Our study showed that the proportion of subjects with inappropriate home medication management practices was 70%. Furthermore, perceived severity of illness, duration of disease, and assessment for response to treatment were significantly associated with overall home medication management.
Actual medication duplication was found in 8.7% of the patients. The proportion of patients with actual medication duplication in our study was lower than that reported in a study done in Australia (20%)[
5], and in a study in California among elderly patients where 24.2% had unnecessary therapeutic duplication [
11]. The populations in those studies were different from our study population. The study in Australia had patients with high risk of medication problems while that in California was in elderly patients who also have a high risk for medication problems. The most commonly duplicated drugs in our study were analgesics in contrast to the study in Australia where cardiovascular drugs were the most commonly duplicated. Although medication duplication was not related to age, education level or multiple prescribers in our study, it is possible that some patients were overwhelmed by the various brands of their medicines available on the market. This high medication duplication is likely to increase the risk of toxicity among patients as well as wastage of resources.
Factors associated with inappropriate home medication management practices
Patients who perceived their disease as moderately severe had 60% reduction in inappropriate medicines management compared to those who perceived their disease as very severe. In addition, patients who perceived their disease as not severe had 65% reduction in inappropriate medicines management compared to those that perceived their disease to be very severe. Our findings are similar to those in the study done in Australia where severity of illness was associated with medication management practices [
9]. Patients who perceive their disease as very severe may take more than the recommended dosage, or take multiple medicines or visit more health providers, all of which are likely to lead to inappropriate medication management practices. Indeed in this study we found that patients that perceived their disease as not severe were less likely to have multiple prescribers for their disease condition. The multiple prescribers further compounded the problem of home management of medicines increasing drug hoarding by 35% with increasing number of prescribers.
Longer duration of disease was associated with inappropriate medication management practices. Patients who had disease for more than 5 years were twice as likely to have inappropriate medication management practices. Patients with prolonged disease may accumulate drugs over time and misuse them, and they may be more likely to visit multiple prescribers in search of a cure. In addition, they may perceive their disease as very severe and may take more than the recommended dosage, or take multiple medicines or visit more health providers in an effort to obtain relief, all of which are likely to lead to inappropriate medication management practices. In this study, there was higher drug hoarding among patients with duration of disease of more than five years. In addition, patients that had longer duration of disease had higher number of chronic diseases which in turn was associated with having multiple prescribers.
Our study showed that poor communication and guidance by the health workers was associated with poor medicine management practices. Patients who reported that the health workers did not ask them about their response to treatment were 2.5 times more likely to have inappropriate medication management practices. This may be indicative of inadequate general management of the patient’s condition due to poor communication and guidance by the health worker. In addition, patients that felt that they had not received adequate information about their disease condition were more likely not to have a medicines administration schedule and had inappropriate medicines storage practices. This calls for better communication between the various health providers (physicians, nurses, and pharmacists) and the patients.
Although highest level of education was not statistically significant, it had a confounding relationship with duration of disease. A bigger proportion of patients with secondary school education had longer duration of disease than other education categories and that was probably the reason why it appeared as an important variable to consider since duration of disease was retained as an important variable.
Our study did not show significant association between overall medication management practices and socio-demographic characteristics, disease characteristics of patients, drug related factors, home environment, type of facility the patient usually attends, and lifestyle characteristics. Our findings are similar to those of Hutchison and others [
16] in USA who did not report any association between adverse events and medication management practices. However, our findings contrast with a study done in Palestinian households which reported that family size, age, and education level were associated with the storage of antibacterial agents [
17]. These differences may be due to the fact that the study in Palestinian households focussed on antibacterial agents whereas our study involved a wide range of drugs used in chronic diseases. Our findings also contrast with the study by Sorensen and others in Australia [
5] which reported that the number of medications was associated with poor medication management practices.
The lack of association between medication management practices and many of the factors in our study suggests that these factors were not important predictors of medication management practices in the population that we studied. Secondly, we may not have had sufficient power to detect associations where they existed for some of the variables.
In our study, some socio-demographic characteristics were associated with specific medicines management practices. There was a reduction in lack of medicines administration schedules in older chronic disease patients and longer distance to the health facility was associated with inappropriate storage of medicines. Older patients may have had the chronic disease longer and have therefore learnt how to effectively manage it by having proper medicines administration schedules or they may try to organize routines in the way they administer their medicines in order to overcome the problems of forgetfulness that increase with age.
Our study was limited in that in many instances, we were not able to enter patients’ houses and evaluate their medicines storage practices. It is therefore likely that patients may have underestimated their poor medicines storage practices in cases where it was obvious what was expected e.g. refrigeration of insulin.
We may not have had adequate power to detect associations for some of the variables that have been related to medicines management in the literature. This is more so because we had to combine several variables to come up with the outcome variable of overall appropriate medicines management practices. The small proportion of respondents with appropriate medicines management practices resulted in small numbers in some categories which may have affected the power of our study. In addition, we had some missing information on some variables further reducing the effective sample size. Associations with expired medicines could not be determined because of the small number of persons that had expired medicines.
The variable “appropriate medicines management” was made up of several items which were equally weighted in the combination and yet some of the items may have had stronger implications for inappropriate medicines management.
A major strength of our study was it was population based since patient’s medicines were evaluated in their homes. Even where we could not view where patients kept their medicines, they could bring them out and evaluate what they had. This enabled us to get valid information about the medicines kept at home rather than relying on patients recall on what was in their medicines storage areas.
In conclusion, home medication management practices among the chronic disease patients were poor. Patients that perceived their disease to be very severe, those with longer duration of disease, and those who the health worker did not assess for response to treatment were more likely to have inadequate medication management practices. Health workers need to strengthen the patients’ education about their medicines especially about the storage and other aspects of home medication management. In addition, the health workers should monitor chronic disease patients more closely. There is need for stronger drug regulation so that patients do not get medicines without proper and current prescriptions.