An investigation into factors contributing to non-adherence of patients collecting medicine from central chronic medication dispensing and distribution pick-up points in the Tshwane disctrict

Abstract

ABSTRACT

Non-communicable diseases are the leading contributing factors to premature mortalities worldwide. Adherence to medication and sustained medication supply is critical for the control of non-communicable diseases and thus reducing mortality due to non-communicable diseases. Central Chronic Medication Dispensing and Distribution (CCMDD) is an out-sourced, public sector centralised dispensing strategy that has been operational in the eight Provincial Health Departments since 2014 (Western Cape Province initiated the strategy in 2005). The strategy aims to ensure medication availability, reduce overcrowding in the healthcare facilities and thus reduce patient waiting times. The study aim was to determine factors associated with the nonadherence of patients registered in CCMDD to collect medication from their chosen pick-up point.

Methods A quantitative, descriptive non-experimental study using a survey method was implemented on patients registered with the CCMDD from 2014 to 2017. A self-developed questionnaire was utilised to collect data from volunteer respondents, to identify factors associated with the nonadherence of patients registered in CCMDD. Data from the questionnaires were captured into Microsoft Excel for analysis and results were descriptively reported.

The researcher discussed ethical considerations with respondents before the completion of the questionnaire, and informed consent signed by those who were willing to participate in this study. Results from this study will assist the Tshwane District Health in strengthening this strategy by accelerating community-orientated approaches like adherence clubs and rolling it out to all facilities.

Analysis of data Data were analysed using Statistical Analysis System (SAS) statistical software. Descriptive statistics, frequencies, and proportions (percentages) were applied to analyse categorical variables (e.g., gender, level of education, etc.). The Chi-square test (χ²) for independence in a two-way contingency table was used to determine and describe the demographics, and other associated factors of patients who did not adhere to collection of medicine. Results were presented in terms of graphs, pie charts, and tables.

Results The questionnaires were completed by 344 respondents yielding a response rate of 98.8% (344/348). The study revealed that 24% (82/344) of respondents failed to honour their appointments. A suggestive barrier in non-adherence is inaccessibility of pick-up points (PUP) 23% (n=79), with 79% (n=232) using public transport to reach their chosen PUP and 17% (n=58) indicating that they stay 10km away from their PUP. Results further revealed the following reasons for missed appointments: late short message service (SMS), forgetfulness, travelling, no money for transport and work commitments.

Conclusion The use of adherence clubs in the community and mobile trucks to reach out to patients at their outreach mobile points was recommended to increase accessibility to collect medication and thus decrease nonadherence. Further follow-up studies can be conducted in the district about the challenges facing adherence clubs and outreach services and to establish and monitor the impact and sustainability of adherence clubs.

Keywords: Adherence, Central Chronic Medication Dispensing and Distribution, nonadherence, registered patients.