Factors impacting chronic disease medication adherence in the UAE: a prospective cohort study, 2021-2022.

Abstract

Aim: To assess the evolution of chronic disease medication adherence factors and identify factors predictive of long-term adherence in the UAE. Materials & methods: Patients ≥18 years old; newly diagnosed with one of the following diseases: ankylosing spondylitis, heart failure, multiple sclerosis, psoriasis, or asthma and prescribed long-term medication were followed ≥12 months (M12), then categorized as followed (continued treatment by prescribing physician) or lost to follow-up. Adherence was assessed using the Patient Needs Assessment Tool (PNAT), which is based on the WHO's five dimensional framework. Results: A total of 111 patients were included, 17 (15.3%) were lost of follow-up at M12. Time spent in consultation by medical doctor (MD) (adjusted odds ratio = 6.89, 95% CI = 2.07-12.76) and anxiety and stress level (adjusted odds ratio = 0.18, 95% CI = 0.11-0.67) were significant predictive factors associated with remaining on treatment at M12. Self organizing map methodology identified predictive factors associated with remaining on treatment at M12 as: patient satisfaction with time spent with prescribing MD, patient involvement in treatment decision, disease management ability, satisfaction with support from family/friends, low dependence on others for daily life activities, difficulties joining community activities, and acknowledgement of an influential role of cultural habits/spiritual beliefs. The highest means score differences from M0 to M12 were for difficulties joining community activities (difference [diff] M12-M0 = 1.32, p < 10^-4), role of cultural habits (diff = 1.05, p < 10^-4), role of spiritual beliefs (diff = 1.02, p < 10^-4), patient involved in treatment decision (diff = 0.67, p = 0.007), and memory difficulties (diff = 0.62, p < 10^-4). Conclusion: Socio-economic factors changed most significantly over 12 months. The identified factors may be used to develop strategies to improve patient satisfaction with the time they spend with the prescribing MD as well as reduce stress, each of which may improve medication adherence. Understanding patient behavior and accurately quantifying adherence are essential for improving outcomes for patients prescribed chronic disease medication in Gulf Arabic countries.