Abstract
ABSTRACT Patients adherence to their healthcare protocols is important to reach the best health outcomes. However, little attention has been given to the assessment of psychometric properties of adherence measures in Libyan population. The study aimed to conduct a comprehensive work for evaluation the relationship between patients noncompliance and medication satisfaction of patients on Clopidogrel, to investigating the argument of ][Libyan physicians. Also, the quality of 4 brands of Clopidogrel is described and compared to the quality of the innovator drug product (PLAVIX ®) in order to support the study. Adherence of patients on various brands of Clopidogrel available in Libyan market were examined by 8-item Morisky Medication Adherence Scale. And four generic alternatives of Clopidogrel were compared to the innovator drug product for weight variation, thickness, hardness, disintegration and dissolution. Patients on different brands of Clopidogrel were randomly selected (n=200), Their mean ages of the study sample was 63 ±10 years. Participants from Tripoli-City hospitals completed an in-person interview assisted questionnaire. The questionnaire was the 8-item Morisky Medication Adherence Scale (MMAS-8). The reliability and validity of the measures were also evaluated. The study found that more than half of patients on Plavix® and Apo-Clopidogrel® reported a high level of adherence 59%, 56% respectively. While about 72% of the patients on other brands of Clopidogrel reported low to medium level of adherence. The present study showed that the 8-item MMAS had good reliability (Cronbach’s alpha= 0.755). Additionally, the exclusion of the “feel hassled by treatment plan,” item improved the overall reliability slightly (46% indicating “feel hassled by treatment plan”). There is a statistically significant relationship (p=0.05) between patients' adherence behaviour and their gender. The study revealed that males have higher adherence toward taking their medication compared to females (53%, 36% respectively). The results clearly indicate that four brands of Clopidogrel tablets comply with the pharmacopeia standards set for these products for weight variation, thickness, hardness and dissolution except Antiplex® tablets which failed in thickness, hardness and dissolution tests. The study concluded that the patients on different brands of Clopidogrel "who had been described by physicians in having low medication efficacy" reported low medication adherence. The quality analysis tests reinforce the previous findings. This proves why the innovator Plavix® is more effective than other generic alternatives .It is also mandatory for manufacturers and all other key players in the drug distribution business to assure that final products reach consumers with high quality and efficacy. This is only possible in an environment of high ethical and moral standards.