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Observational Study
. 2018 Apr 27:13:1377-1388.
doi: 10.2147/COPD.S150411. eCollection 2018.

Adherence to COPD treatment in Turkey and Saudi Arabia: results of the ADCARE study

Nurdan Kokturk  1 , Mehmet Polatli  2 , I Kivilcim Oguzulgen  1 , Sarfraz Saleemi  3 , Mohammed Al Ghobain  4 , Javed Khan  5 , Adam Doble  6 , Luqman Tariq  7 , Fayaz Aziz  7 , Abdelkader El Hasnaoui  7
Affiliations
Observational Study

Adherence to COPD treatment in Turkey and Saudi Arabia: results of the ADCARE study

Nurdan Kokturk et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: COPD affects millions of people worldwide. Poor treatment adherence contributes to increased symptom severity, morbidity and mortality. This study was designed to investigate adherence to COPD treatment in Turkey and Saudi Arabia.

Methods: An observational, cross-sectional study in adult COPD patients in Turkey and Saudi Arabia. Through physician-led interviews, data were collected on sociodemographics and disease history, including the impact of COPD on health status using the COPD Assessment Test (CAT); quality of life, using the EuroQol Five-Dimension questionnaire (EQ-5D); and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Treatment adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). Multivariate logistic regression analysis examined the predictors of non-adherence and the impact of adherence on symptom severity.

Results: Four hundred and five COPD patients participated: 199 in Turkey and 206 in Saudi Arabia. Overall, 49.2% reported low adherence (MMAS-8 <6). Of those, 74.7% reported high disease impact (CAT >15) compared to 58.4% reporting medium/high adherence (p=0.0008). Patients with low adherence reported a lower mean 3-level EQ-5D utility value (0.54±0.35) compared to those with medium/high adherence (0.64±0.30; p<0.0001). Depression with HADS score 8-10 or >10 was associated with lower adherence (OR 2.50 [95% CI: 1.43-4.39] and 2.43 [95% CI: 1.39-4.25], respectively; p=0.0008). Being a high school/college graduate was associated with better adherence compared with no high school (OR 0.57 [95% CI: 0.33-0.98] and 0.38 [95% CI: 0.15-1.00], respectively; p=0.0310). After adjusting for age, gender, and country, a significant association between treatment adherence (MMAS-8 score ≥6) and lower disease impact (CAT ≤15) was observed (OR 0.56 [95% CI: 0.33-0.95]; p=0.0314).

Conclusion: Adherence to COPD treatment is poor in Turkey and Saudi Arabia. Non-adherence to treatment is associated with higher disease impact and reduced quality of life. Depression, age, and level of education were independent determinants of adherence.

Keywords: 8-item Morisky Medication Adherence Scale; CAT; COPD; COPD Assessment Test; EQ-5D; EuroQol Five-Dimension questionnaire; MMAS-8; Saudi Arabia; Turkey; non-adherence.

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Conflict of interest statement

Disclosure AEH, FA, and LT are employees of and shareholders in Glaxo-SmithKline (GSK), which funded the ADCARE study. AD is a director of Foxymed, a medical communication and consultancy company, which participated in the design of the study and the interpretation of the results on behalf of GSK. The other authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Multivariate analysis: predictors of non-adherence to COPD treatment. Notes: Multivariate regression analysis on 355 patients: 170 with low (MMAS-8 <6) adherence to treatment and 185 with medium or high (MMAS-8 ≥6) adherence to treatment (low adherence versus medium/high adherence). *p-value of the Wald Chi-Square test from the logistic regression model. Abbreviations: HADS, Hospital Anxiety and Depression Scale; MMAS-8, 8-item Morisky Medication Adherence Scale.
Figure 2
Figure 2
Association between treatment adherence and CAT score. Notes: Adjusted analysis (by country, age, and gender) of the association between adherence to treatment and the impact of COPD on health status, measured by the CAT: analysis on 307 patients: 207 with a CAT score of >15 and 100 with a CAT score of ≤15 (>15 versus ≤15). *p-value of the Wald Chi-Square test from the logistic regression model. Abbreviation: CAT, COPD Assessment Test.
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