Article Wjpps 1454137474

WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES
Sabu et al. World Journal of Pharmacy and Pharmaceutical Sciences

SJIF Impact Factor 5.210
Volume 5, Issue 2, 694-710 Research Article ISSN 2278 4357
MEDICATION ADHERENCE RATING OF PATIENTS WITH

HYPERTENSION IN A TERTIARY CARE HOSPITAL
Anjana Brijith Johnson, Anu Sebastian, Anusha Sudulaguntla, Arpitha Chinnu Sabu*,
Swetha Meka and Basavaraj K. Nanjwade
The Oxford College of Pharmacy, Hongasandra, Bengaluru-560 068, Karnataka, India and
The Oxford Medical College, Hospital and Research Center, Attibele, Bengaluru-562 107,
Karnataka, India.
Article Received on ABSTRACT

23 Nov 2015,
The main objective of the study was to analyse the adherence of
Revised on 14 Dec 2015,
patients towards antihypertensive medication using Medication
Accepted on 03 Jan 2016
Adherence Rating Scale, to identify the leading cause of non-
adherence and to provide patient counselling to improve adherence and
*Correspondence for
Author quality of life of the patient. The Medication Adherence Rating Scale
Arpitha Chinnu Sabu (MARS) questionnaire was asked during patient interview. Explicit
The Oxford Medical inclusion and exclusion criteria were applied. Adherence was
College, Hospital and
measured based on various parameters such as demographic factors,
Research Center, Attibele,
clinical characteristics, and medication taking characteristics. It was
Bengaluru-562 107,
Karnataka, India. measured before and after patient counselling to see improvement in
adherence. In the study period of 6 months 150 cases were collected.
It was found that elderly patients >60 years of age showed more adherence. 59% of the
patients were males and they showed 91% adherence. Literates were 92% adherent while
illiterates showed 83% adherence. Those who were suffering from hypertension for longer
duration from 1-10 years were found to be more adherent to drug therapy (86-97%). People
from Urban area were of 21% and showed 94% adherence. Two third of the study population
were unaware about the complications of hypertension. Patients who followed a proper diet
showed more adherence to medication than who did not follow. Those who went for follow
up at least once a year or more number of times a year showed comparatively better
adherence. 49% of people had comorbid condition and they showed 91% adherence. During
the first visit only 35.5% of the people were completely adherent. But after patient
counselling and proper interaction, the percentage of adherence increased to 73.3%. Among
www.wjpps.com Vol 5, Issue 2, 2016. 694

the factors affecting adherence, Forgetfulness, ignorance, aloneness, were found to be the
major cause of non-adherence followed by poverty and lack of transportation. Adherence of
the patient can be improved by establishing a good patient-provider relationship and giving
proper patient counselling to patient or their relatives.. Patients should be reminded to take
their medications at the right time, to come for follow up, to regularly measure BP and to
have proper diet.
KEYWORDS: Medication Adherence, Antihypertensive, Tertiary Care, MARS
INTRODUCTION
Adherence to (compliance with) a medication regimen can be defined as the extent to which
the patients take medication as given by the care providers or it refers to the willingness and
ability of an individual to follow health related advice properly, to medication as prescribed,
to attend scheduled clinic appointments, as well as to complete recommended follow-ups.[1]
Medication non-compliance is the failure or discontinuation of proper medication taking
without the concern of prescribed physician.[2] Adherence is also defined by World Health
Organization as the degree to which the persons behavior corresponds with the agreed
recommendations from a health care provider.
Consequences of Non-adherence: Consequences of non-adherence includes worsening of

disease, death, increased health care costs, waste of medication, reduced functional abilities,
lower quality of life, increased use of medical capital such as nursing homes, hospital visits
and hospital admissions, serious health economic consequence.[3]
Factors affecting adherence

According to the WHO, factors which affect adherence are in 5 dimensions i.e. social and
economic factors, condition- and therapy-related factors, health-system and clinician factors,
patient factors, and patient-provider relationship factors.[4]
1. Social and economic factors: Time commitment, Cost of therapy and income, Social
support
2. Condition- and therapy-related factors: Disease factor; Therapy-related factors
identified include; Treatment complexity; Route of administration; Duration of treatment
period; Medication side effects; Degree of behavioral change required. Taste of
medication; Requirement for drug storage.[5]

3. Health-system and clinician factors

Provider Factors: Time spent discussing, patient-provider interaction, communication issues
and satisfaction of the selected patient.[6]
Healthcare system factors: Lack of accessibility to healthcare, long waiting time for clinic
visits, difficulty in getting prescriptions filled, unhappy or unsatisfied clinic visits, nsatisfying
attitude of healthcare members.[5]
4. Patient-Centered Factors: Age, Gender, and Educational level. Ethnicity: As per
various studies, Caucasians have better compliance than African-Americans, Hispanics and
other minorities. This may be due to low socio-economic status as well as language barriers
for minority races. Marital status: help and support from spouse Psychological factors, Health
literacy, Patient knowledge about condition and treatment
5. Other factors: Smoking or alcohol intake, Lifestyle, Forgetfulness.[5]
Methods to improve medication adherence

A systematic approach that could be instituted in improving medication adherence is as
following.
1. Level of prescribing: Introduce a cooperative approach with the patient at the level of
prescribing. Whenever possible we include patients in decision making regarding their
medications so that they have a sense of ownership and they are provided partners in the
treatment plan. Simplify medication taking. Use the most simplified regimen as first choice
based on patient characteristics. Modification will have to be made to medication regimens to
reduce the frequency of administration and/or reduced the number of different medications or
replace with combination products.
2. Communicating with the patient: Explain key information regarding prescribing,

dispensing a medicine, Information about the drugs (what, why, when, how and how long).
Address the common side effects and information that patient should necessarily know. Use
medication adherence improving aids. Forgetfulness can be minimized by reminders i.e.
through directly mailed letters, telephone, pager, WhatsApp, e-mails, text messages to
cellular phones and alarms. Provide medication calendars or schedules which specify the time
to take medications, drug cards, medication charts or medicine related information sheets or
specific packagings such as pill boxes, unit-of-use for packaging and special containers
indicating the time of dose. Provide behavioural support. Work together with patient to

include the medication regimen into his/her daily regimen (mainly the patient taking complex
drug regimens, those having accidental difficulties in adherence (e.g. elderly).
3) During follow ups: Schedule appropriate follow up. Monitor the patient medication
adherence during the follow ups. Assess adherence during consequent follow ups. Check the
adherence by various methods which may be dependent on patient As well as disease
characteristics. Check the effectiveness of medication adherence aids used, if any. This
should be done by physicians as well as by pharmacists. Identified difficulties and barriers
related to adherence, address the problems. Use fixed combinations (poly-pills) to reduce the
number of tablets.
Methods to measure adherence

Various methods are available to measure adherence. The methods available for measuring
adherence can be divided into direct and indirect methods of measurement.
1. Direct methods include direct observed therapy, measurement of the level of a drug or its
metabolite in blood or urine and detection or measurement of a biological marker added
to the drug formulation, in the blood. Direct approaches are one of the most accurate
methods of measuring adherence but it is more expensive.
2. Indirect methods include patient questionnaires, patient self-reports, pill counts, rates of
prescription refills, assessment of patients clinical response, electronic medication
monitors, measurement of physiologic markers, as well as patient diaries.[7]
Medication Adherence Rating Scale

Thompson et al (2000) identified several deficiencies in the DAI as a measure of adherence
and proposed a new inventory, the MARS scale, that incorporates features of both the DAI
and the MAQ (Morisky et al, 1986) but which they claimed to have greater validity and
clinical utility.
They concluded that it was a valid and reliable measure of adherence to psychoactive
medications (Table 1).
The patient should be asked to respond to the statements in the questionnaire by circling the
answer which best describes their behavior or attitude towards their medication.[8]

Table 1: Medication adherence rating scale (MARS)

No. Questions Answer
1 Do you ever forget to take medication? Yes/No
2 Are you careless at times about taking your medication? Yes/NO
3 When you feel better, do you sometimes stop taking your medication? Yes/No
4 Sometimes if you feel worse when you take medication, do you stop taking it? Yes/No
5 I take my medication only when I am sick Yes/No
6 It is unnatural for my mind and body to be controlled by medication Yes/No
7 My thoughts are clearer on medication Yes/No
8 By staying on medication, I can prevent getting sick Yes/No
9 I feel weird, like a zombie on medication Yes/No
10 Medication makes me feel tired and sluggish Yes/No
Hypertension
Blood pressure or hypertension can be defined as the pressure exerted by the blood against
the arteries of the heart pumps blood through the body. Blood pressure readings are given as
two numbers, and the top number is called the systolic blood pressure. The bottom number is
called the diastolic blood pressure. For example, 120 over 80 (written as 120/80 mmHg).
Hypertension is the most common cardiovascular disease in the world. It affects a major
percentage of the adult population, hovering morbidity and mortality rates in both developed
and developing countries. The World Health Organization (WHO) accounts one eighth of all
deaths as being triggered by hypertension, which ranks it third as a cause of mortality
globaly.[9]
Hypertension is one of the global major cardiovascular diseases with increasing popularity,
frequency and complications. Patients are unaware about the disease, its treatment, severity
and complications. They have less knowledge on the drug regimen and lifestyle changes that
has to be brought by them. It is thus necessary to provide patient counselling on the three
basic areas such as disease, drugs, and lifestyle.
Identifying the current level of patients in the graph of medication adherence and providing
necessary advice to patients for better adherence can help in achieving optimal outcomes in
the treatment. As well as by providing patient counselling we can improve the patients
knowledge about the disease and drugs. Changes in lifestyle can improve the quality of life of
the patient. Patient healthcare professional relationship can be improved as well.
Many factors can cause blood pressure, including the amount of water and salt having in your
body, the condition of your kidneys, nervous system, or blood vessels, your hormone levels,
unbalanced diet, stress, physical inactivity, and stiffening of blood vessels due to ageing.

MATERIALS AND METHOD

The study were carried out in the department of General medicine, which includes male
medical ward, female medical ward and general surgery ward, of The Oxford Medical
College Hospital and Research Center located in Attibele, Bangalore. The prospective
observational study was conducted for a period of six month. Study population included 150
patients, who may or may not be admitted for treatment of hypertension.
Inclusion Criteria
In-patients admitted in the general medical ward during the study period (6 months) who
may or may not be admitted for treatment of hypertension.
Patients with previously diagnosed conditions and are on prescription drugs.
Exclusion Criteria
Patients treated as out-patients
Patients treated without prescribed of drugs.
Pediatrics
Pregnant and Breast-feeding Women
Post-operative patients
Dental patients
Operation Modality
Step 1: Data collection: this includes getting consent of patient, collection of information
from patient case data file and assessing medication adherence by asking MARS
questionnaire. According to the scale Patient's that respond "NO" to questions 1-6 and 9-10
and "YES" to questions 7-8 are compliant (Table 1). Hence the score of each patient was
identified and tabulated based on first visit (Table 2). Also graph can be drawn based on the
score vs. number of patients falling in that score. From the graph we can identify the
percentage of patients who are adherent and non-adherent (Figure 6).
Table 2: Score and adherence
Score Adherence
0-3 Non-adherent
4-6 Partially adherent
7-10 Adherent

The demographic details, clinical characteristics and medication taking characteristics were
also analyzed(Table 3).[10]
Table 3: Factors and characteristics

Demographic Factors Clinical Characteristics Medicine Taking-Characteristics
<49 < 1 year Forgetfulness
50-59 Duration of 1-5 years Aloneness
Age (Years) 60-69 disease 6-10 years Ignorance
70-79 11 years and over Poverty
>80 Whether they Yes Old age
know there
Female exists a special No Inactivity
Gender
diet
Male Yes Disgusted
Exercising the Lack of
Illiterate diet No transportation
possibilities
Education status
Awareness Disturbance
Literate about Yes (medicine side
complications effects)
Housewif of
No Reason for not
e hypertension
taking medicine
Retired When I feel ill
as prescribed
Several times a
worker
month
Civil
Once a month
Occupation servant Attending
Unemplo follow-up Once every 3
yed visits months Failure to use
Others multiple
(Farmer, medicines.
Once a year
tradesma
n, etc.)
Urban Having blood Regular
pressure
County measured Irregular
Place of living
regularly
Comorbid Yes
Village
diseases No
Step 2: Patient counseling (Patient counseling sheet)

Step 3: Reassessment: Second visit was made to the patient and the MARS questionnaire was
again asked (Table 1). The score was calculated based on the answers and the improvement
in adherence was identified (Figure 7).
Step 4: Data analysis: The data collected were analysed by descriptive analysis. The
summarised data only was entered into the worksheet in Microsoft Excel, and the graphs
were obtained.

RESULTS AND DISCUSSION

Figure 1: Graphical representation of medication adherence based on age
The people of age group 60-69 showed more adherence compared to other age groups (Figure
1).
Table 4: Tabular Representation Medication Adherence Based on Gender

No: of patients Males Females
Adherent 27 20
Partially adherent 54 29
Non-adherent 8 12
Total Percentage of people 59 41
% Adherence 91 80
The Males were found to be more adherent than females (Table 4).
Figure 2: Graphical representation of awareness about complications of hypertension
Our study showing Two third of the patients were unaware about the complications of
hypertension (Figure 2).

Figure 3: Graphical representation of adherence based on educational status
According to the data obtained, literates were found to be more adherent than illiterates
(Figure 3).
Table 5: Tabular representation of adherence based on occupation

House Civil
No: of patients Retired Workers Unemployed Others
wife servants
Adherent 9 0 15 2 6 13
Partially adherent 20 8 23 4 11 19
Non-adherent 9 1 7 0 0 3
Total Percentage
25 6 30 4 11 23
of people
% Adherence 76 89 84 100 100 91
According to the occupation, Civil Servants and Unemployed people were found to be 100%
adherent (Table 5).
Figure 4: Graphical representation of adherence based on duration of disease

People who had hypertension from 1-5 years are found to be more adherent than those
patients who had hypertension of longer duration (Figure 4).
Figure 5: Graphical representation of adherence based on place of living
People living in county regions are found to show more adherence than those living in village
and urban regions (Figure 5).
Table 6: Tabular representation of adherence based on following of proper diet

No: of patients Yes No
Adherent 33 14
Non-adherent 9 9
% Adherence 89 87
Those who followed a proper diet are more adherent to the medication (Table 6).
Table 7: Tabular representation of adherence related to follow-up

When I feel Several times Once a Once every Once a
No: of patients
ill a month month 3 month year
Adherent 14 3 12 12 6
Partially
46 2 11 13 12
adherent
Non-adherent 13 1 2 3 0
Total Percentage
47 4 17 19 12
of people
% Adherence 82 83 92 90 100
Those patients who go for proper follow up showed comparatively more adherence. This
result shows that at least once a year follow up is sufficient for proper monitoring of patient
condition (Table 7).

Table 8: Tabular representation of blood pressure measure and adherence

No: of patients Regular Irregular
Adherent 27 19
Non-adherent 5 15
% Adherence 91 84
Those patients who monitored their BP levels regularly showed more adherence than who
were irregular (Table 8).
Table 9: Tabular representation of comorbidity and adherence

No: of patients Yes No
Adherent 24 22
Non-adherent 7 13
% Adherence 91 83
Those who had a comorbid condition were found to be more adherent (Table 9).
Figure 6: Graphical representation of adherence measurement of patients during the

first visit
Out of 150 patients only 53 patients showed adherence to medication, during the first visit
(Figure 6).

Figure 7: Graphical representation of adherence measurement of patients during the

second visit
There is improvement in adherence after the first visit, as the patients who were non-adherent
decreased by 12.63%, partially adherent decreased by 25.3% and whose who were adherent
increased by 25.3% (Figure 7).
Figure 8: Graphical representation of medication taking characteristics: reason for not

taking the medicine as prescribed
1. Forgetfulness, aloneness, ignorance

2. Poverty
3. Old-age inactivity
4. Disgusted
5. Lack of transportation possibilities
6. Disturbance (medicine side effects)
7. Failure to use multiple medicines

From Figure 8 it is evident that the major reason for non-adherence is forgetfulness,
aloneness and ignorance which makes 35.25%. The second leading cause is poverty,
followed by old-age inactivity.
Reasons Order of Percentage

Forgetfulness, aloneness, ignorance 35.20
Poverty 14.91
Lack of transportation 12.88
Old-age inactivity 11.52
Disgusted 10.84
Failure to use multiple medicines 9.49
Disturbance (side effects) 5.08
DISCUSSION
We conducted a prospective observational study on medication adherence rating of
hypertensive patients to assess their medication taking characteristics in tertiary care hospital.
Although the medications are given to the patients, it may not be necessary that they comply
with the medication all the time as it is a symptom-less disease and patients probably forget to
take the medication or do not feel the need to take them. Considering all the factors and the
results obtained accordingly, the study can be compared or analysed based on results of other
similar studies.
Reviewing the demographic data, it was found that 45% of the patients were aged 60 69
years (Figure 1). This result is consistent with the study conducted by Papatya Karakurt, and
Magfiret Kas (53.6%). Patients above 70 years were found to be more adherent (90-100%),
whereas in the study conducted by Papatya Karakurt, and Ma gfiret Kas it was only 33.9%.
In our study, only 41% of the patients were females (Table 4). On the contrary Papatya
Karakurt, and Magfiret Kas study reported higher rates of hypertension in females (78%).
Males were more in number and showed comparatively more adherence than females in our
study.
It was found that the great majority of patients about two third of patients do not know about the
complications of hypertension at all (Figure 2). This is almost similar to the result obtained
by Papatya Karakurt, and Magfiret Kas where 99.1% people did not know about the
complications. This problem can be solved by conducting various healthcare programs, and
bringing awareness about prevention, risk factors and complications. Encourage people for
health screening at least once a year.

This study showed that there is significant relation between educational status and adherence
as illiterates were only 83% adherent while literate patients showed 92% adherence (Figure
3). A similar result was obtained in Papatya Karakurt, and Ma gfiret Kas Karakut study.
It was also found that 46% of patients had been suffering from hypertension for 1 - 5 years
(Figure 4). Similar figures for patients suffering from hypertension for 1 - 5 years were
reported by Papatya Karakurt, and Magfiret Kas(43.6%). This frequent result of 1 - 5 years may
be associated with the fact that hypertension is an asymptomatic disease.15 Patients who were
suffering from hypertension 1-10 years showed more adherence to medications. In the study
conducted by Papatya Karakurt, and Magfiret Kas it was found that the patients with a
longer history of hypertension (50.6%) tended more to take their medicine as prescribed.
Patients from urban area showed more adherence compared to those from village and county
(Figure 5). This is in accord with the result obtained by Papatya Karakurt, and Ma gfiret Kas
where people from village showed fewer adherences (34%). This result may also stem from
the difficulties of transportation for patients who live in rural areas or less accessibility.
It was found that 46% of the study participants did not comply with their diet (Table 6), which is
similar to the value obtained by Papatya Karakurt, and Ma gfiret Kas(47.35). This result may
be associated with the likelihood of patients not having had adequate and balanced nutrition
before the disease, which they found keeping a diet difficult, and/or that training by medical
staff was insufficient.
This result showing 37% of patients to have their blood pressures measured regularly
(Table 8), is similar to the rate of 46.3% reported by Papatya Karakurt, and Ma gfiret Kas.
But those who had there BP measured regularly were found to be 91% adherent.
Among the reasons for non-concordance (Figure 8), the grouping of forgetfulness,
aloneness, and negligence (35.2%) took the first place, which is in agreement to that of Papatya
Karakurt, and Ma gfiret Kas (49.3%).
CONCLUSION
From this prospective observational study, we came to the conclusion that the patients who
are 60 years and older are more adherent to their medication. This might be due to fear of
complications, and hope for improvement in patient condition. For elder patients, the family
members care about their health and provide necessary support for them or remind them to

take the medications, which helps in improved adherence to medications. Usually for patients
above 70 years the relatives only give the medication to the patient, as the elderly are
depended on them.
The awareness about the complication of hypertension, diet, follow up, regular measurement
of BP, medication related facts, and adverse effects can be provided to individual patients by
proper patient-provider interaction. When patients are aware of the complications they are
more likely to follow the advice of the prescriber to prevent its occurrence. Patient
counselling can be given to the patient, patient relatives or in written forms such as drug
cards, leaflets or sheets. Reminders about follow up and regular BP measures can help
improve adherence. The more interest the patient shows in the condition, the more chances
they follow a proper diet and medication. From this study we have seen the improvement in
adherence after patient counselling (Figure 7). Patient counselling sheet containing details of
disease, lifestyle modifications, and all necessary information related to drugs to be taken,
were translated to local language and distributed to literate patients. For illiterates, pictograms
of some advices were given for better patient understanding.
Forgetfulness, ignorance and aloneness are one of the major reasons for non-adherence
(Figure 8). The patient can set alarms, reminder notes, or organise which all drugs are to be
taken at which time. The family members can remind the patients.
Health care professionals can also remind the patients through letters, phone calls etc.
Patients who are busy with their occupation can pre-book appointments, make reminders for
clinic visits, and set apart time for monitoring their condition.
Adherence is less in patients living in villages due to lack of transport or accessibility to

medication. This can be improved by providing community based health care services,
conducting health care programs, or free check-ups in health care clinics.
ACKNOWLEDGEMENTS
We wish to express our sincere gratitude to Prof. Dr. Padmaa. M. Paarakh Principal of The
Oxford College of Pharmacy, Bangalore for providing us an opportunity to do our project
works.

REFERENCES
1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med., Aug 2005; 353(5):
487-497.
2. Yegenoglu S, Wertheimer A, Dubin W. Demographical factors affecting patient
adherence to medications in an outpatient psychiatric clinic: A preliminary study.
FABAD J.Pharm.sci., 2003; 28: 77-84.
3. Jimmy B, Jose J. Patient Medication Adherence: Measures in Daily Practice. Oman
Medical Journal., 2011; 26(3): 155-159.
4. World Health Organization. Adherence to Long-Term Therapies: Evidence for Action.
Geneva, Switzerland; 2003. Available at:
http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf. Accessed
September 14, 2009.
5. Jing J, Grant E.S, Vernon M.S, ShuChen. L. Factors affecting therapeutic compliance: A
review from the patients perspective. Therapeutics and Clinical Risk Management 2008;
4(1): 269286
6. Gellad W. F, Grenard.J, McGlynn E.A, A Review of Barriers to Medication Adherence:
A Framework for Driving Policy Options. Mehlman Vogel Castagnetti HEALTH,
RAND Corporation publication., 2009
7. Jimmy .B, Jose. J.Patient Medication Adherence: Measures in Daily Practice. Oman
Medical Journal., 2011; 26(3): 155-159. DOI 10. 5001/omj.2011.3
8. An international educational activity developed by J Kane (USA), W Kissling (Germany)
T Lambert (Australia) and E Parellada (Spain) Adherence rating scales
9. Chen M.A. High Blood Pressure (MedlinePlus), Washington; U.S National Library Of
medicine; March 2015.Available from:
http://www.nlm.nih.gov/medlineplus/ency/article/000468.htm.
10. PapatyaKarakurt, RN, PhD, and MagfiretKaiki, RN, PhD (DECEMBER 2012) 'Factors
affecting medication adherence in patients with hypertension ', JOURNAL OF
VASCULAR NURSING, December 2012; 30: 118-126.

Article Wjpps 1454137474

Enviado por

Dados do documento

Título original

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

Article Wjpps 1454137474

Enviado por

Direitos autorais:

Formatos disponíveis

WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

Sabu et al. World Journal of Pharmacy and Pharmaceutical Sciences

Volume 5, Issue 2, 694-710 Research Article ISSN 2278 4357

MEDICATION ADHERENCE RATING OF PATIENTS WITH

Article Received on ABSTRACT

www.wjpps.com Vol 5, Issue 2, 2016. 694

KEYWORDS: Medication Adherence, Antihypertensive, Tertiary Care, MARS

Consequences of Non-adherence: Consequences of non-adherence includes worsening of

Factors affecting adherence

www.wjpps.com Vol 5, Issue 2, 2016. 695

3. Health-system and clinician factors

Methods to improve medication adherence

2. Communicating with the patient: Explain key information regarding prescribing,

www.wjpps.com Vol 5, Issue 2, 2016. 696

Methods to measure adherence

Medication Adherence Rating Scale

www.wjpps.com Vol 5, Issue 2, 2016. 697

Table 1: Medication adherence rating scale (MARS)

www.wjpps.com Vol 5, Issue 2, 2016. 698

MATERIALS AND METHOD

Table 2: Score and adherence

www.wjpps.com Vol 5, Issue 2, 2016. 699

Table 3: Factors and characteristics

Step 2: Patient counseling (Patient counseling sheet)

www.wjpps.com Vol 5, Issue 2, 2016. 700

www.wjpps.com Vol 5, Issue 2, 2016. 701

RESULTS AND DISCUSSION

Table 4: Tabular Representation Medication Adherence Based on Gender

Figure 2: Graphical representation of awareness about complications of hypertension

www.wjpps.com Vol 5, Issue 2, 2016. 702

Figure 3: Graphical representation of adherence based on educational status

Table 5: Tabular representation of adherence based on occupation

Figure 4: Graphical representation of adherence based on duration of disease

www.wjpps.com Vol 5, Issue 2, 2016. 703

Figure 5: Graphical representation of adherence based on place of living

Table 6: Tabular representation of adherence based on following of proper diet

Table 7: Tabular representation of adherence related to follow-up

www.wjpps.com Vol 5, Issue 2, 2016. 704

Table 8: Tabular representation of blood pressure measure and adherence

Table 9: Tabular representation of comorbidity and adherence

Figure 6: Graphical representation of adherence measurement of patients during the

www.wjpps.com Vol 5, Issue 2, 2016. 705

Figure 7: Graphical representation of adherence measurement of patients during the

Figure 8: Graphical representation of medication taking characteristics: reason for not

1. Forgetfulness, aloneness, ignorance

www.wjpps.com Vol 5, Issue 2, 2016. 706

Reasons Order of Percentage

www.wjpps.com Vol 5, Issue 2, 2016. 707

www.wjpps.com Vol 5, Issue 2, 2016. 708

Adherence is less in patients living in villages due to lack of transport or accessibility to

www.wjpps.com Vol 5, Issue 2, 2016. 709

www.wjpps.com Vol 5, Issue 2, 2016. 710

Você também pode gostar