Ms. Aida
Chacko1, Dr. Larissa Martha Sams2
1MSc
Nursing Student, Laxmi Memorial College of Nursing,
Mangalore.
2Principal
and H.O.D of Medical Surgical Nursing, Laxmi Memorial
College of Nursing, Mangalore.
Corresponding Author Email: aidachacko30@gmail.com
ABSTRACT:
Background: COPD is currently
the fifth-leading cause of global mortality and a major public health problem
in both developed and developing countries. By the year 2020, COPD is expected
to become the third-most-common cause of death in the world and the
fifth-leading cause of disease burden. As with all chronic diseases,
non-adherence in patients with COPD is common and contributes to adverse health
outcomes, reduced quality of life and increased healthcare expenditures. The
evidence base for adherence to therapy in chronic obstructive pulmonary disease
patients is very thin. The limited data available suggest that, as in other
chronic diseases, adherence is often poor, and this has a negative influence on
outcomes. Objectives: To measure the adherence level of COPD patients to
respiratory drug therapy. To find out the association of
adherence of COPD patients with selected demographic variables. Method:
The study design was descriptive survey design. The purposive sampling
technique was used to draw 50 patients as samples. Data was collected by
administering the medication adherence rating scale to assess the adherence.
Results: The result shows that majority 40 (80%) of patients are non adherent
to the respiratory drug therapy and only 10(20%) of patients are adherent to
the drug therapy. there is no association between the adherence to respiratory
therapy and the selected demographic variables like age, sex, education,
diagnosed to have COPD since, habits and significant association between the
occupation (χ2=18.889,p<0.05) and the
adherence level of COPD patients to respiratory drug therapy.
Interpretation and
conclusion: The findings of the study showed that majority of patients are non
adherent to respiratory drug therapy.
KEYWORDS: Assessment, Adherence, Respiratory drug therapy.
INTRODUCTION:
Chronic
obstructive pulmonary disease is currently the fifth-leading cause of global
mortality and a major public health problem in both developed and developing
countries. Chronic obstructive pulmonary disease (COPD) is a major public
health problem for both industrialized and developing countries. The prevalence
of COPD is increasing worldwide, resulting in a substantial economic burden,
including direct and indirect health-care costs. According to the World Health
Organization (WHO), adherence to long-term therapies averages only 50% (WHO,
2003).
Patient adherence in chronic diseases can result in poor health outcomes
and increased health-care expenditures (WHO, 2003). Discontinuation of COPD
therapy contributes to increasing the frequency of exacerbations, the number of
hospitalizations and the mortality rate.1
According to the World Health Organization
(WHO) estimates, currently 210 million people have COPD and 3 million people
died of COPD in 2005. The WHO predicts that COPD will become the fourth leading
cause of death worldwide by 2030. The burden of COPD assessed by
disability-adjusted life years (DALYs) ranks 10th worldwide (WHO 2008). Total deaths from COPD are projected to increase by more
than 30% in the next 10 years unless urgent preventive measures are in place (COPD 2007).2
In 2010, almost 24
million adults over the age of 40 in India had COPD. Data monitor expects this
number to increase 34% to approximately 32 million by 2020. COPD is
predominately a disease of men and only 40% of cases in India occur in women.
The number of men with COPD in 2010 (approximately 14.11 million) was one and a
half times the number of women with COPD in 2010 (approximately 9.57 million);
this pattern will continue through 2020.3
COPD patients have been found to be non adherent with their treatment
recommendations both intentionally and unintentionally. Poor adherence to drug
therapy and disease management programs has been identified as the major factor
resulting in emergency hospitalization among COPD patients.4
Levels of adherence to prescribed
treatment in COPD are correspondingly low. As with all chronic diseases,
non-adherence in patients with COPD is common and contributes to adverse health
outcomes, reduced quality of life and increased healthcare expenditures. The
evidence base for adherence to therapy in chronic obstructive pulmonary disease
patients is very thin. The limited data available suggest that, as in other
chronic diseases, adherence is often poor, and this has a negative influence on
outcomes. Poor adherence in chronic obstructive pulmonary disease patients
seems to be influenced more by patient beliefs and coping behavior than by
demographical factors or disease severity.5
MATERIALS AND METHODS:
Objectives:
1.
To
measure the adherence level of COPD patients to respiratory drug therapy
2.
To
find out the association of adherence of COPD patients with selected
demographic variables.
Hypotheses:
H1: There will be significant association
between the adherence to respiratory drug therapy and selected demographic
variables.
RESEARCH
METHODOLOGY:
Research design:
The
study was carried out using descriptive research design
Setting of the Study
The
study was conducted in 750 bedded A.J Hospital and Research centre at
Mangalore.
Sample: By
using consecutive sampling technique 50
patients were selected.
Ethical
clearance: Ethical clearance has
been obtained from A. J .ethics committee.
Data collection tools: Based
on the objectives, baseline proforma and medication
adherence rating scale were prepared and administered to the patients in
selected hospital in Mangalore. The reliability of the tool was established by
administering the tool (English and Kannada) to 10 (5 each respectively) COPD
patients in tertiary hospitals at Mangalore. The coefficient of internal
consistency of the rating scale was calculated using Spearman’s Rank correlation
reliability test method. The reliability of the scale was 0.9 for the English
and Kannada tool.
Method of
Data Collection
Prior to the data collection permission was obtained from the
concerned authority of the organization for conducting the study. Subjects were
selected according to the selection criteria and confidentiality was assured.
Written consent was obtained from the subjects. Subjects were assigned through
consecutive sampling technique and the
data was obtained using medication adherence rating scale.
RESULTS:
Table
1: Frequency and percentage distribution of subjects according to their
demographic variables.
|
Sl No |
Variables |
Frequency (f) |
Percentage (%) |
|
1 |
Age
( in years) |
|
|
|
|
25-35 |
0 |
0 |
|
|
36-45 |
1 |
2 |
|
|
46-55 |
20 |
40 |
|
|
>55
years |
29 |
58 |
|
2 |
Sex |
|
|
|
|
Male |
40 |
80 |
|
|
female |
10 |
20 |
|
3 |
Education
|
|
|
|
|
Pre university |
12 |
24 |
|
|
Diploma |
16 |
32 |
|
|
Graduate |
6 |
12 |
|
|
Post graduate |
0 |
0 |
|
|
Illiterate |
16 |
32 |
|
4 |
Occupation
|
|
|
|
|
Private employee |
10 |
20 |
|
|
Govt. employee |
2 |
4 |
|
|
Self employed |
35 |
70 |
|
|
unemployed |
3 |
6 |
|
5 |
Diagnosed
to have COPD since |
|
|
|
|
<1year |
9 |
18 |
|
|
1-3years |
23 |
46 |
|
|
4-5years |
15 |
30 |
|
|
>5years |
3 |
6 |
|
6 |
Habits
|
|
|
|
|
Smoking |
41 |
82 |
|
|
Alcoholism |
0 |
0 |
|
|
Tobacco chewing |
6 |
12 |
|
|
All the above |
0 |
0 |
|
|
None of the above |
3 |
6 |
Table 2:Frequency,
percentage distribution on adherence of COPD patients to respiratory drug
therapy. N=50
|
Adherence level |
Range |
Frequency(F) |
Percentage (%) |
|
Non adherent |
0-5 |
40 |
80 |
|
Adherent |
6-10 |
10 |
20 |
Figure
1: Cone diagram
representing the percentage distribution of COPD patients
adherence to respiratory drug therapy.
Table 3:Range,
Mean, Median, Standard Deviation and Mean percentage of adherence to
respiratory drug therapy among COPD patients. N=50
|
Obtained Range |
Maximum Score |
Mean |
Median |
SD |
Mean Percentage |
|
2-7 |
7 |
4.22 |
4 |
1.404 |
0.006 |
Table 4: Chi-Square test
showing association of adherence level with selected demographic variables
|
Sl. No |
Demographic Variables |
χ2 |
df |
Table Value |
Inference |
|
1. |
Age (in years) |
0.335 |
2 |
5.991 |
Not significant |
|
2. |
Sex |
0.765 |
1 |
3.841 |
Not significant |
|
3. |
Education |
0.637 |
3 |
7.815 |
Not Significant |
|
4. |
Occupation |
18.889 |
3 |
7.815 |
Significant |
|
5. |
Diagnosed to have COPD since |
0.47 |
3 |
7.815 |
Not significant |
|
6. |
Habits |
1.436 |
2 |
5.991 |
Not significant |
DISCUSSION:
Majority of patients 29(58%) belongs to
the above 55 years of age group and least percentage 2% belongs to the age
group of 36-45 years. Majority 40(80%) are males and least percentage 20% are
females. Most of the patients are illiterate 16(32%) and diploma holders
16(32%) and least percentage of patients are graduate 6 (12%). Majority 35(70%)of the patients are self employed and least percentage
2(4%) are government employees. Highest percentage 23(43%) are diagnosed to
have COPD since 1-3 years and least participants are diagnosed to have COPD
above 5 years. Most of the participants 41(82%) are smokers and least 3(6%) of
the participants do not have any habits.
Majority 40 (80%) of patients are non
adherent to the respiratory drug therapy and only 10(20%) of patients are
adherent to the drug therapy.
The
present study shows that there is no association between the adherence to
respiratory therapy and the selected demographic variables like age, sex,
education, diagnosed to have COPD since, habits and significant association
between the occupation (χ2=18.889,p<0.05) and the adherence
level of COPD patients to respiratory drug therapy.
REFERENCE:
1.
Tamas Agh and Agnes Meszaros; Adherence
to Therapy inChronic Obstructive Pulmonary Disease; Chronic
Obstructive Pulmonary Disease – Current Concepts and Practice
2.
D R
Ruben, T A Melissa, D W Leonard et al; Medication adherence issues in patients treated for
COPD; International journal of chronic obstructive pulmonary disease; . 2008
September; 3(3): 371–384.
3.
S K Jindal; COPD: The unrecognized epidemic in India; Journal
of the association of the physician of India; Vol:
60, Feb 2012.
4.
J Bourbeau, S J Bartlett; Patient adherence in COPD; Thorax 2008;63:831-838
5.
L Laforest, F Denis et al; Correlates of adherence to
respiratory drug therapy in COPD patients; Primary Care
Respiratory Journal. 2010 Jun;19(2):148-54.
Received on 16.08.2014 Modified
on 08.09.2014
Accepted on 24.09.2014
© A&V Publication all right reserved
Asian J. Nur. Edu. and Research 5(1): Jan.-March
2015; Page 35-37
DOI: 10.5958/2349-2996.2015.00008.7