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On Medication Adherence and Health-Related Quality of Life (Hrqol) of Patients with Chronic Disease at Remote Rural Areas

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On Medication Adherence and Health-Related Quality of Life (Hrqol) of Patients with Chronic Disease at Remote Rural Areas International Journal of Environmental Research and Public Health Article Effects of the Physician–Primary-Healthcare Nurse Telemedicine Model (P-NTM) on Medication Adherence and Health-Related Quality of Life (HRQoL) of Patients with Chronic Disease at Remote Rural Areas Mi Young Kwak 1 , Eun Jeong Hwang 2,* and Tae Ho Lee 1 1 Center for Public Healthcare, National Medical Center, 245 Euljiro, Jung-gu, Seoul 04564, Korea; [email protected] (M.Y.K.); [email protected] (T.H.L.) 2 Department of Nursing, Sehan University, 1113, Samho-eup, Yeongam-gun, Jeollanam-do 58447, Korea * Correspondence: [email protected]; Tel.: +82-10-5305-1581; Fax: +82-61-469-1317 Abstract: Chronic diseases are a major cause of death and have a negative impact on community health. This study explored the effects of a chronic-disease management program utilizing the physician–primary-healthcare nurse telemedicine model (P–NTM) on medication adherence and health-related quality of life (HRQoL) in 113 patients with chronic diseases in remote rural areas. We used a quasi-experimental, nonequivalent-control-group pretest–post-test design. This study used secondary data from the 2018 Pilot Telemedicine Project for Underserved Remote Rural Areas. In this study, 113 subjects participated, in which the patient’s first visit was assigned as a control Citation: Kwak, M.Y.; Hwang, E.J.; group for the previous face-to-face hospital care; after three months of receiving the P–NTM program, Lee, T.H. Effects of the Physician–Primary-Healthcare Nurse the same subjects were assigned to be the experiment group for P–NTM. Data were analyzed by Telemedicine Model (P-NTM) on using descriptive statistics, a paired t-test, and logistic regression. With regard to the results, subjects Medication Adherence and showed a 1.76 times higher probability of improving medication adherence after participating in Health-Related Quality of Life P–NTM compared to hospital care (odds ratio (OR) = 1.76, 95% confidence interval (CI) = 1.34–2.31). (HRQoL) of Patients with Chronic Our findings showed that patients with chronic diseases, especially those who reside in remote rural Disease at Remote Rural Areas. Int. J. areas, should be provided with effective health services, utilizing various strategies to enhance a Environ. Res. Public Health 2021, 18, healthy life. 2502. https://doi.org/10.3390/ ijerph18052502 Keywords: chronic-disease management; medication adherence; health-related quality of life; telemedicine Academic Editor: Diana Castilla Received: 9 February 2021 Accepted: 25 February 2021 1. Introduction Published: 3 March 2021 Chronic diseases are the leading global cause of death, accounting for about 70% of Publisher’s Note: MDPI stays neutral all deaths [1]. Most chronic diseases may deteriorate the living capacity and functional with regard to jurisdictional claims in levels of patients, thereby reducing the overall health level and health-related quality of published maps and institutional affil- life (HRQoL) [2]. If patients with chronic diseases do not follow medication guidelines, iations. they cause negative clinical results, and HRQoL is lowered, causing additional costs [2–4]. Several previous studies [3–11] reported that a major problem with chronic diseases is that it is difficult to maintain proper disease self-management for a long time, such as medication adherence. As many as 30–50% of chronic-disease patients reported that they do not take drugs as prescribed [9,10]. The rate of medication adherence among patients with chronic Copyright: © 2021 by the authors. diseases has been diversely reported to be 30–70% for hypertension patients [7] and 36–93% Licensee MDPI, Basel, Switzerland. This article is an open access article for type 2 diabetes patients [8]. In particular, it may be more difficult for older adults distributed under the terms and due to cognitive decline. It was reported that 38.8% of the elderly forget their medication, conditions of the Creative Commons and 14.3% complained about the difficulty of medication [11]. In general, chronic diseases Attribution (CC BY) license (https:// progress slowly over a long period of time, so the prevalence of chronic diseases tends to creativecommons.org/licenses/by/ exponentially rise with age, including in Korea. It was reported that 87.1% of those aged 4.0/). 65 years or older suffer from one or more chronic diseases, and that 18% of those suffer both Int. J. Environ. Res. Public Health 2021, 18, 2502. https://doi.org/10.3390/ijerph18052502 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 2502 2 of 12 hypertension and diabetes in Korea [12]. Moreover, patients with chronic diseases reside in remote rural areas that are greatly limited in hospital accessibility, so there is a high possibility that greater problems occur in the treatment of diseases and HRQoL. The lack of specialty-care services, physician shortage, and geographic separation in remote rural areas are particularly problematic for patients with chronic diseases [13]. In particular, rural areas may have more problems in the management of patients with chronic diseases due to the higher proportion of elderly populations. The HRQoL of patients with chronic diseases improves if they are provided with early treatment for chronic diseases, steady intervention for behavioral changes, and psychological-disorder intervention [2]. The World Health Organization (WHO) emphasized [10] that innovations to improve treatment adherence may contribute more to public health than developing specific medical treatments. In the last few decades, telemedicine has been conducted to effectively treat and manage patients with chronic diseases who reside in remote rural areas. Several previous studies [13–17] reported that telemedicine has contributed to in- creased access to and improved quality of medical services, particularly in remote rural areas. Telemedicine has obvious advantages in remote areas where it improves access to health services, obviating the need for patients, their caregivers, and healthcare workers to travel [13]. Mehrotra et al. [15] reported that telemedicine subjects increased by more than 25% each year for 10 years, and that there is improved medical accessibility to sick and poor people in rural areas. Remote monitoring through telemedicine is effective for chronic diseases such as diabetes [18], depression [19], and dementia [14]. Wootton [16], reviewing studies related to telemedicine published in the past 20 years, identified that telemedicine had a great effect on chronic-disease management. In addition, telemedicine is suitable for older patients and aims for the early detection and rapid treatment to reduce health deterioration and maintain function and independence [19]. Among older populations in remote rural areas who are at increased risk for chronic diseases, telemedicine has the potential to improve access to healthcare services, thus perhaps reducing adverse health outcomes [13]. Although telemedicine has the limitation that it cannot facilitate smooth interactions between doctors and patients, it can improve the accessibility and quality of patients in areas with poor medical access or rural areas without direct contact with physicians [13,15,16]. In Korea, the medical law on telemedicine was passed in 2002 to provide only to underserved people who reside remote rural areas. On a legal basis, the physician–primary-healthcare nurse telemedicine model (P–NTM) was developed [20]. The P–NTM is a method that manages patients with chronic diseases residing in under- served remote rural areas by interacting with a distant physician and a primary-healthcare nurse at the local site using information and communication technology. Chronic diseases exist in a patient’s life for a long time, and they greatly affect their way of life. Therefore, it is necessary to apply a variety of appropriate management strate- gies over a long time to follow prescribed treatments, continuously control and manage symptoms, and help maintain an optimal life, even in sickness. Patients with chronic disease living in remote areas should not be an exception from effective chronic-disease management. Korean government applied various pilot projects including telemedicine for patients with chronic diseases living in remote areas, but few studies systematically ver- ified the effectiveness of the projects. It is necessary to empirically verify the effects of the chronic-disease management remote-treatment pilot project on the medication adherence and HRQoL of patients with chronic disease in remote rural areas. Therefore, this study explored the effects of a chronic-disease management program utilizing the P–NTM on medication adherence and HRQoL in patients with chronic diseases at remote rural areas. 2. Materials and Methods 2.1. Design The study was conducted by using a quasi-experimental, nonequivalent-control-group pretest–post-test design. Int. J. Environ. Res. Public Health 2021, 18, 2502 3 of 12 2.2. Data Collection and Procedures In this study, secondary data, which are the data of the 2018 Telemedicine Pilot Project at Remote Rural Areas, were used [20]. The subjects of this study were patients with hypertension, hyperlipidemia, and diabetes visited in primary-healthcare centers or clinics located in 11 remote rural areas selected as medically underserved locations. The minimal sample size required for two-tailed t-test analysis was determined by using G*power software (version 3.0) (Faul, F.; Erdfelder, E.; Lang, A.-G.; Buchner, Olshausenstr. 40, D-24098 Kiel, Germany) and setting the effect size at 0.8, significance level (α) at 0.05, and power (1 − b) at 80%. The minimal sample size required was calculated to be 102 individuals [21]. Lastly, 113 subjects participated in this study, so the number of subjects in this study met the minimum. They consisted of subjects who had already been treated for chronic diseases in hospitals before participating in P–NTM. Data on the first day of the visit were collected for medication adherence and HRQoL for the previous face-to-face hospital care. In addition, medication adherence and HRQoL related to telemedicine were repeatedly collected after three months of participation in the P–NTM.
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