Edited by: Tecnológico Superior Corporativo
Edwards Deming
July - December Vol. 8 - 2 - 2024
https://revista-edwardsdeming.com/index.php/es
e-ISSN: 2576-0971
Received: Febrary 09, 2024
Approved: June 10, 2024
Page 85-95
Use and adherence to pharmacological treatment
in patients with chronic noncommunicable diseases
El uso y adherencia al tratamiento farmacológico en
pacientes con enfermedades crónicas no trasmisibles
Iliana Alicia Caicedo Castro
*
Luisana Jiménez
*
Luis Alberto León Bajaña
*
ABSTRACT
TES teachers and students are carrying out research that
responds to the project: Promotion strategies on
adherence to pharmacological treatment in patients at the
León Becerra Hospital in Guayaquil, the result of one of
their activities is reflected in this article. Meanwhile, it is
crucial to provide a complete support system that
addresses both the medical aspects of the treatment.
Therefore, the study focuses on identifying and addressing
the patient's beliefs and perceptions about the medications
and the underlying disease. A mixed methodology was used
that combined field and descriptive research, and various
methodological approaches were used. Among the
theoretical methods, the analysis-synthesis, the inductive-
deductive approach and the systemic-structural approach
were applied. The empirical methods were observation,
interview, survey and documentary review. This
methodological approach allowed us to fulfill the objective
of providing a theoretical basis that is based on the design
of health promotion strategies aimed at improving
adherence to pharmacological treatment and promoting a
culture of safety among patients with NCDs at the León
Becerra Hospital in Guayaquil. The sample consisted of
* MsC. Instituto Superior Tecnológico Universitario Espíritu Santo
iacaicedo@tes.edu.ec, https://orcid.org/0009-0009-9744-9608
* MsC. Instituto Superior Tecnológico Universitario Espíritu Santo,
ljimenez@tes.edu.ec, https://orcid.org/0000-0002-4853-2052
* Lic. Instituto Superior Tecnológico Universitario Espíritu Santo,
laleon@tes.edu.ec
https://orcid.org/0000-0001-8613-3047
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patients with chronic diseases aged 35 to 80 years. In
summary, this study has been instrumental in
understanding patients' perceptions of medications in
chronic non-communicable diseases.
Key words: Diseases, Chronic Diseases, Medications,
Adherence, Treatment.
RESUMEN
Los docentes y estudiantes del TES, están realizando una
investigación que responde al proyecto: Estrategias de
promoción sobre la adherencia al tratamiento
farmacológico en pacientes del Hospital León Becerra de
Guayaquil, cuyo resultado de una de sus actividades se ve
reflejada en este artículo. En tanto, es crucial proporcionar
un sistema de apoyo completo que aborde tanto los
aspectos médicos del tratamiento, Por ende, el estudio se
centra en identificar y atender las creencias y percepciones
del paciente sobre los medicamentos y la enfermedad
subyacente. Se empleó una metodología mixta que
combinó la investigación de campo y la descriptiva, se
utilizaron diversos enfoques metodológicos. Entre los
métodos teóricos se aplicaron el análisis-síntesis, el
enfoque inductivo-deductivo y el enfoque sistémico-
estructural. Los métodos empíricos fueron la observación,
la entrevista, la encuesta y la revisión documental. Este
enfoque metodológico permitió cumplir el objetivo de
brindar una base teórica que parte del diseño de
estrategias sobre la promoción de la salud dirigidas a
mejorar la adherencia al tratamiento farmacológico y a
promover una cultura de seguridad entre los pacientes con
ECNT del Hospital León Becerra de Guayaquil. La muestra
consistió en pacientes con enfermedades crónicas de 35 a
80 años. En resumen, este estudio ha sido fundamental para
comprender las percepciones de los pacientes sobre los
medicamentos en enfermedades crónicas no trasmisibles.
Palabras clave: enfermedades, Crónicas, No
Trasmisibles , Adherencia, Tratamiento.
INTRODUCTION
Initiating drug treatment brings with it a number of significant challenges, especially when
faced with chronic illness. In many cases, people in this situation suffer not only the
physical burden of the disease, but also a considerable emotional and psychological
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burden. The assimilation of this new reality can be a long and difficult process, requiring
time and adequate support. In addition to the patient, close social systems, such as family,
friends and caregivers, are also affected by this transition, underscoring the importance
of addressing not only medical needs, but also emotional and social needs during this
process.
The complexity of chronic noncommunicable diseases can create additional stress,
anxiety and worry for both the patient and their loved ones. Therefore, it is crucial to
provide a comprehensive support system that addresses not only the medical aspects of
treatment, but also the emotional and social needs of all parties involved. This holistic
approach can contribute to improving the patient's quality of life and promote better
long-term adherence to treatment.
The issue surrounding the predominant orientation of studies in the health field towards
the development of curative practices rather than preventive and promotive measures
is a matter of growing concern. For decades, medicine has tended to focus on intervening
once diseases have emerged, rather than taking a proactive approach to prevent their
occurrence. This reactive approach has led to an increasing burden on healthcare
systems, with resources disproportionately allocated to care for established diseases,
rather than investing in strategies that could prevent them in the first place.
Although recent times have seen a shift in mindset toward greater attention to patient
safety and quality of healthcare services, this transformation has not yet reached its full
manifestation. The medical culture and structure of health systems often perpetuate a
reactive paradigm, where problem solving is valued over problem prevention. This lack
of balance between curative and preventive medicine can result in inefficient use of
resources and suboptimal care for the population, especially in terms of public health.
To address this issue effectively, a paradigm shift is needed that prioritizes health
promotion and disease prevention in equal measure to cure. This implies not only
reforms in clinical practice and health policy, but also a cultural shift in the perception of
medicine, where both prevention and cure are valued as equally important components
of medical care. Only through such a comprehensive and balanced approach can health
challenges be addressed more effectively and ensure better well-being for present and
future generations.
The objective is to provide a theoretical basis subsequent to the development of a health
promotion strategy in relation to adherence to pharmacological treatment at the León
Becerra Hospital in Guayaquil. From a scientific perspective, it has been shown that
patients' beliefs and perceptions can significantly influence their adherence to
pharmacological treatment. Studies have revealed that erroneous beliefs about
medications, such as fears about side effects or lack of confidence in their efficacy, can
hinder adherence and compromise health outcomes (Abalo, J. 2016). Therefore,
understanding patient beliefs and perceptions provides valuable information to
personalize the therapeutic approach and design targeted interventions that address
their concerns and promote better adherence to treatment.
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In addition, identifying and addressing patient beliefs and perceptions can contribute to
a stronger and more collaborative patient/physician relationship. By acknowledging the
patient's concerns and doubts about their illness and treatment, health care professionals
can establish more effective and empathic communication, which in turn strengthens the
patient's trust in their health care team. (Joven, Z., & Guáqueta, S. 2019). This trusting
relationship facilitates collaborative shared decision-making and increases the likelihood
that the patient will follow treatment as prescribed. Ultimately, addressing patient beliefs
and perceptions not only improves treatment adherence, but also promotes optimal
health outcomes and greater satisfaction with the medical care received.
The study is of utmost relevance in the healthcare setting for several key reasons. First,
understanding patient beliefs and perceptions allows healthcare professionals to
personalize treatment more effectively. Each patient has a unique view of their disease
and prescribed medications, influenced by a variety of factors such as their education,
previous experiences, and cultural beliefs. By addressing these individualized beliefs,
physicians can tailor treatment to address the patient's specific concerns, increasing the
likelihood of successful adherence and better long-term health outcomes.
In addition, identifying and addressing patient beliefs and perceptions fosters a stronger,
more collaborative patient-physician relationship. Open and empathetic communication
between the patient and the medical team is essential to establishing a mutually trusting
relationship. By showing interest in the patient's concerns and providing clear and
understandable information, health care professionals can strengthen this relationship,
which in turn improves patient satisfaction and promotes greater cooperation in the
management of their disease.
Conducting a study on the use of and adherence to pharmacological treatment in
patients with chronic noncommunicable diseases is justified by the need to address a
significant and complex public health problem. Chronic noncommunicable diseases
represent a considerable burden on health care systems and can have a significant impact
on patients' quality of life. Adherence to drug therapy is a critical factor in the effective
management of these diseases, and understanding the factors that influence adherence
is crucial to improving health outcomes and reducing the burden of chronic diseases. By
conducting a study in this area, effective interventions can be identified to improve
adherence to treatment, which benefits both individual patients and public health in
general by reducing morbidity and mortality associated with chronic diseases.
According to (Mendoza, R., 2021), non-adherence has immediate repercussions that
encompass clinical, economic and social aspects, manifesting itself at two levels: first,
directly in the patient and his or her family environment, and second, at the level of
health systems. Regarding the impact on the patient, the most obvious consequences are
of a clinical nature. The severity of these consequences will vary depending on whether
or not treatment is initiated upon detection of the disease. Even if treatment is not
initiated, what will manifest in the patient's health are the clinical conditions of the
disease in its natural state. These conditions, in the long term and depending on the type
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of disease, can cause irreversible and even fatal effects due to progressive deterioration.
pp. 902-903
According to the author, non-adherence to medical treatment not only has immediate
clinical implications, but also generates significant impacts in the economic and social
spheres. At the individual level, non-adherence can result in a deterioration of the
patient's health and the development of chronic medical conditions or serious
complications. This aspect not only affects the individual directly, but can also have an
emotional and economic impact on his or her family. Therefore, it is crucial to address
nonadherence in a comprehensive manner to mitigate its negative consequences at both
the individual and systemic levels.
Regarding the factors that influence poor adherence to pharmacological treatment in
older adults with chronic noncommunicable diseases, living in loneliness, not knowing
the disease and not being familiar with the name of the medications were identified as
relevant (Padilla & Morales, 2020). The factors that influence non-adherence to
pharmacological treatment in older adults with chronic diseases are of utmost
importance for the design of effective health interventions.
Living in solitude can negatively impact the individual's ability to correctly follow their
treatment, due to the lack of social support and supervision. Ignorance of the disease
also plays a crucial role, as it limits the patient's understanding of the importance of
following the prescribed treatment. Therefore, addressing these factors in a
comprehensive manner is critical to improve adherence to treatment and ultimately
optimize health outcomes in the older adult population with chronic diseases.
Among the patient-associated elements, the relevance of internal motivators was
recognized, in addition to the expectations that patients have regarding treatment
outcomes, desiring noticeable and rapid improvements. Regarding factors linked to the
health system or the medical team, users expressed having adequately received
information about medication dosage, as well as highlighting the ease of access to medical
appointments (Trujillo, J. et al., 2016).
The importance of patient- and health system-related factors in treatment adherence is
critical to ensure effective outcomes. Motivational aspects and patient expectations play
a crucial role in their commitment to treatment, as they influence their perception of
the efficacy and expected benefits of medications. On the other hand, adequate
information provided by the healthcare system, especially regarding medication dosage,
is essential to ensure that patients understand how to take their medications correctly.
The terms "compliance" and "adherence" have been used interchangeably to describe
the implementation of health and therapeutic recommendations. However, the use of
"compliance" suggests passive or active action, which may place the responsibility solely
on one of the parties involved, either the patient or the physician/health care provider.
In contrast, the term "therapeutic adherence" encompasses a broader range of
behaviors, considering the degree to which the patient's actions coincide with the
recommendations agreed upon between the healthcare professional and the patient.
(Ortega, J. et al. 2018)
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Therapeutic adherence, which includes monitoring medication intake, adherence to
diets, or implementation of lifestyle changes by the patient, can be compromised by the
simultaneous consumption of multiple drugs. One way to assess the extent to which
patients follow the indications associated with prescribed treatments is by measuring
medication adherence. It has been observed that chronic diseases are particularly
affected by low adherence, with estimates suggesting that approximately half of the
chronically ill population does not follow the medication regimen as prescribed (Moreno
A, et al. 2018).
The author references that, the complexity of following a therapeutic regimen, which
includes taking medications, adhering to specific diets, and making lifestyle changes, can
be exacerbated by the need to manage multiple medications simultaneously. This
situation poses an additional challenge for patients, which can result in reduced
adherence to treatment.
Measuring medication adherence thus becomes a crucial tool for assessing how well
patients follow the instructions prescribed by their physicians. The severity of this
problem is particularly highlighted in the case of chronic diseases, where approximately
half of patients do not follow their treatment adequately, underscoring the importance
of addressing adherence as a central aspect in the management of these health
conditions.
MATERIALS AND METHODS
The research was based on Ecuador's legal regulations and academic literature related
to health promotion in terms of adherence to medication treatment in patients with
chronic noncommunicable diseases (NCDs) and safety culture as an essential part of
health care quality. A diversified methodological approach was adopted, combining field
research and description, which facilitated the active participation of the community in
all stages of the study (Binda, N. & Balbastre, F. 2013).
Various methods were employed, both theoretical and empirical, including analysis-
synthesis, the inductive-deductive approach and the systemic-structural approach, as
well as observation, interview, survey and documentary review. This allowed the
development of health promotion strategies aimed at improving compliance with drug
treatment and fostering a culture of safety among patients with NCDs at the León
Becerra Hospital in Guayaquil.
The survey was applied to a sample of patients with chronic non-communicable diseases,
aged between 35 and 80 years, with the objective of obtaining a diverse representation
of experiences and perspectives, once the data was collected through the Google Forms
survey, a results analysis technique was used to examine and understand emerging
patterns. This analysis involved tabulating data, calculating descriptive statistics, and
interpreting results (Lopez, J. & Herrero, J. 2006). Specifically, the Likert scale was used
to measure patients' responses and understand their degree of agreement or
disagreement regarding certain statements related to the topic of study.
According to Matas, A. (2018), Likert scales are psychometric measurement tools in
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which participants express their degree of agreement or disagreement with a statement,
question or utterance, using a graduated and unidimensional scale.
According to the author, the use of Likert scales in research has proven to be an
invaluable technique for measuring attitudes, opinions and perceptions in a quantitative
and structured manner. By allowing respondents to express their degree of agreement
or disagreement with specific statements, these scales provide data that are easy to
analyze and compare.
RESULTS
Following the collection and tabulation of the data derived from the study, an exhaustive
documentary search was carried out with the purpose of establishing significant
connections between the findings obtained. This documentary search not only facilitated
a broader contextualization of the results obtained in the current study, but also made
it possible to identify trends, discrepancies and possible areas of convergence between
the conclusions reached in the present work.
The results obtained show that a large majority of respondents, 88.3% agree or strongly
agree with the importance of taking their medications as prescribed. Only 11.8%
expressed disagreement or felt neutral in this regard. This suggests a generalized
understanding of the importance of adherence to drug treatment among the participants.
Regarding the perception of whether respondents have sufficient information about their
disease and the purpose of their treatment, it is observed that almost half, 47.1% exactly
agree, while 29.4% feel neutral about it. This indicates that there is a considerable group
of participants who could benefit from more education about their condition and
treatment.
Regarding concerns about possible side effects of medications, 94.1% of respondents
expressed having concerns about this. This finding highlights the importance of
addressing and mitigating patients' concerns about side effects to improve adherence to
treatment. Regarding fear of taking medications due to information received, it is noted
that approximately half of the respondents, exactly 64.7% agree or strongly agree in
feeling fear for this reason. This suggests the need to address and clarify erroneous or
misunderstood information about medications to reduce patient anxiety.
Regarding concern about treatment efficacy, 88.2% expressed agreement. This highlights
the importance of establishing effective communication between patients and healthcare
professionals to address these concerns and optimize treatment. Regarding doubts
about whether they should continue taking their medications, 58.8% agreed. This
underscores the importance of providing ongoing education and support to improve
adherence to treatment.
On the desire to receive more information about their treatment and how they can
benefit, the majority of respondents, 88.2% agree or strongly agree. This highlights the
importance of improving communication between patients and healthcare professionals
to meet these informational needs.
In terms of feeling comfortable sharing concerns and questions about treatment with
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healthcare professionals, 82.4% of respondents agree or strongly agree. This highlights
the importance of establishing a relationship of trust and openness in communication
between patients and healthcare providers. The integration of the results of the current
study with the relevant academic literature contributed to enriching the overall
understanding of the topic and deepening its critical analysis, offering a more complete
and informed perspective on the implications and practical applications of the results
obtained.
In the study by Chamorro, A. (2024), it was found that most of the participants were
between 67 and 70 years old, were female, identified themselves as mestizos, were
married, had primary education, were economically dependent on family support and
most suffered from hypertension. Aspects that influenced adherence to treatment
included economic factors, factors related to the health care system and team, as well
as factors related to therapy, in which the majority reported that they never found it
difficult to follow their treatment without interruptions. In addition, patient-related
factors showed that all agreed on the usefulness of the treatment and took responsibility
for taking care of their own health.
In the findings of his research on adherence to pharmacological and non-pharmacological
treatment in patients with chronic non-communicable diseases, González, Y. (2014),
highlighted that men accounted for 53.7% of the respondents, outnumbering women.
Most of the participants belonged to the older adult group, with 43.7% of the sample,
and the vast majority resided in socioeconomic strata 1 and 2, with incomes that did not
exceed two minimum wages. Regarding family medical history, arterial hypertension was
the most commonly reported disease, followed by diabetes. In addition, the most
prevalent disease among respondents was hypertension.
In his thesis entitled "Adherence to pharmacological and non-pharmacological treatment
in patients with cardiovascular risk factors ", Fontal, P. (2014), reports on the level of
adherence to pharmacological and non-pharmacological treatment among the research
participants. It was observed that 76% of patients are in a favorable situation for
adherence, while 14% are at risk of not adhering to treatment, and 9% show no
adherence at all.
The search not only provided a broader contextualization of the results of the current
study, but also allowed us to identify trends, discrepancies, and possible areas of
convergence between the conclusions reached in this work. The integration of the
results of the study with the relevant academic literature enriched the overall
understanding of the topic and deepened its critical analysis, offering a more complete
and informed perspective on the implications and practical applications of the results
obtained to be developed in the subsequent discussion.
DISCUSSION
Analysis of the results revealed that a large majority of respondents agree or strongly
agree with the importance of taking their medications as prescribed, suggesting a
widespread understanding of the importance of adherence to drug treatment among
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participants. However, it was also noted that almost half of the respondents agree that
they have sufficient information about their disease and the purpose of their treatment,
indicating that there is a sizable group that could benefit from further education about
their condition and treatment.
The majority of respondents agree or strongly agree that they would like to receive
more information about their treatment and how they can benefit, highlighting the
importance of improving communication between patients and healthcare professionals
to meet these informational needs. Also, a large percentage of respondents agree or
strongly agree that they feel comfortable sharing concerns and questions about
treatment with health care professionals, highlighting the importance of establishing a
relationship of trust and openness in communication between patients and health care
providers.
The study by Chamorro, A. (2024), offers a detailed view of the factors that influence
adherence to treatment in patients with hypertension, highlighting the importance of
considering economic aspects, related to the health care system, and the patient's
attitude and responsibility. These findings highlight the complexity of treatment
adherence and underscore the need to address multiple variables to promote better
disease management and more positive health outcomes.
The results obtained by Gonzalez, Y. (2014), shed light on the challenges faced by
patients with chronic noncommunicable diseases in terms of treatment adherence. The
fact that most of the participants are older adults and belong to low socioeconomic
strata suggests that they may face additional barriers, such as economic constraints and
limited access to health care resources. Furthermore, the prevalence of diseases such
as arterial hypertension among family medical history and hypertension among
respondents highlights the importance of addressing these diseases effectively to
improve public health and the quality of life of the population.
The study by Fontal, P. (2014), provides a clear assessment of the level of adherence to
pharmacological and non-pharmacological treatment in patients with cardiovascular risk
factors. The results reveal that most patients are in a favorable situation for adherence,
suggesting adequate compliance with the prescribed treatment. However, it is of
concern to identify that a significant percentage of patients are at risk of nonadherence
to treatment, highlighting the need to implement interventions to improve adherence
and prevent possible cardiovascular complications. These findings underscore the
importance of addressing factors that influence adherence to treatment to ensure the
effectiveness of medical interventions and improve health outcomes for patients with
cardiovascular risk factors.
Possible directions for future studies include more detailed investigations of effective
strategies to address patients' concerns about medication side effects and anxiety
associated with taking medications. In addition, it would be relevant to examine how
disease- and treatment-specific education may influence patients' perceptions of
treatment efficacy and disposition. These lines of research can contribute significantly to
improving the medical care and quality of life of patients with chronic diseases.
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