[1] MINISTRY OF HEALTH HANOI UNIVERSITY OF PHARMACY NGO THI THU HUONG EVALUATE PERSEVERANCE AND COMPLIANCE WITH THE USE OF DRUGS BY OUTPATIENTS WITH TYPE 2 DIABETES AT THE 108 CENTRAL MILITARY HOSPITAL PHARMACIST GRADUATION THESIS HANOI - 2025 MINISTRY OF HEALTH HANOI UNIVERSITY OF PHARMACY NGO THI THU HUONG Student ID: 2001277 EVALUATE PERSEVERANCE AND COMPLIANCE WITH THE USE OF DRUGS BY OUTPATIENTS WITH TYPE 2 DIABETES AT THE 108 CENTRAL MILITARY HOSPITAL PHARMACIST GRADUATION THESIS Instructor: 1. Le Thu Thuy 2. Nguyen Duc Trung Location: 1. Military Central Hospital 108 2.
Faculty of Pharmaceutical Economics and Management HANOI - 2025 ACKNOWLEDGMENTS First of all, I would like to express my sincere gratitude and deepest gratitude to MSc. Le Thu Thuy, Lecturer at the Faculty of Management and Pharmaceutical Economics, Hanoi University of Pharmacy, and Dr. Nguyen Duc Trung, Head of the Department of Pharmacy, 108 Military Central Hospital, are the teachers who have directly guided and imparted valuable knowledge, dedicated to instructing, helping and encouraging during the time I have been working on this project. I would also like to sincerely thank the teachers in the Faculty of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, especially MSc.
Nguyen Le Hiep for guiding, helping and facilitating me during my research at the Faculty. I would also like to sincerely thank the Faculty of Pharmacy and the Information Technology Department and especially MSc. Hoang Anh Tuan, Manager of Pharmacy, 108 Military Central Hospital for helping and supporting in the process of extracting project data for research. I would also like to express my gratitude to the Board of Directors and all the teachers in the school who have imparted knowledge and guided me during my 5 years at the school.
Finally, I would like to express my deep gratitude to my family and friends, who have always cheered, encouraged, cared, shared, and helped me throughout the process of studying and implementing the project. Hanoi, June 2, 2025 Student Ngo Thi Thu Huong TABLE OF CONTENTS CATEGORIES OF ACRONYMS. 1 CATALOGUE OF DRAWINGS AND GRAPHS. 3 ASK THE PROBLEM.
Concept of diabetes. Treatment of type 2 diabetes. Epidemiology of type 2 diabetes mellitus. Disease burden of diabetes.
Comply with the use of medication and persist in treatment. The concept of drug adherence and perseverance. The role of medication adherence and treatment persistence. Methods of assessment of drug use compliance.
8 The data used in this study were extracted from the hospital’s outpatient management software system, covering the period from January 1, 2022, to December 31, 2024. The data were exported in tabulated form and cleaned before being used for analysis. All personal information was anonymized to ensure compliance with confidentiality regulations and ethical standards in scientific research. Evaluation of drug persistence.
Some studies on medication adherence and persistence based on data in people with type 2 diabetes. In the world .The Necessity of Evaluating Medication Adherence Using Database Systems. Some features of the research site. Military Central Hospital 108.
Treatment for patients with type 2 diabetes. RESEARCH OBJECTS AND METHODS. Subjects of study. Subjects of study.
Location and time of the study. Data collection methods. Data processing and analysis methods. Ethics in research.
RESULTS AND DISCUSSION. Assessment of drug compliance of patients with type 2 diabetes at the 108th Military Central Hospital. Description of compliance with the use of drugs. Analysis of some factors related to drug use compliance.
Multivariate regression analysis of some factors related to drug use compliance. Analysis of some factors related to perseverance. Multivariate Regression Analysis of Some Factors Related to Persistence. Persistence and adherence to medication use of people with type 2 diabetes.
Some factors affecting compliance and persistence in the use of oral diabetes medications of people with type 2 diabetes. Pros and cons of the study. 52 CONCLUSIONS AND RECOMMENDATIONS. Assessment of drug compliance of patients with type 2 diabetes at the 108th Military Central Hospital.
Evaluation of the persistence of patients with type 2 diabetes at the 108th Military Central Hospital. For health workers. 5 CATEGORIES OF ACRONYMS Acronym English Vietnamese American Diabetes ADA American Diabetes Association Association BN Patient Health Health Insurance Insurance Health Health Insurance Payments Insurance DM Directory DPP-4 Dipeptidyl peptidase 4 Mobile phones Diabetes mellitus International Pharmaceutical International Pharmaceutical FIP Federation Federation GDP Gross Domestic Product Gross Domestic Product Indernational Diabetes International Diabetes IDF Federation Federation KQNC Research Results OAD Oral Antidiabetic Drug - OAD Oral diabetes medications Sodium glucose SGLT2 contransporter National Guard Central Army 108 108 Who World Health Organization World Health Organization LIST OF TABLES Table 1. Treatment objectives for patients with type 2 diabetes mellitus in adults, not pregnant [3].
Medications for Type 2 Diabetes [11] .3 Methods for assessing medication adherence [25]. A review of some studies on medication adherence and persistence based on data in people with type 2 diabetes. Variables in the study. Steps to process data on excel.
Demographics between compliant and non-compliant groups. Treatment drug factors between adherence and non-adherence groups. Regression analysis of some factors related to medication adherence. Demographic factors between persistent and non-persistent groups35 Table 3.
Therapeutic drug factors between persistence and non-persistence groups. Testing factors between persistent and non-persistent groups. Factors of treatment costs between persistent and non-persistent groups. Multivariate regression analysis of factors related to treatment persistence.
43 CATALOGUE OF DRAWINGS AND GRAPHS Figure 3. Graph of patient medication compliance according to MPR. Probability chart of inclusion of variables in the multivariate regression model of factors related to medication adherence. Probability diagram of variables included in the multivariate regression model, factors related to drug persistence.
43 ASK THE PROBLEM Diabetes is emerging as a global pandemic with an alarming rate of increase. The World Health Organization (WHO) has shown a four-fold increase in the number of adults with diabetes worldwide since 1990, exceeding 800 million by 2024 [1]. According to the World Diabetes Federation (IDF), it is estimated that about 589 million adults (20-79 years old) have diabetes, equivalent to 1 in 9 adults with diabetes in 2024. The IDF forecasts that 853 million people will have diabetes by 2050.
Vietnam is one of the countries with the fastest growth rate of people with diabetes in the world, with about 7 million people counted in 2023. Diabetes creates a great economic burden on society, families and Vietnamese patients themselves. The annual cost of treatment for type 2 diabetes is estimated to account for about 7-11% of GDP per capita in Vietnam [2]. Therefore, effective blood sugar control, through proper nutrition, scientific exercise and the use of medications as prescribed by doctors, plays a key role in the treatment of patients with diabetes in general and type 2 diabetes in particular.
Maintaining stable blood glucose and achieving long-term treatment goals in patients with type 2 diabetes will help minimize the risk of developing complications, limit the number of hospitalizations and the risk of death. To achieve this, adherence to the use of medication and perseverance in adherence to treatment are an indispensable factor. According to the treatment guidelines of the Ministry of Health, it is recommended to start treatment for patients with type 2 diabetes with oral medications. In particular, metformin (biguanide) is the first-line treatment drug.
Combination therapy with oral diabetes medications is recommended if monotherapy is ineffective. If oral diabetes medications are ineffective, a combination or replacement therapy with insulin is chosen [3]. Therefore, adherence to treatment from the beginning, i. compliance in patients using oral diabetes medications, is very important and concerned.
Vietnam aims for 100.0% of hospitals to deploy electronic medical records by October 2025 [4]. This will create favorable conditions for the management of medical examination and treatment and at the same time create great opportunities in research from the exploitation of electronic databases. The trend of research on drug adherence and treatment adherence from electronic databases has been carried out for a long time in the world. There have been many studies published around the world on the assessment of drug adherence and persistence from electronic databases [5-7].
However, in Vietnam, this is still a new field that needs to be exploited. Military Central Hospital 108 (108th National Hospital) is the last line hospital of the army, a national special-class hospital, and a general hospital. The number of patients with type 2 diabetes being treated at hospitals is large and tends to increase. The 1 number of patients with diabetes treated in hospitals in 2022 is about 4200 patients, which has increased to more than 5000 patients in 2024.
In particular, the majority of patients only use oral diabetes medication (accounting for more than 60% of patients with type 2 diabetes). Therefore, the management of treatment, especially the issue of adherence to medication and persistent adherence to treatment of patients using oral diabetes medication is a matter of great concern. Assessing medication adherence and persistence of people with type 2 diabetes will help propose appropriate solutions to improve disease management and treatment. According to our knowledge, at the 108th National Hospital, there have also been a number of studies on drug adherence in patients with type 2 diabetes [8], [9].
However, previous studies have assessed adherence mainly by a set of questionnaires, and no studies have evaluated adherence to medication use in patients with type 2 diabetes based on data extracted from software. Therefore, we Conducting research on the topic "Assessment of persistence and adherence to medication use of patients with type 2 diabetes at the 108th Military Central Hospital" with two objectives: 1. Assessment of medication compliance among patients with type 2 diabetes using data from the 108 Central Military Hospital, 2022–2024. Assessment of medication perseverance among patients with type 2 diabetes using data from the 108 Central Military Hospital, 2022–2024.
The results of the study will help provide the current situation of patient persistence and adherence to medication use in hospitals and identify a number of factors that help predict the patient's ability to persist and comply with medication use, thereby proposing appropriate solutions to better manage patients with type 2 diabetes. Concept of diabetes According to the Ministry of Health: "Diabetes mellitus is a metabolic disorder, characterized by chronic hyperglycemia due to defects in insulin secretion, in the effects of insulin, or both. Long-term chronic hyperglycemia causes disorders in the metabolism of carbohydrates, protides, lipids, causing damage to many different organs, especially in the heart and blood vessels, kidneys, eyes, and nerves” [3]. According to The American Cellular Association (ADA) is " Diabetes mellitus is a group of metabolic pathologies characterized by hyperglycemia due to defects in insulin secretion, poor insulin activity, or both.
Chronic hyperglycemia often leads to the destruction and dysfunction of many organs, especially the eyes, kidneys, heart, nerves and blood vessels. Thus, diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or the body cannot effectively use the insulin produced. Type 2 diabetes Diabetes mellitus can be classified as type 1 diabetes, type 2 diabetes, gestational diabetes, and diabetes due to other causes. In which, type 2 diabetes accounts for the most, accounting for 90-95% of cases of diabetes [3].
Type 2 diabetes was formerly known as older adult diabetes or non-insulin- dependent diabetes. This form of the disease includes people who are relatively insulin deficient along with insulin resistance. Patients do not have autoimmune destruction of beta cells, no autoimmune antibodies in the blood. The majority of patients are obese or overweight and/or obese in the abdomen with a large waist.
