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| ORIGINAL ARTICLE |
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| Year : 2020 | Volume
: 4
| Issue : 4 | Page : 349-354 |
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Reported patients' attitudes and practices for knowledge of prescribed medications with chronic disease conditions: A cross-sectional study
Anmar Al-Taie
Department of Pharmacy, Faculty of Pharmacy, Girne American University, Mersin, Turkey; Department of Pharmacy, Osol Aldeen University College, Baghdad, Iraq
| Date of Submission | 09-Oct-2020 |
| Date of Acceptance | 22-Oct-2020 |
| Date of Web Publication | 30-Dec-2020 |
Correspondence Address:
Dr. Anmar Al-Taie
Pharmacy Department, Faculty of Pharmacy, Girne American University, 99428 Kyrenia, North Cyprus, Mersin 10
 Source of Support: None, Conflict of Interest: None  | 3 |
DOI: 10.4103/bbrj.bbrj_174_20
Background: Patients' medication knowledge plays an essential role in the management of chronic disease conditions. Poor patient's knowledge is associated with low medication adherence, incorrect medication use, improper management of chronic disease conditions, treatment failure, and poor health-related outcomes. The aim of the present study was to assess and compare the attitudes and practices of knowledge about the prescribed medications in patients diagnosed with chronic disease conditions under chronic medication treatment in community pharmacy settings in Baghdad province, Iraq. Methods: A descriptive, cross-sectional study conducted among 384 participants through an interview using a structured 3-parts questionnaire, consisting of 20 items assessing the demographic characteristics, attitudes, and practices of knowledge about the prescribed medications. Results: A total of 384 participants enrolled in this study. About 62.3% of the study participants reported having the previous provision of knowledge about the prescribed medications within the past 12 months. About 61.7% of the study participants reported that the physicians were the primary healthcare professional (HCP) for providing knowledge about the prescribed medications, while 43.5% stated that the medication information leaflets (MILs) were an additional source for providing knowledge about the prescribed medications. There was a difference between the HCP-based knowledge and MIL-based knowledge about the prescribed medications on various elements of medication-related information for the name of the medicine, indication or reason for medicine use, the dosage of the medicine, frequency of the medicine administration and route of medicine administration (100% vs. 43.5%), respectively. Conclusion: The study revealed acceptable attitudes and practices of knowledge about the prescribed medications in patients diagnosed with chronic disease conditions under chronic medication treatment among patients in the Iraqi community; however, there are gaps in the general knowledge about the use of MILs.
Keywords: Attitudes, chronic diseases, Iraq, medication knowledge, patient information leaflet, practice
How to cite this article:
Al-Taie A. Reported patients' attitudes and practices for knowledge of prescribed medications with chronic disease conditions: A cross-sectional study. Biomed Biotechnol Res J 2020;4:349-54 |
How to cite this URL:
Al-Taie A. Reported patients' attitudes and practices for knowledge of prescribed medications with chronic disease conditions: A cross-sectional study. Biomed Biotechnol Res J [serial online] 2020 [cited 2023 Mar 27];4:349-54. Available from: https://www.bmbtrj.org/text.asp?2020/4/4/349/305639 |
| Introduction | |  |
Health literacy is defined as the degree to which individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions.[1] An important area of health literacy is patients' knowledge about prescribed medications, which is defined as the awareness of a drug's name, purpose, special instructions and dosing schedule, adverse effects, and necessary dietary modifications.[2] For safe and effective medications use, patients should have knowledge about the names of the medicines, the purpose and duration of therapy, the dose and frequency of administration and the most common side effects.[3] Accordingly, patients' medication knowledge plays an essential role in the management of disease conditions, as it is positively correlated with medication adherence, and lifestyle changes, a higher quality of life, and improved patient-related outcomes.[4],[5]
On the other hand, poor patient's knowledge on prescribed medications is particularly of concern among elderly patients with a diagnosis of chronic disease conditions treated with polypharmacy.[6],[7] Therefore, poor patient's knowledge about medications is associated with low medication adherence, incorrect medication use, low safety, improper management of chronic disease conditions, treatment failure, increase rate of drug-related problems, prolong hospitalization and increase re-admissions and rates of morbidity and mortality and a burden on public health care.[8],[9],[10],[11],[12] Meanwhile, patients' medication knowledge for better use of medications can be enhanced through several practices, such as improving the interaction with the healthcare professionals (HCPs) or through reading the drug information leaflets which contains the essential information need to enable patients to use the medicine both safely and effectively thereby achieving long-term therapeutic goals.[13],[14] The aim of the present study was to assess and compare the attitudes and practices of knowledge about the prescribed medications in patients diagnosed with chronic disease conditions under chronic medication treatment in community pharmacy settings in Baghdad province, Iraq.
| Methods | | |
Study design and population settings
This was a descriptive, cross-sectional study involving convenient participants sample enrolment from December 2018 to February 2019. A sample of participants of different age groups and both genders older than 18 years of age with a diagnosis of chronic disease conditions and medications intake who expressed willingness to take part in this study were included, while those who declined participation were excluded. All study participants who expressed willingness, agreement, and the ability to take part were fully informed about the proposed study and provided with written informed consent.
By using Cochran's sample size formula, a sample size of a large population whose degree of variability is not known and assuming the maximum variability and taking 95% confidence level with ±5% precision, the sample size required was 384 participants. The study was approved by the human research ethics committee of the Pharmacy Department, Osol Aldeen University College, Baghdad province, Iraq (06. 15.11.2018). All procedures performed in the study involving human participants followed the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.
Around the time of performing the present study as no up-to-date list of community, pharmacies were available and to ensure generalizability and minimize selection bias, a four-step sampling approach was achieved. This involves the following procedure: First, the two main parts (divisions) of Baghdad province were selected (Al-Karkh and Al-Rusafa). Second, each of these two parts was divided into four locations (south, north, east, and west). Third, a list of districts within each of these eight locations was collected and two of the most populous districts from each location were selected using random numbers. Finally, community pharmacies were selected by convenience sampling within each of the two selected districts.
Questionnaire design
As aforementioned, all data were collected from the community pharmacies in Baghdad province, Iraq. The information was gathered via a structured self-administered questionnaire that was developed for the present study, distributed and filled by direct interviews with the participants. The purpose and procedures of the study were described in an introductory letter included with the questionnaire, which took about 15 min to complete. The questionnaire was developed after a thorough and comprehensive literature search in well-known databases and customized to suit the study purpose. The questionnaire was translated from English into Arabic language and subjected to a process of forwarding and backward translation. In addition, questions were reworded, reformatted, and reordered in light of the feedback received. The face and content validity of the drafted questionnaire was validated and performed by two academicians from the pharmacy and medical background with extensive experience in survey-based research and two community pharmacists. Furthermore, a preliminary test was applied to a representative sample for around 5% of the target sample (n = 19) to address any ambiguity in the questions and to determine whether the data would provide reliable information. The data collected during this pilot part of the study were excluded from the final data statistical analysis.
The final version of the questionnaire consisted of 20 questions divided into three sections. The first section (seven items) gathered data on demographic and clinical characteristics of the participants, including age, gender, educational level, cigarette smoking, chronic disease conditions, polypharmacy, and times of refilling the prescriptions within the past 12 months. The second section consisted of four items which evaluated patients' attitudes towards the pattern of knowledge about the prescribed medications, including the previous provision of knowledge about the prescribed medications within the last 12 months, times of knowledge about the prescribed medications within the last 12 months, HCP-based knowledge about the prescribed medications and medication information leaflet (MIL)-based knowledge about the prescribed medications. The third section consisted of nine items which evaluated and compared patients' knowledge about prescribed medications based on the type of source knowledge regarding the following parameters: Name of the medicine, the purpose for medicine use, the dosage of the medicine, frequency of the medicine administration, route of medicine administration, duration of medicine therapy, storage conditions of the medicine, medicine cautionary advice and medicine side effects.
Data were analyzed using Microsoft Office Excel 2013. Descriptive analysis was used to describe the study population, and the results were expressed in numbers, percentages, means, and standard deviations, and in terms of all items related to the assessment the level of knowledge about patients' attitudes toward the pattern of knowledge about the prescribed medications and assess patients' knowledge about the cautionary advice stated for the proper and safe medicine use among the study participants.
| Results | | |
Regarding the socio-demographic characteristics of the study participants, the mean age of the respondents was 50.9 ± 13.5 years. The largest percentage was in the 31–60 year age group (57.3%). The majority of the study participants was males (52.1%) and possessed a university-level qualification (54.9%) and more than half of the study participants (56.3%) were nonsmokers. In the present study, hypertension (24%), diabetes mellitus (18.5%), and ischemic heart disease (15.1%) were the most common chronic disease conditions encountered among the study participants. A total of 775 drugs, with an average of two medicines per patient were recorded in the present study. Patients receiving <4 medications simultaneously (polypharmacy) were seen in 62% of the study participants. Regarding the times of refilling the prescriptions, 38.5% of the study participants reported that they had 1–3 times of refilling the prescriptions within the past 12 months followed by 4–6 times (34.1%), as shown in [Table 1]. | Table 1: Demographic and clinical characteristics of the study participants (n=384)
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Regarding the pattern of patients' knowledge about the prescribed medications, 62.3% of the study participants reported having the previous provision of knowledge about the prescribed medications within the past 12 months. Meanwhile, 58.6% of the study participants stated receiving knowledge about the prescribed medications 1–3 times in comparison to 41.4% who received 4–6 times within the past 12 months. On the other hand, 61.7% of the study participants reported that the physicians were the primary HCP for providing knowledge about the prescribed medications, while 43.5% stated that the MILs were an additional source for providing knowledge about the prescribed medications, as shown in [Table 2]. | Table 2: Pattern of patients' knowledge about the prescribed medications (n=384)
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The present study also reported that the study participants highly relied on HCPs to get knowledge about their chronic medications to use. This was observed as a difference between the HCP-and MIL-based knowledge on various elements of medication-related information for the name of the medicine and indication or reason for medicine use (100% vs. 43.5%), respectively. Similarly, there was a difference in patients' knowledge about the prescribed medications regarding the HCP-and MIL-based knowledge about the dosage of the medicine, frequency of the medicine administration and route of medicine administration (100% vs. 43.2%), respectively. There was also a difference regarding the HCP-and MIL-based knowledge for the duration of medicine therapy (100% vs. 42.7%), respectively. However, the present study showed that there was a near proportion in patients' knowledge about the prescribed medications regarding the HCP-and MIL-based knowledge about the proper condition for medicine storage (45.1% vs. 42%), medicine cautionary advice (44.3% vs. 42.2%) and medicine side effects occurrence (45.6% vs. 42.7%), respectively, as shown in [Figure 1] and [Figure 2]. | Figure 1: Patients' knowledge about prescribed medications based on HCP type of knowledge. Data present as number and percentage: n, (%), MIL: Medication information leaflet
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 | Figure 2: Patients' knowledge about prescribed medications based on MIL type of knowledge. Data present as number and percentage: n, (%) MIL: Medication information leaflet
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| Discussion | | |
In the present study, the majority of the study participants were in the 31–60 year age group and possessed a high-level qualification. Earlier evidence reported that level of education could be considered as a predictor of good medication knowledge and more educated patients were more likely to indicate a desire for information, with high medication adherence.[15],[16] The findings of the present study are in agreement with a study conducted by Ramia et al.[17] which reported that patients with higher education levels and younger age were significantly associated with good medication knowledge. Meanwhile, lack or poor knowledge regarding the prescribed medication regimen, medication names and appearance, and proper storage conditions of the medications further contribute to confusion to the issue of polypharmacy.[18]
The present study showed that the majority of the study participants reported having the previous provision of knowledge about the prescribed medications 1–3 times within the past 12 months, and the physicians followed by pharmacists were the primary HCPs for providing knowledge about the prescribed medications. This is in line with Ramia et al. study[17], which reported that 55.7% of the study participants had optimal knowledge about their medications. Physicians are actively involved in enhancing patients' medication knowledge levels to communicate major medication use and safety measures, especially for those with lower educational.[18] The findings of the present study are higher than those by Perera et al.[19] which reported unsatisfactory physicians' contribution toward educating patients on drug information, with 33% of the patients received medication knowledge by the physicians. However, considering that the majority of patients are seen in the community pharmacies, this highlights the responsibility of pharmacists to educate and improve patients' understanding and knowledge about proper medication use and treatment. Pharmacists are HCPs who are mainly responsible for providing necessary, complete, readable, relevant and comprehensible medication information to patients in written, verbal or both forms for the maximum benefit.[20] This kind of pharmacists' counselling plays an important role in preventing drug-related problems. Previous studies revealed that pharmacist educational intervention appeared to improve patients' knowledge about proper and safe medication use with improved patient-related outcomes.[21],[22],[23],[24] In Iraq, community pharmacists, a part of their routine practice, are considering providing pharmaceutical care activities such as medication counselling and describing the long-term benefits of medication adherence to chronic disease patients to improve medication knowledge.
Good knowledge on various elements of medication-related information is essential for clarifications for patients with both new and refill prescriptions. It is unethical for patients to be left ignorant about the medicines they are dispensed and patients should know the name of the medicine, indication for medicine use, dosage, frequency and route of the medicine administration and duration of medicine therapy, etc., to avoid errors in the route of administration, overdosing or duplications thereby achieving the desired therapeutic outcomes and avoiding adverse effects and/or sub-therapeutic effects.[25] Furthermore, adequate provision of information is essentially needed when dispensing new prescriptions rather than re-fill prescriptions.[26] The present study reported that the participants had good medication knowledge on various elements of medication-related information, which are in accordance by Ramia et al.[17] which reported that patients had good knowledge about the medication name captured the highest recall (82%), followed by dosage regimen (74.4%), indication (54.8%), and strength (54.2%). However, the findings of the present study showed promising results in comparison to those by Perera et al.[19] which reported that the majority of patients (61.5%) had unsatisfactory medication knowledge and >90% of the patients requested further information on drug names, dose, indications, and side effects.
On the other hand, the study participants were highly relied on the HCPs to get knowledge about their chronic medications to use and 43.5% stated that the MILs were an additional source for providing knowledge about the prescribed medications. In our study, these findings are higher than a study by Ramia et al.[17] which reported that 36% of the study participants reported reading the drug information leaflet and around 17%–21% reported reading the leaflet rarely and never, respectively. Meanwhile, in our study, this was observed as a difference between the HCP-and MIL-based knowledge on various elements of medication-related information for the name of the medicine, indication or reason for medicine use, dosage, frequency and route of the medicine administration and duration of medicine therapy. Undoubtedly, the HCPs are responsible for educating patients about their medicines; meanwhile, the drug information leaflet is also trustful and highly regulated. However, readability and instructions for prescribed medications could be related to education level and reading may trigger feelings of anxiety and reduce adherence for some patients who find the information difficult to understand.[27],[28],[29] A study by Davis et al.[30] found that poorly literate patients had more difficultly to read and understand dosing instruction. Besides, polypharmacy and age might also affect the readability and comprehensibility of the MIL among the study participants. Our study assessed only whether the patients read the leaflet without assessing patients' understanding of the leaflet information they read or its effect on patients-related outcomes. However, this could be a motivation for health-care providers, including the pharmacists to provide counseling to patients about the MIL.
To the best of our knowledge, this is the first cross-sectional study conducted to assess and compare the practices of knowledge about the prescribed medications in patients diagnosed with chronic disease conditions in community pharmacy settings in Baghdad province, Iraq. However, the study has some limitations that could be taken into consideration in future studies. First, the study was conducted in Baghdad province and did not include other parts of Iraq. Second, the study outcomes were based on the patients' reports and perspectives, which might lead to a recall bias. Thirdly, the study did not take in consideration the assessment of medication adherence and patients' health literacy. Fourthly, the study did not assess patients' understanding of the leaflet information they read or its effect on patients-related outcomes.
| Conclusion | | |
The study revealed acceptable attitudes and practices of knowledge about the prescribed medications in patients diagnosed with chronic disease conditions under chronic medication treatment among patients in the Iraqi community. The study also revealed that the affected persons frequently consult health-care providers for providing more knowledge about the prescribed medications. However, the study describes gaps in general knowledge about the use of MILs, and this might emphasize on more extensive knowledge-based health education programs conducted specifically by the pharmacists to improve the basic knowledge of this misconception and decrease this malpractice.
Acknowledgement
The author would like to express a deep gratitude to the pharmacist Zainab Mahmmoud for her help and valuable collaboration.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]
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