Improving Adherence to Prescribed Antidiabetics and Cardiovascular Medications in Primary Health Care Centers in Nyala City, South Darfur State-Sudan
Ahmed Dahab Ahmed, Asim Ahmed Elnour, Mirghani Abd Elrahman Yousif, Farah Hamad Farah, Hasab Alrasoul Akasha Ahmed Osman, Abobakr Abasaeed
College of Pharmacy and Health Sciences, Ajman University of Sciences and Technology, Ajman, UAE;.
College of Pharmacy, Clinical Pharmacy, Taif University, Taif, KSA;.
Consultant Clinical Pharmacist, Al Ain Hospital, Abu Dhabi Health Services Company (SEHA), Al Ain, UAE; Department of Pharmacology, College of Medicine and Health Sciences, UAE University, Al Ain, UAE.
Revolving Drug Fund (RDF), Ministry of Health (MOH), Nyala, Sudan; Department of Pharmaceutics, Faculty of Pharmacy, Gezira University, Medani, Sudan.
Social and Clinical Pharmacy Department, Faculty of Pharmacy, Charles University, Hradec Kralove, Czech Republic; Registration and Drug Control Department, Ministry of Health, Abu Dhabi, UAE..
The Epidemiological Laboratory (Epi-Lab), Khartoum, Sudan;.
DOI: 10.4236/pp.2013.49098   PDF    HTML     3,761 Downloads   5,928 Views   Citations


Aims: Prospective pharmacist’s interventions aimed to improve patient’s knowledge and behaviors to adhere to medications in patients with type 2 diabetes with or without cardiovascular medical conditions in primary health care (PHCs) centers in Nyala city, South Darfur State, Sudan. Methodology and Materials: 300 patients were enrolled for assessing adherence with the Brief Medication Questionnaire (BMQ) in ten PHCs in Nyala city. We assessed patients’ responses to BMQ pre-and post-interventions plan by: complex interventions, humanitarianism and disease outcomes determined by health-related outcomes (SF-36), glycosylated hemoglobin (HbA1c) and blood pressure. Results: BMQ scores have improved significantly in four screens (pre-and post-interventions): regimen [4.6 ± 0.2 to 1.8 ± 0.1; P = 0.001], belief [1.6 ± 0.3 to 0.3 ± 0.3; P = 0.007], recall [1.7 ± 0.2 to 0.6 ± 0.2; P = 0.043] and access screens [1.8 ± 0.1 to 0.4 ± 0.1; P = 0.005]; which have indicated an improved patients’ adherence to medications. Percentage of subjects reaching target of post prandial blood glucose (PPBG) have increased from 28.0% to 49.3%; [P = 0.02] post interventions. PPBG mean values have decreased significantly from [11.1 ± 0.6 mmol/L to 8.1 ± 0.8 mmol/L;

Share and Cite:

Ahmed, A. , Elnour, A. , Yousif, M. , Farah, F. , Osman, H. and Abasaeed, A. (2013) Improving Adherence to Prescribed Antidiabetics and Cardiovascular Medications in Primary Health Care Centers in Nyala City, South Darfur State-Sudan. Pharmacology & Pharmacy, 4, 701-709. doi: 10.4236/pp.2013.49098.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] M. Viswanathan, C. E. Golin, C. D. Jones, M. Ashok, S. J. Blalock, R. C. M. Wines, E. J. L. Coker-Schwimmer, D. L. Rosen, P. Sista and K. N. Lohr, “Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States: A Systematic Review,” Annals of Internal Medicine, Vol. 157, No. 11, 2012, pp. 785-795.
[2] S. Al-dabbagh, D. T. Mandh and S. Aswad, “Compliance of Hypertensive Patients to Management in Duhok Governorate Using Morisky-Green Test,” Duhok Medical Journal, Vol. 4, No. 1, 2010.
[3] M. C. S. Wong, J. Y. Jiang and S. M. Griffiths, “Factors Associated with Antihypertensive Drug Compliance in 83884 Chinese Patients: A Cohort Study,” Journal of Epidemiology and Community Health, Vol. 64, No. 10, 2010, pp. 895-890.
[4] A. D. K. Bowry, W. H. Shrank, J. L. Lee, M. Stedman and N. K. Choudhry, “A Systematic Review of Adherence to Cardiovascular Medications in Resource-Limited Settings,” Journal of General Internal Medicine, Vol. 26, No. 12, 2011, pp. 1479-1491.
[5] A. G. Elzubier, A. A. Husain, I. A. Suleiman and Z. A. Hamid, “Drug Compliance among Hypertensive Patients in Kassala, Eastern Sudan,” Eastern Mediterranean Health Journal, Vol. 6, 2000, pp. 100-105.
[6] A. Elnour, A. Shehab, A. Sadiq and N. H. Ellahham, “Monitoring the Doctors’ Prescribing Patterns in Outpatient Polyclinic Setting: The Clinical Pharmacist’s Approach,” Khartoum Pharmacy Journal, Vol. 11, No. 1, 2008, pp. 6-11.
[7] B. L. Svarstad, B. A. Chewning, B. L. Sleath and C. Claesson, “The Brief Medication Questionnaire: A Tool for Screening Patient Adherence and Barriers to Adherence,” Patient Education and Counseling, Vol. 37, No. 2, 1999, pp. 113-124.
[8] J. E. Brazier, R. Harper, N. M. Jones, A. O’Cathain, K. J. Thomas, T. Usherwood and L. Westlake, “Validating the SF36 Health Survey Questionnaire: New Outcome Measure for Primary Care,” BMJ, Vol. 305, No. 6846, 1992, pp. 160-164.
[9] R. Adepu and S. S. M. ARri, “Influence of Structured Patient Education on Therapeutic Outcomes in Diabetes and Hypertensive Patients,” Asian Journal of Pharmaceutical and Clinical Research, Vol. 3, No. 3, 2010.
[10] E. Vigneshwaran, Y. P. Reddy and N. Devanna, “Enhancing Quality of Life and Medication Adherence through Patient Education and Counseling among HIV/ AIDS Patients in Resource Limited Settings—Pre and Post Interventional Pilot Trial,” British Journal of Pharmaceutical Research, Vol. 3, No. 3, 2013.
[11] M. Ho, C. L. Bryson and J. S. Rumsfeld, “Medication Adherence: It’s Importance in Cardiovascular Outcomes,” Journal of the American Heart Association, 2009.
[12] K. V. Nair, D. A. Belletti, J. J. Doyle, R. R. Allen, R. B. McQueen, J. J. Saseen, J. V. Griend, J. V. Patel, A. McQueen and S. Jan, “Understanding Barriers to Medication Adherence in the Hypertensive Population by Evaluating Responses to a Telephone Survey,” Patient Preference and Adherence, Vol. 5, 2011, pp. 195-206.
[13] T. B. Hong, E. Z. Oddone, T. K. Dudley and H. B. Bosworth, “Medication Barriers and Anti-Hypertensive Medication Adherence, the Moderating Role of Locus of Control,” Psychology, Health & Medicine, Vol. 11, No. 1, 2006, pp. 20-28.
[14] G. Harmon, J. Lefante and M. Wood-Krousel, “Overcoming Barriers: Role of Providers in Improving Patient Adherence to Antihypertensive Medications,” Current Opinion in Cardiology, Vol. 21, No. 4, 2006, pp. 310-315.
[15] S. B. Sridhar, M. G. Naraharib, K. C. Gurudevb and P. Gurumurthy, “Impact of Clinical Pharmacist-Provided Education on Medication Adherence Behaviour in ESRD Patients on Haemodialysis,” IJPS, Vol. 5, No. 1, 2009, pp. 21-30.
[16] D. S. Friedman, S. R. Hahn, L. Gelb, J. Tan, S. N. Shah, E. E. Kim, T. J. Zimmerman and H. A. Quigley, “Doctor-Patient Communication, Health-Related Beliefs, and Adherence in Glaucoma Results from the Glaucoma Adherence and Persistency Study,” Ophthalmology, Vol. 115, No. 8, 2008, pp. 1320-1327.
[17] I. Krass, S. J. Taylor, C. Smith and C. L. Armour, “Impact on Medication Use and Adherence of Australian Pharmacists’ Diabetes Care Services,” Journal of the American Pharmacists Association, Vol. 45, No. 1, 2005, pp. 33-40.
[18] A. Avignon, Radauceanu and L. Monnier, “Non-Fasting Plasma Glucose Is a Better Marker of Diabetic Control than Fasting Plasma Glucose in Type-II Diabetes,” Diabetes Care, Vol. 20, 1997, pp. 1822-1826.
[19] M. M. Engelgau, T. J. Thompson, W. H. Herman, J. P. Boyle, R. E. Aubert, S. J. Kenny, A. Badran, E. S. Sous and M. A. Ali, “Comparison of Fasting and 2-Hour Glucose and HbA1c Levels Fordiagnosing Diabetes: Diagnostic Criteria and Performance Revisited,” Diabetes Care, Vol. 20, No. 5, 1997, pp. 785-791.
[20] B. Balkau, M. Shipley, K. P. Jarrett, M. Pyorala, A. Forhan and E. Eschwege, “High Blood Glucose Concentration Is a Risk Factor for Mortality in Middle-Aged Non-Diabetic Men: 20-Year Follow-Up in the Whitehall Study, the Paris Prospective Study and the Helsinki Policemen Study,” Diabetes Care, Vol. 21, No. 3, 1998, pp. 360-367.
[21] N. Fikri-Benbrahim, M. J. Faus, F. Martínez-Martínez, D. G. Alsina and D. Sabater-Hernández, “Effect of a Pharmacist Intervention in Spanish Community Pharmacies on Blood Pressure Control in Hypertensive Patients,” American Journal of Health-System Pharmacy, Vol. 69, No. 15, 2012, pp. 1311-1318.
[22] G. Corrao, A. Zambon, A. Parodi, E. Poluzzi, I. Baldi, L. Merlino, G. Cesana and G. Mancia, “Discontinuation of and Changes in Drug Therapy for Hypertension among Newly-Treated Patients: A Population-Based Study in Italy,” Journal of Hypertension, Vol. 26, No. 4, 2008, pp. 819-824.
[23] M. Fujisawa, Y. Ichikawa, K. Yoshiya, S. Isotani, A. Higuchi, S. Nagano, S. Arakawa, G. Hamami, O. Matsumoto and S. Kamidono, “Assessment of Health-Related Quality of Life in Renal Transplant and Hemodialysis Patients Using the sf-36 Health Survey,” Elsevier Science, 2000.
[24] L. Osterberg and T. Blaschke, “Adherence to Medication,” New England Journal of Medicine, Vol. 353, No. 5, 2005, pp. 487-497.
[25] J. P. Anaya, J. O. Rivera, K. Lawson, J. Garcia, J. Luna Jr and M. Ortiz, “Evaluation of Pharmacist-Managed Diabetes Mellitus under a Collaborative Drug Therapy Agreement,” American Journal of Health-System Pharmacy, Vol. 65, No. 19, 2008, pp. 1841-1845.
[26] J. Dunbar-Jacob, J. A. Erlen, E. A. Schlenk, C. M. Ryan, S. M. Sereika and W. M. Doswell, “Adherence in Chronic Disease,” Annual Review of Nursing Research, Vol. 18, No. 1, 2000, pp. 48-90.
[27] A. Lagi, A. Rossi, M. T. Passaleva, A. Cartei and S. Cencetti, “Compliance with Therapy in Hypertensive Patients,” Internal and Emergency Medicine, Vol. 1, No. 3, 2006, pp. 204-208.
[28] J. J. Gascon, M. Sanchez-Ortuno, B. Llor, D. Skidmore and P. J. Saturno, “Why Hypertensive Patients Do Not Comply with the Treatment,” Family Practice, Vol. 21, No. 2, 2004, pp. 125-130.
[29] K. V. Mini, A. Ramesh, G. Parthasarathi, S. N. Mothi and V. T. Swamy, “Impact of Pharmacist Provided Education on Medication Adherence Behaviour in HIV/AIDS Patients Treated at a Non-Government Secondary Care Hospital in India,” Journal of AIDS and HIV Research, Vol. 4, No. 4, 2012, pp. 94-99.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.