UNIVERSITI TEKNOLOGI MARA

PATIENT SATISFACTION AND MEDICATION ADHERENCE ASSESSMENT IN DIABETES

MEDICATION THERAPY ADHERENCE CLINIC (MTAC)

ZANARIAH BINTI ABU BAKAR

Dissertation submitted in partial fulfilment of the requirements for the degree of

Master in Pharmacy Practice

Faculty of Pharmacy

January 2015

I certify that a Panel of Examiners has met on 15n January 2015 to conduct the final

examination of Zanariah Binti Abu Bakar on her Master in Pharmacy Practice

dissertation entitled "Patient Satisfaction and Medication Adherence Assessment in

Diabetes Medication Therapy Adherence Clinic (MTAC) " in accordance with

Universiti Teknologi MARA Act 1976 (Akta 173). The Panel of Examiners

recommends that the student be awarded the relevant degree. The panel of Examiners

was as follows:

Mathumalar Loganathan, PhD Senior Lecturer Faculty of Pharmacy Universiti Teknologi MARA (Supervisor)

Yogheswaran Gopalan (a), Gopal, PhD Senior Lecturer Faculty of Pharmacy Universiti Teknologi MARA (Internal Examiner)

Shariza Sahudin, PhD Senior Lecturer Faculty of Pharmacy Universiti Teknologi MARA (External Examiner)

AISHAH AD^M^PhD Professor Dean Faculty of Pharmacy Universiti Teknologi MARA Date : 23rd February, 2015

n

AUTHOR'S DECLARATION

I declare that the work in this dissertation was carried out in accordance with the

regulations of Universiti Teknologi MARA. It is original and is the results of my own

work, unless otherwise indicated or acknowledged as referenced work. This

dissertation has not been submitted to any other academic institution or non-academic

institution for any degree or qualification.

I, hereby, acknowledge that 1 have been supplied with the Academic Rules and

Regulations for Post Graduate, Universiti Teknologi MARA, regulating the conduct of

my study and research.

Name of Student :

Student I.D. No. :

Programme :

Faculty :

Dissertation Title :

S ignature of Student :

Date :

Zanariah Binti Abu Bakar

2013269806

Master in Pharmacy Practice

Pharmacy

Patient Satisfaction and Medication Adherence

Assessment in Diabetes Medication Therapy

Adherence Clinic (MTAC)

yvtf&tr. January 2015

in

ABSTRACT

The measurement of patient satisfaction and adherence are indeed important in disease management services especially in chronic disease as a mean of service benefit and quality assurance. This study aims to determine the satisfaction and adherence of diabetes mellitus patients at the DMTAC and to determine the relationship between patient satisfaction and adherence. The questionnaires were guided administered by the researcher and consists of three sections. 1) Socio-demographic, medical and medication history and clinical parameters, 2) Patient Satisfaction with Pharmaceutical Care Questionnaire (PSPCQ) and 3) The eight-item Morisky Medication Adherence Scale (MMAS). 165 patients from Hospital Sultanah Aminah, Hospital Sultanah Nora Ismail and Hospital Pakar Sultanah Fatimah who had received counselling at DMTAC were recruited. Data were analysed with SPSS 18.0, using the descriptive statistics and non-parametric tests. The majority were female (50.9%), aged > 60 years (40.0%), Malay (72.7%), had secondary education level (55.2%) and were unemployed (56.4%). Most of the patients had at least 4 visits (60.6%), had diabetes for more than 5 years (80.0%), on both oral and insulin (55.2%) and had 2 comorbidities (43.0%). 87% of patients were satisfied with DMTAC service (score 60-100) with mean scores of 76.8 and 26.1% had high adherence (score=8). There was a significant (p

TABLE OF CONTENTS

CONFIRMATION BY PANEL OF EXAMINERS \\

AUTHOR'S DECLARATION iii

ABSTRACT iv

ACKNOWLEDGEMENT v

TABLE OF CONTENTS vi

LIST OF TABLES xii

LIST OF FIGURES xiv

LIST OF ABBREVIATIONS xv

CHAPTER 1 1

INTRODUCTION 1

1.1 Research Background 1

1.2 Problem Statement 3

1.3 Research Objectives 3

1.3.1 General Objective 3

1.3.2 Specific Objectives 3

1.4 Research Hypothesis 4

CHAPTER 2 5

LITERATURE REVIEW 5

2.1 Diabetes Mellitus 5

2.2 Diabetes Treatment 5

2.3 Patient Satisfaction 7

2.3.1 Patient Satisfaction with Pharmaceutical Care Service 9

vi

AUTHOR'S DECLARATIONABSTRACTTABLE OF CONTENTSCHAPTER 1: INTRODUCTION1.1 RESEARCH BACKGROUND1.2 PROBLEM STATEMENT1.3 RESEARCH OBJECTIVES1.3.1 General Objective1.3.2 Specific Objectives

1.4 RESEARCH HYPOTHESIS

CHAPTER 2: LITERATURE REVIEW2.1 DIABETES MELLITUS2.2 DIABETES TREATMENT2.3 PATIENT SATISFACTION2.3.1 Patient Satisfaction with Pharmaceutical Care Service

2.4 PATIENT ADHERENCE2.4.1 Correlates of Adherence

2.5 MEDICATION ADHERENCE2.6 MEDICATION THERAPY ADHERENCE CLINIC2.6.1 DMTAC2.6.2 DMTAC Procedure2.6.3 DMTAC in hospitals in Johor

CHAPTER 3: RESEARCH METHODOLOGY3.1 STUDY DESIGN3.2 SAMPLING METHOD3.2.1 Inclusion Criteria3.2.2 Exclusion Criteria

3.3 SAMPLE SIZE DETERMINATION3.4 INSTRUMENTS3.4.1 Socio-demographic, medical and medication history and clinical parameters3.4.3.1 MMAS scoring

3.5 STUDY PROCEDURE3.6 DATA COLLECTION METHOD3.7 DATA ANALYSIS

CHAPTER 4: RESULTS4.1 PATIENT CHARACTERISTICS4.1.1 Socio-demographic Characteristics4.1.2 Medical and medication status and clinical parameters

4.2 PATIENT SATISFACTION SCALE4.2.1 PSPCQ scoring

4.3 ADHERENCE SCALE4.3.1 MMAS scoring

4.4 ASSOCIATION BETWEEN PATIENT SATISFACTION AND PATIENT CHARACTERISTICS4.4.1 Socio-demographic Characteristics4.4.2 Medical and medication status and clinical parameters

4.5 ASSOCIATION BETWEEN MEDICATION ADHERENCE AND PATIENT CHARACTERISTICS4.5.1 Socio-demographic Characteristics4.5.2 Medical and medication status and clinical parameters

4.6 RELATIONSHIP BETWEEN PATIENT SATISFACTION AND PATIENTS CHARACTERISTIC4.6.1 Socio-demographic characteristics4.6.2 Medical and medication status and clinical parameters

4.7 RELATIONSHIP BETWEEN MEDICATION ADHERENCE AND PATIENTS CHARACTERISTICS4.7.1 Socio-demographic characteristics4.7.2 Medical and medication status and clinical paramete

4.8 ASSOCIATION AND RELATIONSHIP BETWEEN PATIENT SATISFACTION AND MEDICATION ADHERENCE4.9 RELATIONSHIP BETWEEN MEDICATION ADHERENCE AND TWO DIMENSION; FRIENDLY EXPLANATION AND MANAGING THERAPY

CHAPTER 5: DISCUSSION5.1 CHARACTERISTIC OF THE PATIENTS5.1.1 Socio-demographic characteristics5.1.2 Medical and medication status and clinical parameters

5.2 PATIENTS SATISFACTION TOWARDS PHARMACEUTICAL CARE5.2.1 PSPCQ scoring5.2.2 Association between patient satisfaction and patient characteristics5.2.2.1 Socio-demographic characteristics5.2.2.2 Medical and medication status and clinical parameters

5.3 MEDICATION ADHERENCE5.3.1 MMAS5.3.2 Association between patient adherence level and patient characteristics5.3.2.1 Socio-demographic characteristics5.3.2.2 Medical and medication status and clinical parameters

5.4 ASSOCIATION AND RELATIONSHIP BETWEEN PATIENT SATISFACTION AND ADHERENCE5.5 RELATIONSHIPS BETWEEN MEDICATION ADHERENCE AND TWO DIMENSION: FRIENDLY EXPLANATION AND MANAGING THERAPY

CHAPTER 6: CONCLUSION, LIMITATIONS AND RECOMMENDATIONS6.1 CONCLUSION6.2 LIMITATIONS6.3 RECOMMENDATIONS

REFERENCESAPPENDICES