FACTORS INFLUENCING TREATMENT COMPLIANCE IN TYPE 2 DIABETES MELLITUS CLIENTS AT THE KOMFO ANOKYE TEACHING HOSPITAL DIABETIC CLINIC

ABSTRACT
Introduction
Diabetes mellitus (DM) is a life-long advancing metabolic disorder delineated by an increase in blood glucose level. One of the three major types of diabetes is type 2 diabetes and it’s the most common type. In this condition there is a high level of sugar (glucose) in the blood as a result of absolute or relative deficiency of insulin hormone. Available evidence suggests that, vigorous management of type 2 diabetes mellitus can reduce the morbidity and mortality of the disease by decreasing the chronic complications that come along with it. However, research suggests that compliance to therapy is low among clients with type 2 DM. As a result, the study aimed at assessing the factors that influence compliance to treatment in clients with type 2 diabetes at the Komfo Anokye Teaching Hospital (KATH) Diabetic Center.
Methods
Descriptive cross-sectional study design was used to conduct the study and the study population included type 2 diabetes mellitus clients who visited the diabetic clinic of Komfo Anokye Teaching Hospital during the period of the study. Data were gathered using structured questionnaire and systematic random sampling technique was adopted to administer the structured questionnaire to 400 diabetic patients. The data were entered into Microsoft Access 2013 and was transported to Stata version 12.0 for analysis. Statistical significant was set at 0.05
Results
Majority of the respondents (99.0%) acknowledged the fact that type 2 DM can be managed by treatment compliance with medications, diet planning, exercises, monitoring and injury prevention management. Also, most of the clients mentioned factors such as accessibility of KATH (28.5%), registration with NHIS (94.3%), medications covered by NHIS (62.2%), ability to afford medications not covered by the NHIS (26.1%) as perceived factors influencing treatment compliance. Finally, there was a significant relationship between socio-demographic characteristics such as educational level of the respondents and their compliance to diet (p-value=0.03), medication (0.01) and injury prevention (p-value=0.03). Also the relationship between occupational status of the diabetics (p-value=0.01) as socio-demographic characteristic and compliance to medication was statistically significant.
Conclusion and Recommendation
Accessibility of KATH, registration with NHIS, medications covered by NHIS, clients’ ability to afford medications not covered by NHIS were found to be factors influencing treatment compliance from the perspective of clients. Therefore, the need to create support fund by the support organizations to assist diabetes patients in the purchase of non-insured medications.


CHAPTER ONE: INTRODUCTION
1.0 Background of the study
Diabetes mellitus (DM) is a lifelong advancing metabolic disorder delineated by an increase in blood glucose level (Shrivastava et al., 2013). This is mainly due to absolute or relative deficiency of insulin hormone which could result in extensive damage to most of the systems in the body especially the nerves and blood vessels (Shrivastava et al., 2013). DM has been classified into two main types namely; type 1 insulin dependent diabetes mellitus and type 2, non-insulin dependent diabetes mellitus (Thent et al., 2013).

Worldwide, 347 million people have diabetes and type 2 diabetes makes up about 90% (WHO, 2013). The World Health Organization (WHO) has projected it to be the seventh leading cause of death by 2030 (WHO, 2013). In addition, the WHO has estimated that about 80% of people suffering from DM live in the low and middle income countries like Ghana (WHO, 2013). In Africa, the prevalence is increasing dramatically with estimated rate of 10.4 million people (WHO, 2013). Ghana has about 4million people who have been affected by diabetes mellitus (G.N.A, 2012) and the national prevalence for diabetes in 2013 was 3.35% (International Diabetes Federation, 2013)

Compliance to healthcare is defined as the extent to which a patient’s behavior in terms of taking medication, executing the lifestyle changes, undergoing medical test or keeping appointment with the physician coincides with the healthcare provider’s recommendations for health and medical advice (Khan et al., 2012). Research suggests that compliance to therapy is low among clients with type 2 diabetes mellitus (Vermeire et al., 2009). Available evidence suggests that, vigorous management of type 2 diabetes mellitus can reduce the morbidity and mortality of the disease by decreasing the chronic complications that come along with it (Wens et al., 2005). Irrespective of the benefits derived from therapy, studies in the USA have shown that recommended glycemic goals are attained by 50% of patients which is related to decreased compliance to treatment (Garcia-Perez et al., 2013). In relation to this, a study conducted in Sudan revealed that about 45% of the type 2 diabetics had poor metabolic control. This was also due to non-compliance with diet, drugs and lack of education on the condition (Bos and Agyemang, 2013).

Compliance to treatment in patients with type 2 diabetes mellitus is dependent upon a number of factors, including those specific to the patient, to the provider, and to the treatment (David, 2012). Non-compliance to therapy is thus not restricted to client’s failure to take prescribed medication. It also encompasses their refusal to change their lifestyle, carrying out prescribed investigations and adhering to review appointments. A study carried out in Nigeria to assess the factors that influence compliance to oral hypoglycemic revealed that factors like forgetfulness, high cost and fear of side effects contributed to non-compliance to treatment (Adisa et al., 2009). Thus, the problem of poor adherence to therapy is a very complex one as it is multifaceted. In Ghana, available evidence indicates that, complications which often result in the death and disability of type 2 diabetics can be attributed to poor compliance to treatment and late diagnosis, making DM the eleventh top cause of death in the country (WHO, 2013).

Records available at the KATH Biostatistics Unit (2010) indicate that diabetes featured prominently among the top 10 causes of admission and death. Irrespective of the numerous efforts made by health care workers to reduce the burden the disease imposes on clients, lots of complications and death are still recorded at KATH. This may be due to a low level of compliance to treatment regimen. However, the contributing factors for clients’ compliance to their treatment regimen have not been fully exploited. This has necessitated the conduct of a study to assess the factors that influence compliance to treatment among type 2 diabetics.

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Item Type: Ghanaian Project Material  |  Attribute: 119 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH50  |  Delivery: Within 30Mins.
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