title: Factors affecting medication adherence in Lebanese patients with chronic diseases.
abstract: BACKGROUND
  Non-adherence to prescribed medications represents an obstacle toward achieving treatment goals. This problem is more pronounced in patients with chronic illness.
  
  
  OBJECTIVE
  To identify the extent of adherence in Lebanese outpatients with chronic diseases, and to suggest possible predictors of non-adherence in this population. The secondary objective was to assess if medication adherence affects patients' quality of life.
  
  
  METHODS
  A questionnaire was administered face-to-face to a sample of Lebanese adults visiting the external clinics at two Tertiary Care Hospitals in Beirut. The level of adherence was assessed using the 8-item Morisky Medication Adherence Scale which was first validated. The health-related quality of life (HRQoL) of patients was measured using the EQ-5D. Linear regression and logistic regression analyses examined possible predictors of adherence.
  
  
  RESULTS
  Out of the 148 patients included in this study, 42.6% were classified as adherent. In the univariate analyses, statistically significant predictors of high adherence included good physician-patient relationship (p=0.029) and counseling (p=0.037), a high level of HRQoL (p<0.001), and a high level of perceived health (p<0.001). Predictors of low adherence included a declining memory (p<0.001), anxiety/depression (p=0.002), little drug knowledge (p<0.001), and postponing physician appointments (p<0.001). The multivariate analyses revealed similar results. In the linear regression, the most powerful predictor of non-adherence was the disbelief that the drug is ameliorating the disease (beta=0.279), however, in logistic regression, patient who were willing to skip or double doses in case of amelioration/deterioration were found to be 7.35 times more likely to be non-adherent than those who were not (aOR=0.136, 95% CI: 0.037-0.503).
  
  
  CONCLUSIONS
  The findings of this study reassure the view that patients should be regarded as active decision makers. Patient education should be regarded as a cornerstone for treatment success. Additional studies as well are needed to test the practicability and effectiveness of interventions suggested to enhance adherence.
authors.affiliation: Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy-Clinical Pharmacy department, Lebanese University . Beirut ( Lebanon ). hajj.amal@hotmail.com.
authors.forename: Amal
authors.initials: A
authors.lastname: Al-Hajje
authors.affiliation: Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy-Clinical Pharmacy department, Lebanese University . Beirut ( Lebanon ). sanaa3a@hotmail.com.
authors.forename: Sanaa
authors.initials: S
authors.lastname: Awada
authors.affiliation: Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy-Clinical Pharmacy department, Lebanese University . Beirut ( Lebanon ). samar.rachidi@outlook.com.
authors.forename: Samar
authors.initials: S
authors.lastname: Rachidi
authors.affiliation: Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy-Clinical Pharmacy department, Lebanese University . Beirut ( Lebanon ). salamzein@hotmail.com.
authors.forename: Salam
authors.initials: S
authors.lastname: Zein
authors.affiliation: Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy-Clinical Pharmacy department, Lebanese University . Beirut ( Lebanon ). w.bawab@hotmail.com.
authors.forename: Wafa
authors.initials: W
authors.lastname: Bawab
authors.affiliation: Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy-Clinical Pharmacy department, Lebanese University . Beirut ( Lebanon ). elhajj.zainab@gmail.com.
authors.forename: Zeinab
authors.initials: Z
authors.lastname: El-Hajj
authors.affiliation: Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy-Clinical Pharmacy department, Lebanese University . Beirut ( Lebanon ). mayssam_bouzeid@hotmail.com.
authors.forename: Mayssam Bou
authors.initials: MB
authors.lastname: Zeid
authors.affiliation: Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy-Clinical Pharmacy department, Lebanese University . Beirut ( Lebanon ). mohyas1990@gmail.com.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Yassine
authors.affiliation: Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy-Clinical Pharmacy department, Lebanese University . Beirut ( Lebanon ). pascalesalameh1@hotmail.com.
authors.forename: Pascale
authors.initials: P
authors.lastname: Salameh
keywords: Causality; Lebanon; Medication Adherence; Multivariate Analysis; Prevalence