VALUE-RELEVANT DETERMINANTS OF MEDICATION ADHERENCE IN CARDIAC PATIENTS ACROSS PUBLIC AND PRIVATE HOSPITALS IN NORTHWEST PAKISTAN
Author(s)
Arslan Khan, MSc, PharmD1, Saima Mushtaq, PhD2, Amjad Khan, MPhil, RPh, PharmD, PhD3, Rabia Hussain, MPhil, RPh, PharmD, PhD4, Jie Chang, PharmD, MSc, PhD5, Yu Fang, PharmD, MSc, PhD5.
1President - ISPOR LMIC Student Chapter | Postgraduate Researcher @ CDSP, XJTU, Center For Drug Safety and Policy Research (CDSP), School of Pharmacy, Xi'an Jiaotong University, Bannu, Pakistan, 2Center For Drug Safety and Policy Research (CDSP), School of Pharmacy, Xi'an Jiaotong University, Xi’an, China, 3Quaid-i-Azam University, Islamabad, Pakistan, 4Universiti Sains Malaysia, Penang, Malaysia, 5Center For Drug Safety and Policy Research (CDSP), School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.
1President - ISPOR LMIC Student Chapter | Postgraduate Researcher @ CDSP, XJTU, Center For Drug Safety and Policy Research (CDSP), School of Pharmacy, Xi'an Jiaotong University, Bannu, Pakistan, 2Center For Drug Safety and Policy Research (CDSP), School of Pharmacy, Xi'an Jiaotong University, Xi’an, China, 3Quaid-i-Azam University, Islamabad, Pakistan, 4Universiti Sains Malaysia, Penang, Malaysia, 5Center For Drug Safety and Policy Research (CDSP), School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.
OBJECTIVES: Cardiovascular diseases remain the leading global cause of mortality, accounting for 19.8 million deaths in 2022, while medication non-adherence contributes to preventable morbidity, avoidable hospital use, and substantial healthcare costs. In South Asian and low- and middle-income settings, adherence evidence remains limited despite high cardiovascular risk and affordability barriers. This study assessed medication adherence and value-relevant patient, economic, clinical, and health-system determinants among cardiac patients in Northwest Pakistan.
METHODS: A multicenter cross-sectional study was conducted among cardiac patients attending public/private hospitals in Northwest Pakistan. Medication adherence was assessed using the licensed 8-item Morisky Medication Adherence Scale (MMAS-8). Data were collected on sociodemographic characteristics, hospital type, cardiac diagnosis, comorbidities, medication access, side effects, confidence in medication management, reminder support, financial barriers, treatment duration, hospitalization, and cardiac medication count. Descriptive statistics and non-parametric tests were used to examine factors associated with adherence.
RESULTS: Among 600 patients, mean age was 57.4 years; 53.8% were male, 62.5% were rural residents, 67.8% were low-income, and 66.5% had no formal education. Low adherence was observed in 85.5% of patients, while 14.5% had medium adherence. Common non-adherent behaviors included forgetting medicines (83.5%), stopping treatment when the condition felt controlled (66.5%), cutting back or stopping due to feeling worse (63.7%), and missing doses in the previous two weeks (42.3%). Financial barriers were reported by 57.7%, side effects by 29.0%, and lack of reminder support by 39.3%. Adherence was significantly associated with reminder support (p=0.043), duration since cardiac diagnosis (p=0.001), and cardiac-related hospitalization in the previous year (p=0.006).
CONCLUSIONS: Low cardiovascular medication adherence was highly prevalent and linked with modifiable support and utilization-related factors. Findings support pharmacist-led counseling and a low-cost adherence support pathway using refill cards, family-based reminders, free SMS/WhatsApp reminders, and pharmacy refill follow-up to improve adherence, reduce avoidable hospital use, and strengthen equitable cardiovascular care in LMIC settings.
METHODS: A multicenter cross-sectional study was conducted among cardiac patients attending public/private hospitals in Northwest Pakistan. Medication adherence was assessed using the licensed 8-item Morisky Medication Adherence Scale (MMAS-8). Data were collected on sociodemographic characteristics, hospital type, cardiac diagnosis, comorbidities, medication access, side effects, confidence in medication management, reminder support, financial barriers, treatment duration, hospitalization, and cardiac medication count. Descriptive statistics and non-parametric tests were used to examine factors associated with adherence.
RESULTS: Among 600 patients, mean age was 57.4 years; 53.8% were male, 62.5% were rural residents, 67.8% were low-income, and 66.5% had no formal education. Low adherence was observed in 85.5% of patients, while 14.5% had medium adherence. Common non-adherent behaviors included forgetting medicines (83.5%), stopping treatment when the condition felt controlled (66.5%), cutting back or stopping due to feeling worse (63.7%), and missing doses in the previous two weeks (42.3%). Financial barriers were reported by 57.7%, side effects by 29.0%, and lack of reminder support by 39.3%. Adherence was significantly associated with reminder support (p=0.043), duration since cardiac diagnosis (p=0.001), and cardiac-related hospitalization in the previous year (p=0.006).
CONCLUSIONS: Low cardiovascular medication adherence was highly prevalent and linked with modifiable support and utilization-related factors. Findings support pharmacist-led counseling and a low-cost adherence support pathway using refill cards, family-based reminders, free SMS/WhatsApp reminders, and pharmacy refill follow-up to improve adherence, reduce avoidable hospital use, and strengthen equitable cardiovascular care in LMIC settings.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PCR218
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care, Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas