis has been placed on medication adherence. There has been a shift in thinking about medication adherence, moving from “compliance” and historically paternalistic models of care, to seeking better ways of characterizing dynamic and complex relationships that determine medication adherence and diabetes control. This study sought to understand the relationship between patient’s attitudes and medication adherence for oral anti-diabetics in Thailand. Methods In-depth interviews of patients with type 2 diabetes mellitus, taking oral anti-diabetic drugs, at the out-patient clinic run by the Department of Family Medicine, Chiang Mai University between May and December 2016. Thematic analysis followed the WHO framework for medication adherence in chronic disease to explore patient’s attitudes and their influence on medication compliance. Results Of 24 patients, 9 were men. The mean age was 62 years (SD 8.9 years). 67% had high compliance. Four themes were identified as important factors related to medication adherence: attitudes toward disease, attitudes toward treatment, attitudes toward family support and attitudes toward health care team. Specifically, symptoms at diagnosis, understanding and acceptance in taking medication, the presence of family support and the perception of concern by the doctor relate to improved medication compliance. Conclusions Medication adherence in Thai patients with diabetes requires support from both the health care providers and the family. The patient’s perception of the doctor’s concern creates greater patient trust in the health care team. This trust, along with family support, helps deepen patients’ understanding of the disease, accept the chronic nature of their disease, and engenders a positive attitude towards taking medication that can improve medication adherence.
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Affiliation(s)
- Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Korsin Junjom
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Nisachol Dejkriengkraikul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Anawat Wisetborisut
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Iliatha Papachristou
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Ahmar Hashmi
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand.
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Abstract
Objectives To derive improved understanding of the implicit meanings of challenges in daily life from the perspective of persons with type 2 diabetes. Methods A meta-synthesis was conducted with an interpretive and constructivist approach. Four databases were searched for articles published between 2007 and 2011, producing 37 articles for analysis. Van Deurzen’s life world theory was applied as an analytic grid. Results Challenges in daily life with type 2 diabetes could be understood as living in a tension between opposing forces, implying a struggle with inevitable paradoxes: living in the present and for the future, trusting oneself while relying on others, and being normal while feeling changed and different. Discussion This synthesis adds knowledge to previous understanding of living with type 2 diabetes, revealing the complexity of daily life when struggling with a lifelong illness. Person-centred care could be used to understand what challenges diabetes may cause in family and working life and the ambivalent feelings the illness can lead to. Future research is needed to implement and evaluate a person-centred care in practice. Since new qualitative research is continuously added to this topic, metasyntheses should be undertaken regularly.
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Affiliation(s)
- Inga-Britt Lindh
- Faculty of Health Sciences, School of Health and Society, Kristianstad University, Kristianstad, Sweden
| | - Kerstin Blomqvist
- Faculty of Health Sciences, School of Health and Society, Kristianstad University, Kristianstad, Sweden
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Huynh J, Menezes HT, Gerstein H, Sherifali D. Exploring the Experiences of Adults With Type 2 Diabetes on Sodium Glucose Cotransporter 2 Inhibitors. Can J Diabetes 2019; 44:184-191. [PMID: 31451424 DOI: 10.1016/j.jcjd.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 06/08/2019] [Accepted: 06/18/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Diet-related quality of life has not been explored previously in patients with type 2 diabetes using sodium glucose cotransporter 2 (SGLT-2) inhibitors, the latest class of diabetes medications. In this study, we sought to describe the patient experience on SGLT-2 inhibitors and examine whether there have been improvements in dietary perception and satisfaction with these drugs. METHODS Adults ≥40 years of age with type 2 diabetes and using SGLT-2 inhibitors for at least 1 month were recruited to take part in one-time 1-on-1 interviews. An interpretive descriptive methodology was used. Data collection and analysis occurred concurrently and a constant comparative analysis was used. RESULTS An overall positive response to SGLT-2 inhibitor use was observed. Interviews revealed 3 themes: Recognizing, Reckoning and Realizing. In Recognizing, all patients reported a significant relationship with food that was typically negative and included feelings of food restriction and deprivation. Positive side effects of the drug in Reckoning included better glycemic control, weight loss and improved energy. Some participants were motivated in Realizing to pursue additional behavioural changes to improve their diabetes management. CONCLUSIONS An improved dietary-related quality of life was described by some participants. Although not all individuals were seen to move into the Realizing phase after initiating an SGLT-2 inhibitor, there appeared to be an opportunity to create a behaviour change after positive Reckoning experiences.
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Affiliation(s)
- Jennifer Huynh
- Department of Medicine, Halton Healthcare, Oakville, Ontario, Canada
| | | | - Hertzel Gerstein
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Diabetes Care and Research Program, The Boris Clinic, McMaster University Medical Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Diana Sherifali
- School of Nursing, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Diabetes Care and Research Program, The Boris Clinic, McMaster University Medical Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada.
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Pikkemaat M, Boström KB, Strandberg EL. "I have got diabetes!" - interviews of patients newly diagnosed with type 2 diabetes. BMC Endocr Disord 2019; 19:53. [PMID: 31126267 PMCID: PMC6534850 DOI: 10.1186/s12902-019-0380-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 05/15/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To be diagnosed with type 2 diabetes is a challenge for every patient. There are previous studies on patients' experience in general but not addressing the increased cardiovascular risk and multifactorial treatment. The aim of this study was to explore the thoughts, experiences and reactions of newly diagnosed patients with diabetes to this diagnosis and to the risk of developing complications. METHODS Ten adults (7 men/3 women, aged 50-79) diagnosed with type 2 diabetes within the last 12 months were interviewed at a primary health care center in Sweden. An interview guide was used in the semi-structured interviews that were transcribed verbatim. The analysis was qualitative and inspired by systematic text condensation (Malterud). The text was read several times and meaning units were identified. Related meaning units were sorted into codes and related codes into categories during several meetings between the authors. Finally, the categories were merged and formed themes. RESULTS We defined three main themes: Reaction to diagnosis, Life changes and Concerns about the future. Most patients reacted to the diagnosis without intensive feelings. Lifestyle changes were mainly accepted but hard to achieve. The patients' major concerns for the future were the consequences for daily life (being able to drive and read) and concerns for relatives rather than anxieties regarding medical issues such as laboratory tests. There were considerable differences in how much patients wanted to know about their future risks. CONCLUSIONS The results of this study might help to focus doctor-patient communication on issues highlighted by the patients and on the importance of individualizing information and recommendations for each patient.
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Affiliation(s)
- M Pikkemaat
- Husensjö Health Care Center, Skaragatan 102, S-25363, Helsingborg, Sweden.
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | - K Bengtsson Boström
- R&D Center Skaraborg Primary Care, Skövde, Sweden
- Department of Public Health and Community Medicine, Primary Health Care, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E L Strandberg
- Department of Clinical Sciences Malmö, Family Medicine, Lund University, Malmö, Sweden
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Cheng LJ, Wang W, Lim ST, Wu VX. Factors associated with glycaemic control in patients with diabetes mellitus: A systematic literature review. J Clin Nurs 2019; 28:1433-1450. [PMID: 30667583 DOI: 10.1111/jocn.14795] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 11/19/2018] [Accepted: 01/14/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To perform a systematic review search and critically review the empirical evidence concerning the factors affecting glycaemic control in patients with type 1 or 2 diabetes mellitus. BACKGROUND Previous primary studies have investigated the factors associated with glycaemic control among patients with type 1 or 2 diabetes, but attempts to amalgamate these evidences have been methodologically limited. Hence, a robust review of the evidence is essential to explore factors that can be addressed to promote good glycaemic control in patients with diabetes. DESIGN Mixed-method systematic review using the Preferred Reporting Items for Systematic review and Meta-Analysis 2009 flow diagram, integrating evidence from qualitative and quantitative studies (see Supporting Information File S1). METHODS A systematic review of the literature published between 2006-2017 was conducted in seven electronic databases (CINAHL, MEDLINE, Scopus, EMBASE, PsycINFO, PubMed and ScienceDirect) using the search terms "diabetes mellitus," "glycemic control," "self-concept," "knowledge," "self-efficacy," "empowerment," "race," "ethnicity," "duration," "medication," "obesity" and "comorbidity." RESULTS A total of 1,582 articles were initially retrieved, and 24 of these articles were included in this systematic literature review. The overall empirical evidence suggested that higher socio-economic status, greater dietary knowledge, and higher self-efficacy and empowerment improve glycaemic control among patients with diabetes mellitus. CONCLUSIONS This review presented the factors associated with glycaemic control that may pose significant socio-economic problems to most nations worldwide and impede development nationally, regionally and even globally. Greater emphasis needs to be placed on implementing lifestyle changes on a societal level to stem the tide of the epidemic. RELEVANCE TO CLINICAL PRACTICE There is a need to implement self-management initiatives, that incorporate dietary knowledge, to empower patients with diabetes in their own care. Future public health policy must be geared towards increasing the capability of dealing with the rising incidence of diabetes and implementing primary prevention.
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Affiliation(s)
- Ling Jie Cheng
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore City, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Suan Tee Lim
- National University Hospital, National University Health System, Singapore City, Singapore
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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Seidlein AH, Salloch S. Illness and disease: an empirical-ethical viewpoint. BMC Med Ethics 2019; 20:5. [PMID: 30626443 PMCID: PMC6327539 DOI: 10.1186/s12910-018-0341-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 12/25/2018] [Indexed: 12/16/2022] Open
Abstract
Background The concepts of disease, illness and sickness capture fundamentally different aspects of phenomena related to human ailments and healthcare. The philosophy and theory of medicine are making manifold efforts to capture the essence and normative implications of these concepts. In parallel, socio-empirical studies on patients’ understanding of their situation have yielded a comprehensive body of knowledge regarding subjective perspectives on health-related statuses. Although both scientific fields provide varied valuable insights, they have not been strongly linked to each other. Therefore, the article aims to scrutinise the normative-ethical implications of patient perspectives in building a bridge to the empirical ethics debates. Main text Three potential fields of tension between the illness and the disease perspective are presented. Consequently, findings from empirical research examining patient perspectives on illness are displayed and the practical implications and associated ethical issues which arise are discussed. This leads to the conclusion that an explicit and elaborate empirical-ethical methodology is needed to deal appropriately with the complex interaction between patients’ views and the medico-professional view of disease. Kon’s four-stage model of normative-empirical collaboration is then applied against the background of empirical data on patient perceptions. Starting from this exemplary approach, the article suggests employing empirical-ethical frameworks for further research on the conceptual and normative issues, as they help to integrate perspectives from the philosophy of medicine with socio-empirical research. Conclusion The combination of theoretical and empirical perspectives suggested contributes to a more nuanced discussion of the normative impact of patients’ actual understanding of illness. Further empirical research in this area would profit from explicitly considering potential ethical issues to avoid naturalistic fallacies or crypto-normative conclusions that may compromise healthcare practice. Vice versa, medico-theoretical debates could be enriched by integrating subjective views of those people who are immediately affected.
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Affiliation(s)
- Anna-Henrikje Seidlein
- Institute of Ethics and History of Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Germany
| | - Sabine Salloch
- Institute of Ethics and History of Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Germany.
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Dimova ED, Ward A, Swanson V, Evans JMM. Patients' Illness Perceptions of Type 2 Diabetes: A Scoping Review. Curr Diabetes Rev 2019; 15:15-30. [PMID: 29283073 DOI: 10.2174/1573399814666171227214845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND People's personal perceptions, or illness representations, of type 2 diabetes can act as barriers to successful self-management. INTRODUCTION Understanding patients' subjective perceptions of type 2 diabetes can aid the design of evidence-based care and appropriate educational programmes. This scoping review provides a narrative account of previous knowledge of patients' illness representations of type 2 diabetes. METHODS Quantitative and qualitative studies that explored patients' illness representations of type 2 diabetes, as defined by Leventhal's Common Sense Model, were included. RESULTS Thirty four studies were identified for this review, but only 14 studies were carried out in a general population of people with diabetes. Illness representations varied across study populations. While it is clear that the perceptions of ethnic minorities and marginalised groups are embedded in their historical and cultural backgrounds, it is also important to understand the views of the wider population. CONCLUSION The review highlights the need for self-management interventions to reflect the target population's representations of type 2 diabetes in order to inform interventions and clinical practice.
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Affiliation(s)
- Elena D Dimova
- Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA, Scotland, United Kingdom
| | - Ashleigh Ward
- Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA, Scotland, United Kingdom
| | - Vivien Swanson
- Faculty of Natural Sciences, University of Stirling, FK9 4LA, Scotland, United Kingdom
| | - Josie M M Evans
- Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA, Scotland, United Kingdom
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15
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Aloudah NM, Scott NW, Aljadhey HS, Araujo-Soares V, Alrubeaan KA, Watson MC. Medication adherence among patients with Type 2 diabetes: A mixed methods study. PLoS One 2018; 13:e0207583. [PMID: 30533042 PMCID: PMC6289442 DOI: 10.1371/journal.pone.0207583] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 11/02/2018] [Indexed: 12/02/2022] Open
Abstract
Objective Oral hypoglycemic agents (OHAs) are highly effective in managing Type 2 diabetes if taken appropriately. This study assessed adherence to OHAs among patients with Type 2 diabetes and explored factors associated with adherence behaviour. Research design and methods Mixed methods were used comprising a cross-sectional study using the Arabic version of the Morisky Medication Adherence Scale followed by semi-structured interviews using the Theoretical Domain Framework to explore key determinants of adherence. Results The cross-sectional study included 395 patients of whom 40% achieved a high level of OHA adherence. Lower adherence was associated with younger age (Odds Ratio (OR) 1.084; 95% CI 1.056 to 1.112), higher numbers of non-OHAs (OR 0.848; 95% CI 0.728 to 0.986) and higher HbA1c levels (OR 0.808; 95% CI 0.691 to 0.943). Semi structured interviews based on the Theoretical Domain Framework were completed with 20 patients and identified a wide range of factors potentially associated with OHA adherence, particularly behavioural related factors (e.g. scheduling medication intake, ability to develop a habitual behaviour), social influences (e.g. acting as a role model, the effect of family support), and gaps in knowledge about diabetes and its management with OHAs. Conclusions This unique mixed-methods study has highlighted possible reasons for the low levels of OHA adherence in this patient population. Whilst the theoretically-derived determinants of behaviour illustrate the complexities associated with OHA adherence, they also provide a robust underpinning for future intervention(s) development to improve adherence and maximise patient health outcomes.
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Affiliation(s)
- Nouf M. Aloudah
- Clinical Pharmacy Department, King Saud University, Riyadh, Saudi Arabia
| | - Neil W. Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, United Kingdom
| | - Hisham S. Aljadhey
- Clinical Pharmacy Department, King Saud University, Riyadh, Saudi Arabia
| | - Vera Araujo-Soares
- Institute of Health & Society, Newcastle University, Newcastle, United Kingdom
| | | | - Margaret C. Watson
- School of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
- * E-mail:
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Zhang Z, Monro J, Venn BJ. Carbohydrate Knowledge and Expectations of Nutritional Support among Five Ethnic Groups Living in New Zealand with Pre- and Type 2 Diabetes: A Qualitative Study. Nutrients 2018; 10:nu10091225. [PMID: 30181471 PMCID: PMC6163622 DOI: 10.3390/nu10091225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/03/2018] [Accepted: 09/03/2018] [Indexed: 01/29/2023] Open
Abstract
Despite availability of diabetes and nutrition information for people with pre- and type 2 diabetes, the uptake and understanding of these resources may differ among ethnic groups. Our objective was to explore dietary knowledge and diabetes experiences amongst Māori, European, Pacific Island, Indian and East Asian people living in New Zealand with a focus on carbohydrate-containing foods. A registered diabetes dietitian led ethnic-specific discussions in groups involving 29 people with pre- or type 2 diabetes. Discussions were audio-recorded, fully transcribed and coded independently by two investigators. Themes were developed using deductive and inductive techniques. Five themes emerged: knowledge, concerns, achievements, simplicity and self-determination. Nutritional knowledge was lacking and a greater awareness of trustworthy dietary resources was needed. There were concerns about diabetes complications and appropriate carbohydrate-containing foods and portions. Contrary to this, people felt proud when achieving dietary goals and grateful for support from health care providers and family. Participants were willing to engage in self-care if advice from health professionals was given in plain language, and in a culturally appropriate manner. Given the desire to take an active role in diabetes self-management and willingness to use electronic devices, an ethnic-specific nutrition education resource could be a valuable tool.
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Affiliation(s)
- Zhuoshi Zhang
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - John Monro
- New Zealand Institute for Plant & Food Research Ltd., Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Bernard J Venn
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
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Al Hamid AM, Ghaleb M, Aljadhey H, Aslanpour Z. Factors contributing to medicine-related problems in adult patients with diabetes and/or cardiovascular diseases in Saudi Arabia: a qualitative study. BMJ Open 2017; 7:e017664. [PMID: 29133322 PMCID: PMC5695315 DOI: 10.1136/bmjopen-2017-017664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To investigate the factors contributing to medicine-related problems (MRPs) among patients with cardiovascular diseases (CVDs) and/or diabetes in Saudi Arabia. DESIGN Qualitative semistructured interviews were conducted. Interviews were audio recorded then transcribed into Microsoft Word. The transcribed interviews were then imported into the qualitative analysis software NVivo where thematic analysis was applied. Thematic synthesis was achieved by coding and developing subthemes/themes from the findings of the interviews. SETTING Five healthcare centres in Najran, Saudi Arabia. PARTICIPANTS 25 adult patients with diabetes and/or CVDs. RESULTS The study cohort included 16 men and 9 women with a median age of 61.8 years (40-85 years). Diabetes was the main condition encountered among 23 patients and CVDs were reported among 18 patients. Perceived factors leading to MRPs were of four types and related to: patient-, healthcare system-, clinical (condition-) and medicine-related factors. Patient-related factors were related to living situation, religious practices, diet/exercise and patients' behaviour towards the condition and medicines. Healthcare system-related factors comprised sources and availability of medicines, ease of access to healthcare system and patient satisfaction with healthcare providers. Clinical (condition-) related factors associated with both the knowledge and control over condition, and effects of the condition among medicines intake. Medicine-related factors included lack of knowledge about medicines and medicine use. CONCLUSIONS The results of this study uncovered many factors associated with MRPs among patients with CVDs and diabetes in Saudi Arabia, especially in reference to lifestyle and medicine use. Improving communication with healthcare professional alongside the introduction of national clinical guidance would mitigate the unwanted health complications related to medicine use.
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Affiliation(s)
- Abdullah Mahdi Al Hamid
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Maisoon Ghaleb
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Hisham Aljadhey
- College of Pharmacy, King Saud University, Riyadh, Riyadh, Saudi Arabia
| | - Zoe Aslanpour
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
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Lee CS, Tan JHM, Sankari U, Koh YLE, Tan NC. Assessing oral medication adherence among patients with type 2 diabetes mellitus treated with polytherapy in a developed Asian community: a cross-sectional study. BMJ Open 2017; 7:e016317. [PMID: 28912194 PMCID: PMC5640112 DOI: 10.1136/bmjopen-2017-016317] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES The disease burden of type 2 diabetes mellitus (T2DM) is rising due to suboptimal glycaemic control leading to vascular complications. Medication adherence (MA) directly influences glycaemic control and clinical consequences. This study aimed to assess the MA of patients with T2DM and identify associated factors. DESIGN Analysis of data from a cross-sectional survey and electronic medical records. SETTING Primary care outpatient clinic in Singapore. PARTICIPANTS Adult patients with T2DM. MAIN OUTCOME MEASURES MA to each prescribed oral hypoglycaemic agent (OHA) was measured using the five-question Medication Adherence Report Scale (MARS-5). Low MA is defined as a MARS-R score of <25. Demographic data, clinical characteristics and investigation results were collected to identify factors that are associated with low MA. RESULTS The study population comprised 382 patients with a slight female predominance (53.4%) and a mean±SD age of 62.0±10.4 years. 57.1% of the patients had low MA to at least one OHA. Univariate analysis showed that patients who were younger, of Chinese ethnicity, married or widowed, self-administering their medications or taking fewer (four or less) daily medications tended to have low MA to OHA. Logistic regression revealed that younger age (OR 0.97; 95% CI 0.95 to0.99), Chinese ethnicity (OR 2.80; 95% CI 1.53 to5.15) and poorer glycaemic control (HbA1c level) (OR 1.27; 95% CI 1.06 to1.51) were associated with low MA to OHA. CONCLUSIONS Younger patients with T2DM and of Chinese ethnicity were susceptible to low MA to OHA, which was associated with poorer glycaemic control. Polytherapy was not associated with low MA.
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Affiliation(s)
- Cia Sin Lee
- SingHealth Polyclinics, Singapore, Singapore
| | | | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Eknithiset R, Somrongthong R. Effectiveness of a diabetes mellitus pictorial diary handbook program for middle-aged and elderly type 2 diabetes mellitus patients: a quasi-experimental study at Taladnoi Primary Care Unit, Saraburi, Thailand. J Multidiscip Healthc 2017; 10:327-334. [PMID: 28860800 PMCID: PMC5571847 DOI: 10.2147/jmdh.s138815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM The research question is "How does a diabetes mellitus (DM) pictorial diary handbook (PDHB) affect the knowledge, practice, and HbA1c among patients with DM type 2?" The aim of this study was to evaluate the effect of a PDHB program among middle-aged and elderly patients with DM type 2 in primary care units in Thailand. PATIENTS AND METHODS A quasi-experimental study design was applied. DM type 2 patients were recruited in the PDHB program by a simple random sampling method. The 3-month program consisted of a weekly health education structured for ~20 minutes, a 15-minute group activity training, a 10-minute individual record of participants' knowledge and practice regarding diet control, exercise, oral hypoglycemic drug taking, diet, self-care, alcohol consumption, smoking, weight management, and HbA1c, and a 15- to 30-minute home visit as well as the PDHB for recording self-care behavior daily. The control group received only the usual diabetes care. The primary expected outcomes were changes in HbA1c from the baseline data to 3 months after the program compared between the intervention and control groups. The secondary expected outcomes were compared within the intervention group. The third expected outcomes were changes in the mean score of knowledge and practice from baseline to 3 months after the program within and between the intervention and control groups. RESULTS Compared with the baseline data, there was no significant difference in HbA1c, knowledge, and practice mean score between the intervention and control groups. However, there was a significant difference in HbA1c, knowledge, and practice mean score in the intervention group after they received a 3-month PDHB program and within the intervention group (p-value =0.00). CONCLUSION The PDHB program was effective in lowering HbA1c while also improving the mean score of knowledge and practice among elderly patients with DM type 2. However, larger and longer trial studies will be needed to evaluate the sustainability of this program.
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Affiliation(s)
- Rapat Eknithiset
- College of Public Health Sciences, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Ratana Somrongthong
- College of Public Health Sciences, Chulalongkorn University, Pathumwan, Bangkok, Thailand
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McSharry J, McGowan L, Farmer AJ, French DP. Perceptions and experiences of taking oral medications for the treatment of Type 2 diabetes mellitus: a systematic review and meta-synthesis of qualitative studies. Diabet Med 2016; 33:1330-8. [PMID: 27150899 DOI: 10.1111/dme.13152] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 12/01/2022]
Abstract
AIMS To explore patients' perceptions and experiences of taking oral medications for the pharmacological management of Type 2 diabetes mellitus. METHODS Cinahl, EMBASE, Medline and PsycINFO databases were searched in 2014 to identify qualitative studies exploring patients' perceptions or experiences of taking medications for the management of Type 2 diabetes. Key concepts and themes were extracted and synthesized using meta-ethnography. RESULTS Eight studies were included. Primary study findings were synthesized to develop three higher-order constructs that moved beyond the results of individual studies. The first construct, Medications for diabetes: a necessary evil, outlines how patients' negative perceptions of medication risks co-exist with a resounding view that medications are beneficial. Passive patients but active experimenters highlights the contrast between patients' passive acceptance of medication prescriptions and the urge to actively experiment and adjust doses to optimize medication use in daily life. Finally, Taking oral medication for Type 2 diabetes: a unique context describes features specific to the Type 2 diabetes medication experience, including lack of symptoms and the perceived relationship between medication and diet, which may influence adherence. CONCLUSIONS Medication-taking for Type 2 diabetes is a unique adherence context, which requires the development of condition-specific interventions. The present findings indicate patients understand the need for medications but adjust dosage and timing in their daily lives. This review suggests providers should acknowledge patient preferences in the development of management strategies, and highlights an opportunity to direct the motivation evident in patients' experimentation towards potentially more beneficial medication-taking behaviours.
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Affiliation(s)
- J McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland.
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK.
| | - L McGowan
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - A J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - D P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
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Al Hamid A, Ghaleb M, Aljadhey H, Aslanpour Z. A systematic review of qualitative research on the contributory factors leading to medicine-related problems from the perspectives of adult patients with cardiovascular diseases and diabetes mellitus. BMJ Open 2014; 4:e005992. [PMID: 25239295 PMCID: PMC4170202 DOI: 10.1136/bmjopen-2014-005992] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To synthesise contributing factors leading to medicine-related problems (MRPs) in adult patients with cardiovascular diseases and/or diabetes mellitus from their perspectives. DESIGN A systematic literature review of qualitative studies regarding the contributory factors leading to MRPs, medication errors and non-adherence, followed by a thematic synthesis of the studies. DATA SOURCES We screened Pubmed, EMBASE, ISI Web of Knowledge, PsycInfo, International Pharmaceutical Abstract and PsycExtra for qualitative studies (interviews, focus groups and questionnaires of a qualitative nature). REVIEW METHODS Thematic synthesis was achieved by coding and developing themes from the findings of qualitative studies. RESULTS The synthesis yielded 21 studies that satisfied the inclusion and exclusion criteria. Three themes emerged that involved contributing factors to MRPs: patient-related factors including socioeconomic factors (beliefs, feeling victimised, history of the condition, lack of finance, lack of motivation and low self-esteem) and lifestyle factors (diet, lack of exercise/time to see the doctor, obesity, smoking and stress), medicine-related factors (belief in natural remedies, fear of medicine, lack of belief in medicines, lack of knowledge, non-adherence and polypharmacy) and condition-related factors (lack of knowledge/understanding, fear of condition and its complications, and lack of control). CONCLUSIONS MRPs represent a major health threat, especially among adult patients with cardiovascular diseases and/or diabetes mellitus. The patients' perspectives uncovered hidden factors that could cause and/or contribute to MRPs in these groups of patients.
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Affiliation(s)
- A Al Hamid
- Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - M Ghaleb
- Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - H Aljadhey
- Medication Safety Research Chair, Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Z Aslanpour
- Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
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Pujilestari CU, Ng N, Hakimi M, Eriksson M. "It is not possible for me to have diabetes"-community perceptions on diabetes and its risk factors in Rural Purworejo District, Central Java, Indonesia. Glob J Health Sci 2014; 6:204-18. [PMID: 25168994 PMCID: PMC4825520 DOI: 10.5539/gjhs.v6n5p204] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/05/2014] [Accepted: 04/25/2014] [Indexed: 12/16/2022] Open
Abstract
Accumulating evidence suggests that negative perceptions towards diabetes can limit the management and prevention of the disease. The negative perceptions towards diabetes are prevalent in many different settings, especially among rural communities. Few qualitative studies have been performed to understand how the community views diabetes and its associated risk factors. This study aimed to explore general community perceptions of diabetes and its risk factors in rural Indonesia. A total of 68 participants were recruited to 12 focus group discussions (FGDs) comprised of different age groups and sexes. The FGDs were conducted in six villages in rural Purworejo District, Central Java, Indonesia, from 2011 to 2012. All FGDs were recorded and transcribed. Qualitative content analysis was performed to describe and analyse how the rural community perceived diabetes and its risk factors. Diabetes was perceived as a visible and scary sugar disease, and the affected individuals themselves were blamed for getting the disease. Recognised as ‘sugar’ or ‘sweet-pee’ disease with terrifying effects, diabetes was believed to be a disease with no cure. The participants seemed to have an unrealistic optimism with regards to the diabetes risk factors. They believed that diabetes would not affect them, only others, and that having family members with diabetes was necessary for one to develop diabetes. Our findings demonstrate that rural communities have negative perceptions about diabetes and at the same time individuals have unrealistic optimism about their own risk factors. Understanding how such communities perceive diabetes and its risk factors is important for planning prevention strategies. Health messages need to be tailored to health-related behaviours and the local culture’s concepts of diseases and risk factors.
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Sweileh WM, Zyoud SH, Abu Nab’a RJ, Deleq MI, Enaia MI, Nassar SM, Al-Jabi SW. Influence of patients' disease knowledge and beliefs about medicines on medication adherence: findings from a cross-sectional survey among patients with type 2 diabetes mellitus in Palestine. BMC Public Health 2014; 14:94. [PMID: 24479638 PMCID: PMC3909379 DOI: 10.1186/1471-2458-14-94] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 01/29/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a common serious health problem. Medication adherence is a key determinant of therapeutic success in patients with diabetes mellitus. The purpose of this study was to assess medication adherence and its potential association with beliefs and diabetes - related knowledge in patients with type II DM. METHODS This study was carried out at Al-Makhfia governmental diabetes primary healthcare clinic in Nablus, Palestine. Main outcome of interest in the study was medication adherence. The Beliefs about Medicines Questionnaire (BMQ) was used to assess beliefs. Morisky Medication Adherence Scale (MMSA-8©) was used to assess medication adherence. The Michigan diabetes knowledge test (MDKT) was used to assess diabetes - related knowledge. Univariate and multivariate analysis were carried out using Statistical Package for Social Sciences (SPSS 20). RESULTS Four hundred and five patients were interviewed. The mean ± SD age of the participants was 58.3 ± 10.4 (range = 28 - 90) years. More than half (53.3%) of the participants were females. Approximately 42.7% of the study sample were considered non-adherent (MMAS-8© score of < 6). Multivariate analysis showed that the following variables were significantly associated with non-adherence: disease-related knowledge, beliefs about necessity of anti-diabetic medications, concerns about adverse consequences of anti-diabetic medications and beliefs that medicines in general are essentially harmful. Diabetic patients with high knowledge score and those with strong beliefs in the necessity of their anti-diabetic medications were less likely to be non-adherent ([O.R = 0.87, 95% CI of 0.78 - 0.97] and [O.R = 0.93, 95% of 0.88 - 0.99] respectively). However, diabetic patients with high concerns about adverse consequences of anti-diabetic medications and those with high belief that all medicines are harmful were more likely to be non-adherent ([O.R = 1.09; 95% C.I of 1.04 - 1.16] and [O.R = 1.09, 95% C.I of 1.02 - 1.16] respectively). CONCLUSIONS Beliefs and knowledge are important factors in understanding variations in medication adherence among diabetic patients. The BMQ can be used as a tool to identify people at higher risk of non-adherence. Improving knowledge of patients about their illness might positively influence their medication adherence.
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Affiliation(s)
- Waleed M Sweileh
- Department of Pharmacology/ Toxicology, College of medicine and health sciences, An-Najah National University, Nablus, Palestine
| | - Sa’ed H Zyoud
- Department of clinical pharmacy and Pharmacotherapy, College of medicine and health sciences, An-Najah National University, Nablus, Palestine
| | - Rawan J Abu Nab’a
- Pharm. D Program, College of medicine and health sciences, An-Najah National University, Nablus, Palestine
| | - Mohammed I Deleq
- Pharm. D Program, College of medicine and health sciences, An-Najah National University, Nablus, Palestine
| | - Mohammed I Enaia
- Pharm. D Program, College of medicine and health sciences, An-Najah National University, Nablus, Palestine
| | - Sana’a M Nassar
- Pharm. D Program, College of medicine and health sciences, An-Najah National University, Nablus, Palestine
| | - Samah W Al-Jabi
- Department of clinical pharmacy and Pharmacotherapy, College of medicine and health sciences, An-Najah National University, Nablus, Palestine
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Sahril N, Aris T, Mohd Asari AS, Yaw SL, Saleh NC, Omar MA, Teh CH, Abdul Muttalib K, Idzwan MF, Low LL, Junid NZ, Ismail F, Ismail NA, Abu Talib N. Oral health seeking behaviour among Malaysians with type II diabetes. ACTA ACUST UNITED AC 2014. [DOI: 10.7243/2055-7205-1-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chung WW, Chua SS, Lai PSM, Chan SP. Effects of a pharmaceutical care model on medication adherence and glycemic control of people with type 2 diabetes. Patient Prefer Adherence 2014; 8:1185-94. [PMID: 25214772 PMCID: PMC4159395 DOI: 10.2147/ppa.s66619] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a lifelong chronic condition that requires self-management. Lifestyle modification and adherence to antidiabetes medications are the major determinants of therapeutic success in the management of diabetes. PURPOSE To assess the effects of a pharmaceutical care (PC) model on medication adherence and glycemic levels of people with type 2 diabetes mellitus. PATIENTS AND METHODS A total of 241 people with type 2 diabetes were recruited from a major teaching hospital in Malaysia and allocated at random to the control (n=121) or intervention (n=120) groups. Participants in the intervention group received PC from an experienced pharmacist, whereas those in the control group were provided the standard pharmacy service. Medication adherence was assessed using the Malaysian Medication Adherence Scale, and glycemic levels (glycated hemoglobin values and fasting blood glucose [FBG]) of participants were obtained at baseline and after 4, 8, and 12 months. RESULTS At baseline, there were no significant differences in demographic data, medication adherence, and glycemic levels between participants in the control and intervention groups. However, statistically significant differences in FBG and glycated hemoglobin values were observed between the control and intervention groups at months 4, 8, and 12 after the provision of PC (median FBG, 9.0 versus 7.2 mmol/L [P<0.001]; median glycated hemoglobin level, 9.1% versus 8.0% [P<0.001] at 12 months). Medication adherence was also significantly associated with the provision of PC, with a higher proportion in the intervention group than in the control group achieving it (75.0% versus 58.7%; P=0.007). CONCLUSION The provision of PC has positive effects on medication adherence as well as the glycemic control of people with type 2 diabetes. Therefore, the PC model used in this study should be duplicated in other health care settings for the benefit of more patients with type 2 diabetes.
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Affiliation(s)
- Wen Wei Chung
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Pharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Siew Siang Chua
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, University Malaya Primary Care Research Group, Kuala Lumpur, Malaysia
| | - Siew Pheng Chan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Correspondence: Siew Siang Chua, Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia, Tel +60 3 7967 6688, Fax +60 3 7967 4964, Email
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Chew BH, Ghazali SS, Ismail M, Haniff J, Bujang MA. Age ≥ 60 years was an independent risk factor for diabetes-related complications despite good control of cardiovascular risk factors in patients with type 2 diabetes mellitus. Exp Gerontol 2013; 48:485-91. [PMID: 23454736 DOI: 10.1016/j.exger.2013.02.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 02/05/2023]
Abstract
Providing effective medical care for older patients with type 2 diabetes mellitus (T2D) that may contribute to their active aging has always been challenging. We examined the independent effect of age ≥ 60 years on disease control and its relationship with diabetes-related complications in patients with T2D in Malaysia. This was a cross-sectional study using secondary data from the electronic diabetes registry database Adult Diabetes Control and Management (ADCM). A total of 303 centers participated and contributed a total of 70,889 patients from May 2008 to the end of 2009. Demographic data, details on diabetes, hypertension, dyslipidemia and their treatment modalities, various risk factors and complications were updated annually. Independent associated risk factors were identified using multivariate regression analyses. Fifty-nine percent were female. Malay comprised 61.9%, Chinese 19% and Indian 18%. There were more Chinese, men, longer duration of diabetes and subjects that were leaner or had lower BMI in the older age group. Patients aged ≥ 60 years achieved glycemic and lipid targets but not the desired blood pressure. After adjusting for duration of diabetes, gender, ethnicity, body mass index, disease control and treatment, a significantly higher proportion of patients ≥ 60 years suffered from reported diabetes-related complications. Age ≥ 60 years was an independent risk factor for diabetes-related complications despite good control of cardiovascular risk factors. Our findings caution against the currently recommended control of targets in older T2D patients with more longstanding diseases and complications.
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Affiliation(s)
- Boon How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
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Sahri N, Mahmud SZ, Saari R, Naidu BM, Abd Hamid HA, Abdul Mutalip HM. Medication labeling literacy among Malaysian with diabetes: a cross-sectional study. ACTA ACUST UNITED AC 2012. [DOI: 10.7243/2050-0866-1-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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