Adherence to antihypertensive or antihyperlipidemic co-medications in diabetes: patterns, predictors, and intervention

Adherence and persistence to chronic preventive medications remain poor in high- and low-middle-income countries, which may lead to poor health outcomes and increased health care costs. Medication adherence refers to whether patients take their medications as prescribed, whereas persistence refers to whether they continue to take the medication. In patients with type 2 diabetes, medication taking is particularly complex because they often need not only antidiabetic medication, but also antihypertensive and antihyperlipidemic co-medications which may give particular adherence and persistence problems. This thesis aims to get more insight in the patterns and factors associated with non-adherence and non-persistence to antihypertensive and antihyperlipidemic medications among patients with type 2 diabetes. These insights were used to develop a targeted and tailored pharmacist-led intervention to improve adherence to antihypertensive medications among these patients. We focused on patient populations in the Netherlands as example of high-income countries and Indonesia as example of low- and middle-income countries. We concluded that both non-modifiable and modifiable factors are relevant for interventions to improve non-adherence and/or non-persistence to cardiometabolic medications. Non-modifiable factors, including the medication involved and the time since medication initiation, are important for targeting interventions. Modifiable factors, including lack of knowledge, motivation and forgetfulness, can be addressed in a tailored intervention. While the extent of pharmacist involvement in patient care may vary between the Netherlands and Indonesia, a targeted and tailored pharmacist-led intervention that is effective and can be integrated into the community pharmacy workflow is needed in both countries.