COMPARATIVE ANALYSIS OF FACTORS AFFECTING ADHERENCE AND NON-ADHERENCE TO STATINS USING A CROSS-SECTIONAL STUDY IN PALESTINE

Abstract

Abstract Background Cardiovascular diseases are one of the causes of morbidity and mortality in the world. Statins are significant in the management of lipids and the risk of cardiovascular diseases, but their adverse clinical association are greatly hindered by low adherence to medications. Objectives The purpose of the research was to determine the rate of adherence with statin therapy among Palestinian patients and to determine the demographic, behavioral, psychosocial, and economical factors associated to adherence. Methodology A cross-sectional analysis of 379 statin using patients was done. Pharmacies and outpatient clinics all across the West Bank in Palestine were sampled by using a paper questionnaire which comprised of sociodemographic, economic and behavioral variables. The rate of statin adherence was assessed with the help of the Morisky Medication Adherence Scale (MMAS-8), and the attitude of a patient concerning statin therapy was measured with the help of Attitude Score. Statistical analyses were non- parametric and Chi-square tests that were used to analyze the association between independent variables and adherence levels. Results The low adherence rate was 73.6%, moderate adherence was 25.3% and high adherence was 1.1% out of the 379 patients. There was no statistically significant association between statin adherence and age and sex, education level and place of residence (p < 0.05). Nevertheless, the association between statin adherence and smoking (p < 0.001), type of health insurance (p = 0.029), costs of medication (p < 0.001), and social support (p < 0.001) were found to be statistically significant. Poor adherence was associated to behavioral factors, including forgetfulness, drug stopping when the symptoms are better, and disruption during traveling. Statistically significant relationship did not exist between familial hypercholesterolemia and adherence to statins (p > 0.05). Conclusions adherence to statin therapy is very low among the Palestinians. Adherence was mostly dependent on behavioral and socioeconomic factors as opposed to demographic characteristics. In routine clinical practice, cardiovascular outcomes and interventions need to be optimized through the use of targeted interventions, such as pharmacist-led education, follow-up, cost-reduction, and family involvement interventions. Keywords Statins adherence, Hypercholesterolemia, MMAS-8, Cross-sectional study, Medication adherence