Factors Associated with Medication Adherence Behavior among Hypertensive Patients

Objective: To assess the medication adherence behavior and investigate factors related to medication adherence behavior of hypertensive patients. Methods: In this cross-sectional study, a sample of 460 patients diagnosed with primary hypertension were recruited through systematic random sampling at Saithongwattana Community Hospital. Data were collected by using questionnaires. Content validity was confirmed by three experts with an index of congruence of 0.94. Reliability of questions of knowledge about hypertension was acceptable with a KR-20 coefficient of 0.77, questions about factors based health belief model, enabling factors, reinforcing factors, and medication adherence was acceptable with Cronbach’s alpha coefficients of 0.66, 0.71, 0.71, and 0.71 respectively. Descriptive statistics and logistic regression analysis were used to determine factors associated with medication adherence behavior. Results: About 40.4% of the participants had medication adherence. Women were 1.81 times more likely to adhere to their medications than men (ORadj. = 1.81, 95% CI: 1.21 to 2.73). Patients aged 60 years or younger were 1.91 times more likely to have medication adherence compared to their counterparts (ORadj. = 1.91, 95% CI: 1.23 to 2.96). Participants with low scores of perceived barriers were more likely to have medication adherence compared to their counterparts (ORadj. = 2.61, 95% CI: 1.62 to 4.19). Conclusion: Medication adherence was found in 40.4% of hypertensive patients, and was associated with age, gender and perceived barriers. Activities to reduce perceived barriers should be created. Keywords: medication adherence, hypertensive patients, perception, enabling factors, reinforcing factor

Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand

This paper examines primary care performance in three types of community health facilities in five provinces in northern Thailand. Tambon (sub-district) health promotion hospitals (THPHs) were introduced in 2009 to upgrade the services offered by the previous health centres, but were hampered by shortages of trained doctors and nurses. The Ministry of Public Health (MoPH) designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. While the plan is to move over time to doctor-staffed THPHs, many rural areas rely on facilities staffed by public health officers or nurses. The study used structured interviews to measure patient views on performance, defined in terms of accessibility, continuity, comprehensiveness, co-ordination and community orientation, in 23 THPHs divided across the three types. Counter-intuitively it was the THPHs staffed by public health officers which achieved the highest scores, followed by nurse-staffed facilities and then doctor-staffed facilities. The sharpest differences found were in the scores for accessibility, continuity, and comprehensiveness of care. The authors argue that these are associated with local services, which rural patients in particular value more than services offered by doctors on rotation in larger outpatient department-like centres. Patients value these aspects of care more than professional skill-mix per se. This is not an argument for delaying an increase in use of qualified staff, but an indication of the need to do this in a way that preserves the features of local services that patients value

Assessing the implementation of the family care team in the district health system of health region 2, Thailand

Background: The family care team (FCT) was established to improve the quality of care. This study aimed to explore the perceptions of FCT implementation and describe the challenges inherent in implementing the FCT. Methods: Forty in-depth interviews were conducted. The interviewees consisted of five primary care managers in the provincial medical health office, five directors of community hospitals, five administrators in district health offices, ten subdistrict health-promoting hospital directors, representatives from ten local organizations, and five heads of village health volunteers. Data were collected in accordance with semistructured interview guidelines and analyzed by thematic analysis. Results: Participants’ expressed their opinions through five themes: (1) the role and scope of practice, (2) the communication in collaboration of the FCT, (3) the management of the FCT, (4) the impact of the FCT on the team members’ feelings and primary care performance, and (5) the main challenges, including the insufficiency of a teamwork culture and a biomedical approach. Conclusion: The information suggests the importance of issues such as the clarification of the team members’ roles and managers’ roles, communication within and across FCTs, and the preparation for training of interprofessionals to enhance collaborative management to achieve the optimal care for people in the district health system

Care performance scores in three types of primary care facilities (n = 825).

<p>Care performance scores in three types of primary care facilities (n = 825).</p

Multiple comparisons: analysis of accessibility, continuity, comprehensiveness, coordination, community orientation and total scores.

<p>Multiple comparisons: analysis of accessibility, continuity, comprehensiveness, coordination, community orientation and total scores.</p