Title:Assessment of Alternative Medicine Use, Costs, and Predictors of
Medication Adherence among Diabetes Mellitus Patients in Palestine
Volume: 24
Issue: 4
Author(s): Rami Mosleh*, Ala’ U’wais, Anas Hamdan, Mustafa Ghanim and Yazun Jarrar
Affiliation:
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Keywords:
Medication adherence, alternative medicine, type i diabetes, type ii diabetes, hypertension, dyslipidemia.
Abstract:
Background: Diabetes Mellitus (DM) is considered the fourth leading cause of death in
Palestine, with a prevalence of 9.1% in patients aged 20-79 years, and has increased to 20.6% in 2020.
Aims: This study aims to estimate DM costs, compare DM total health care cost among patient
characteristics and DM management (e.g. anti-diabetic medications and alternative medicine), as
well as assess MA and its predictors including patient characteristics, DM management, alternative
medicine use, and DM costs.
Methods: A cross-sectional study was conducted for the past one year among 479 diabetic patients,
selected by convenience sampling and snowball sampling methods via electronic post of an online
questionnaire, including a web link to the questionnaire page in a Google Form via email or public
social media pages and applications. Data on patients’ socio-demographic and clinical characteristics,
medication profile, use of medicinal plants as alternative medicine, costs, and Medication Adherence
(MA) were collected. The Statistical Package for Social Sciences (SPSS v. 25) was used to
perform a descriptive, Kolmogorov-Smirnov test, univariate analysis, Mann-Whitney or Kruskal-
Wallis test, multiple linear regression, binary logistic regression, and multiple logistic regression
analysis. A p-value < 0.05 was considered statistically significant.
Results: More than half of the participants were male and living in villages (50.7%, 59.1%, respectively).
Approximately 51.4% received Oral Hypoglycemic Drugs (OHDs) and only 16.1% received
insulin. The participants receiving ≤3 medications daily acquired the highest percentage
(55.7%), and less than half received medicinal plants as an alternative medicine for the management
of DM. The estimated total DM health care cost per year incurred by patients and family
members was Israeli Shekel 988,276 (US Dollar 307,590). More than half of the participants were
considered adherent with the Eight–Item Morisky Medication Adherence Scale (MMAS–8) score
≥6. It is noteworthy that the use of alternative medicine was significantly associated with total
health care cost and MA. Furthermore, DM duration was significantly associated with MA. These
results are worth taking into consideration.
Conclusion: This study reflects the need for strengthening the patient-health care professionals’ relationship,
and to enhance the role of preventive education, and the importance of awareness about MA,
DSCMBs, and the use of alternative medicine based on evidence-based strategies to improve MA,
glycemic control, meanwhile reducing the costs incurred by patients and family members.
