Patterns of Medication Prescription and Barriers to Medication Adherence Among Outpatients at a Rural Tertiary Hospital in South-South Nigeria

Abstract

Context: Medication adherence is vital for optimal therapeutic outcomes; however, nonadherence remains a major public health concern, resulting in suboptimal health outcomes and higher medical expenses.

Objective: This study evaluated medication prescription patterns, adherence levels, and associated barriers among patients attending outpatient clinics at the Irrua Specialist Teaching Hospital (ISTH), Edo State, Nigeria.

Materials and Methods: A descriptive cross-sectional study was conducted among 164 patients using a two-stage sampling technique (purposive sampling technique for clinic selection, and systematic random sampling technique for participant selection) at the Irrua Specialist Teaching Hospital (ISTH) outpatient clinics, using a structured questionnaire to assess socio-demographics, prescription patterns, adherence behaviors, and barriers. Adherence was evaluated using an adapted Morisky Medication Adherence Scale (MMAS-8). Data were analysed using descriptive statistics and inferential (chi-square) tests.The level of significance was p<0.05.

Results: The mean age of participants was 45.33 ± 3.79 years. More than half were females (62.8%). Most patients n (81.1%) received three or more medications, predominantly via the oral route. Analgesics (30%), antihypertensives (22%), and antidiabetics (20%) were the most frequently prescribed medications. Adherence was low (42%) to moderate (30%), driven by stopping medication upon symptom improvement (63.4%), skipping doses due to cost (56.1%), and forgetfulness (53.0%). Socio-demographic factors showed no significant association with adherence (p>0.05). However, medication type (p=0.022), number of prescribed drugs (p=0.016), primary prescriber (p = 0.043), and frequency of prescription review (p=0.003) were significantly associated with adherence. High drug costs (38.4%) and long waiting times (18.9%) were the most commonly reported barriers.

Conclusion: Polypharmacy and oral administration were the predominant patterns of medication prescription to outpatients in ISTH. Medication adherence was suboptimal and was primarily influenced by regimen and health system factors rather than by sociodemographic factors. Simplifying regimens, reducing drug costs, improving education, and conducting regular reviews are recommended strategies to improve adherence.