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Despite advencements of modern medicine, plants have been used as medicines widely. Medication adherence is an indispensible part of drug therapy, and non-adherence is associated with increased mortality, morbidity and treatment costs. Disbelief or dissatisfaction with conventional medicine in terms of effectiveness or safety may play a role in preference of herbal medicines over conventional ones, and decrease medication adherence. However, effect of herbal medicine use in medication adherence have not been evaluated so far. Therefore, we conducted a cross sectional survey in order to investigate the effect of herbal medicine use in medication adherence.
All patients admitted to the outpatient cardiology clinics, who had been prescribed at least one cardiovascular drug before, were asked to complete a questionnaire. Three hundred and eighty accepted our offer and were enrolled into our study after giving informed consent. The participants were asked if they have been using any herbals with an expectation of beneficial effect on health. Aims and reasons for preference of herbals were also noted. Medication adherence were measured by using Morisky Scale (table 1). High adherence was defined as a Morisky score <2, and a score ≥2 was accepted as low adherence.
Totally 390 patients, 214 (54.9%) males and 176 (45.1%) females, participated in our study. Mean age of the participants were 58.9 (± 10.3). Among the participants, 266 (68.2%) had hypertension, 180 (46.2%) had hyperlipidemia, and 116 (29.7%) had diabetes mellitus. A hundred and sixteen (29.7%) of the participants had been consuming herbals. Thirty nine patients used herbals in a hope to reduce high cholesterol, 35 to maintain general cardiac health, 31 to protect hearth vessels and 19 for hypertension. Sixty six patients used herbals because they believe herbals are natural and thus they are harmless. Only 9% of the patients informed their doctors about their herbal use. Furthermore, 12.9% knew herbals may have side effects, and 11% knew herbals may have drug interactions. Age, gender and presence of hypertension, diabetes mellitus and hyperlipidemia were similar between herbal users and nonusers. The median Morisky score was significantly higher in herbal users than herbal nonusers (p<0.001). Rate of low adherence, according to the Morisky Scale, was also higher in herbal users (61.2% vs. 29.9%, p<0.001). In stepwise multivariate logistic regression analyze, herbal use was significantly associated with low medication adherence (OR:3.76, 95% CI 2.36-6.09, p<0.001).
Medication adherence was worse in herbal drug users and herbal drug use is associated with low medication adherence. Despite having side effects, drug interactions and association with low medication adherence, herbal drugs are used widely by cardiology patients. Physicians should be vigilant about the issue and patients should be informed adequately about risks of herbal remedies.
|Do you ever forget to take your medicine?|
|Are you careless at times about taking your medicine?|
|When you feel beter, do you sometimes stop taking your medicine?|
|Sometime if you feel worse when you take the medicine, do you stop taking it?|
One point given for every YES answer. 0-1 points: high adherence, 2-4 points: low adherence