Technological advancement in the medical field has brought about new means of preventing and treating illnesses. One of these is the intake of pharmaceutical drugs leading to a treatment process referred to as pharmacotherapy. Every physician must ensure that he/she prescribes the right amount of dosage and intake intervals for the patient . Patient safety and health have been prevalent in health care, and one of the factors that impede its enhancement is wrong prescriptions made by physicians. Every doctor must have a vast awareness of a drug’s pharmacodynamics and pharmacokinetics (Culig, 2018). This will ensure that the medication provided to patient accomplishes its indented goals. In case this is not achieved, it will indicate that the physician did not issue the right medication and thus calling for the need to sue a different medication or therapeutic procedure.
However, it is not only the doctor who plays a role in ineffective drug treatments. Another primary determinant of treatment success is adherence to the prescribed therapies. According to the World Health Organization, it defines medication adherence as “the degree to which a person’s behavior corresponds with the agreed recommendations from a health care provider.” However, people have always misinterpreted the meaning of adherence and compliance. In this case, compliance is defined as the patient taking heed of the doctor’s authority and obeying all that is said to him or her. In the case of adherence, it requires a collaboration between the doctor and the patient with an overall objective of enhancing the patient’s well-being and health. This is only made possible through an integration of the doctor’s medical opinion and patient preferences for care, values, and lifestyle.
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According to Culig (2018), 4% of patients do not adhere to their doctor’s prescriptions. Correspondingly, more than 50% of patients suffering from chronic illness engage in non-adherence by either skipping the medication, breaking off from prescribed intake patterns or forget to take the medication. There are various types of non-adherence resulting from the physicians or patient’s side. However, the most common physician caused non-adherence is primary non-adherence. In this case, it will see a physician writing a prescription, but medication is never initiated or filled (Solomon & Majumdar, 2010). This type of non-adherence is also referred to as non-fulfillment adherence. A non-persistent adherence is common in patients. It will see the patients decided to stop taking their medications after starting without seeking advice from a health practitioner. In most instances, this type of non-adherence is unintentional for it results from a miscommunication between the patient and physician (Schofield, Sebti & Harris, 2015). The other is unintentional non- adherence. In this case, the existence of barriers such as resources and capacity forcing a patient not to access the recommended medication. On the other hand, intentional non-adherence is dependent on the attitudes, principles, and prospects that affect patient enthusiasm to either continue or begin with treatment prescription. A non-conforming non-adherence will see a patient taking medication at incorrect times, skipping doses or taking more or less than prescribed dosages.
Non-adherence has negative consequences such as an elevated usage of nursing homes, hospital visits and hospital admissions, reduced functional abilities, waste of medication, disease progression and lower quality of life (Hugtenburg et al., 2013). According to Jimmy and Jose ( 2011), the hospitalization rate was higher in patients suffering from congestive heart failure; hypertension and diabetes were because of non-adherence to prescribed medication. Moreover, a poor adherence rate in patients suffering from chronic obstructive pulmonary disease leads to emergency hospitalization.
Influences of non-adherence
Medication adherence is determined by a complex combination of factors such as patient access and service issues, illness characteristics, views, and attitudes. Similarly, certain barriers impede the effective use of medication such as a poor doctor-patient communication channel. Inadequate comprehension of a medication and its use, fear of adverse medication effects, costs and access.
However, adherence to medication also varies across individuals and age groups, time and recommended diseases and behaviors. In the case of children, their adherence to medication is dependent on the adult caregiver. In the case of elderly patients, the medication adherence rates range from 38%-57%. In case patients are symptom-free , their adherence is also minimal. Jimmy and Jose (2011) state that, 77% of patients have a higher adherence rate in case the medication aims at curing disease.In case its role is prevention, the rates are much lower at 63% (Jimmy & Jose,2011). Patients with low literacy abilities do not adhere to medication, as they cannot partially or fully understand the instructions. Likewise, these patients from low socio-economic status bracket tend to be associated with high-risk health behaviors such as poor diets. Determining the root cause of such behavior is not an easy task since they are heavily intertwined with societal, social and cultural norms
Non-adherence in cardiovascular patients has been known to ensue in more than 60% of the patients. In the case of patients suffering from coronary artery diseases, the rates stand at less than 40%. Some of the medications used in cardiovascular diseases include aldosterone receptor antagonists, angiotensin receptor blockers, enzyme inhibitors, beta-blockers, and stanines and antiplatelet agents (Baroletti & Dell’Orfano, 2010). The medications present different adherence rates from the patients with a 21% adherence rate in aspirin, beta-blockers, and lipids. Likewise, within 6 to 12 months, more than 50% of the patient’s adherent to antihypertensive medications will become non-adherent and less than 40% will continue taking the medication after two years since hospitalization (Baroletti & Dell’Orfano, 2010). Primary non-adherence in cardiovascular patients leads to an increase in one-year mortality after hospitalization while secondary non-adherence leads to increased costs, hospital admissions , and death . For this reason, the aim of this research is to scrutinize medication adherence prevalence among cardiovascular patients in Saudi Arabia using a sample from Medina Cardiac Centre. In this research, an answer is sought to the question whether the cardiovascular patients have higher or lower medication adherence and in case it is higher, the study will outline targeted interventions to be enforced to reduce the negative public health effects of non-adherence.
Research Problem
Adhering to a doctor’s medication prescriptions is a vital requirement that every patient must observe. The prescribed drug dosages will help the patient whether they are to be taken for treatment or preventative purposes. Adherence to prescribed medication dosages and time intervals will bring about an increased quality of life for the patient. Through eliminating any occurrence of additional complications or disease progression. Medication adherence also helps in removing the unnecessary costs that will result from readmissions and hospitalization. More importantly, this will help the state and the federal government in saving the ever-ballooning healthcare expenditure and eliminate harmful psychological impacts on one’s family.
Research Significance
Through this research, it will aid the government in formulating various policies that support increased medication compliance. Moreover, it will help doctors in building an effective communication channel with the patient has to make sure that they can offer them advice on how to take medication and the importance of adhering to prescribed dosages. Similarly, the patients will have the ability to have an awareness of the negative impacts of non-adherence and the causes of non-adherence. This will enable them in changing their views or perspectives that are contributing towards non-adherence.
Research Objectives
The study aims to;
Investigate the prevalence of medication adherence among cardiovascular patient in Medina Cardiac Center.
Identify subjects at high risks for poor medication adherence and management, so targeted interventions may be enforced to reduce public health.
Hypothesis
H0: There is a high prevalence of medication adherence among adult cardiovascular diseases patients in Medina Cardiac Center
H1: There is a low prevalence of medication adherence among adult cardiovascular diseases patients in Medina Cardiac Center.
Methodology
The study was conducted in Medina Cardiac Centre in Medina, Kingdom of Saudi Arabia. The study was conducted as from January 28, 2019. The study was carried out using a hospital-based descriptive cross-sectional design involving quantitative methods. The main reason for using this type of research design is that it offers a researcher ease of gathering and assessing data . T he research design is less expensive for a substantial number of hospitals, in this case, have the information within their database. (Olsen, 2010) It will save the researcher time and money that would have been spent in gathering the data Olsen, 2010).
The study participants included all adult cardiovascular patients attending the facility on an outpatient basis. The minimum age for the participants was 45 years old, and the maximum age was 75 . Likewise, the study participants included literate and illiterate adults in this case participants with a bachelor’s degree and those with or without a high school diploma. Fifty cardiovascular patients were carefully chosen for the research using a random selection basis. The aim for this was to ensure that the sample population equally represented the entire adult population making it much easier to generalize the study findings (Antonisamy, Solomon, & Prasanna, 2010). However, patients who were suffering from any psychotic condition, critically ill and unable to communicate with the researcher during data collection due to any other underlying medical condition were excluded .
The data was gathered using a questionnaire, and it consisted of the 8- item , Dr. Kolig medication adherence scale. The instrument was adapted to the study’s set-up and had self-reporting medicating adherence items relating to the use of medicines and significant reasons for non-adherence, which were designed, based on extensive literature reviews of similar studies.
The questionnaire was presented to each respondent, and the purpose and directions were thoroughly explained to ensure there was enough clarity and accuracy as they responded . The respondents were each asked to sign an informed consent form that would ensure that any answer they offered would not be published using their original identities. The participants were each given ample time of 45-60 minutes to go through the questions and offer their response. The researcher carried out data gathering, and he provided any answers to the respondents in case of queries. After the data gathering process was completed , the data was input into the Statistical Package for the Social Sciences (SPSS) version 25 for analysis
Literature Review
Aljefree and Ahmed (2015) state that cardiovascular disease is among the leading causes of disability and mortality in the world. The WHO estimated that there were 17.3 million deaths in 2008 resulting from cardiovascular disorders (Mendi, Puska & Norrving, 2011). However, out of the 17.3 million deaths, heart attacks accounted for 7.3 million while strokes accounted for 6.2 million (Mendi et al., 2011). The Gulf Cooperation Council is comprised of Kuwait, United Arab Emirates, Qatar, Bahrain, and Saudi Arabia and was created in 1981 . Following an increased development of oil-based industries and mining, it has seen the members of nations changing their lifestyles and are now consuming poor dietary foods and living sedentary lives. This has brought about an increased cardiovascular disease rate in the Gulf-based countries over the years that have surpassed those of the developed nations. The number of deaths arising from hypertensive and ischemic heart diseases in Northern Africa, the Middle East including Gulf Cooperation Council countries was115/100,000 and 294/100,000 respectively (Aljefree & Ahmed,2015). The number of disability-adjusted lives resulting from hypertensive and ischemic heart diseases has also risen to 1389/100,000 and 3702/100,000 (Aljefree & Ahmed,2015), In Oman and Kuwait, cardiovascular disease accounted for 49% and 46% of all deaths (Aljefree & Ahmed,2015). The rates were also higher in Qatar, Bahrain, UAE, and Saudi Arabia at 23%, 32%, 38%, and 42% respectively.
The prevalence of acute coronary heart syndrome was higher in males at 77% as compared to women at 23% according to the Saudi Project Assessment of Coronary Events (SPACE) report. Similarly, 32% of the study population suffered from ischemic heart related conditions. The other common risk factor for cardiovascular diseases in the region was diabetes at 56%, being a current smoker at 39% and hyperlipidemia at 31% (AL Habib et al., 2009).
Cardiovascular disease is a preventable cause of death for its risk factors are controllable or preventable. Over the years, the deaths related to cardiovascular disease has been linked to patient non-adherence. This has become a progressively recorded factor through various patient populations all over the globe. According to a meta-analysis of 20 types of research comprising of 376,160 patients, there was a 43% non-adherence rate across variety of drug types as calculated using the pharmacy refill information (Awad, Osman &Altayib, 2017). According to the WHO, this non-adherence is even lower as compared to that of cardiovascular diseases medications in developed nations, which is higher than 50% (Awad et al., 2017) . The outcomes of such non-adherence have been closely linked to poor clinical outcomes such as increased health care expenses and readmissions.
Researches carried out in developed nations have been able to show the link between cardiovascular medication adherence, non-adherence effects, causes of non-adherence and incidence of non-adherence to cardiovascular drugs. However, statistics from developing nations is limited. Few studies conducted in the countries have shown that the incidence of adherence to cardiovascular medication was 57.5% (Awad et al., 2017). This is an indication that there is still a higher rate of non-adherence, 42.5% and this call for intervention from various health agencies and the governments of the developed and developing nations.
According to a study conducted by Patel, Shetty, and Rasras (2015) in Riyadh, Saudi Arabia, they were able to find out that elderly patients tend to have a higher rate of medication non-adherence. The primary reason for this is that the patients suffer from chronic illnesses that require longer therapies. T hus, they lose interest along the way. Hypertension is now the leading case of cardiovascular disease around the globe. A considerable number of older adults have a higher chance of suffering from hypertension. Following their medication non-adherence, hypertension is known to bring about severe and life-threatening complications. One of the primary reasons that patients lose their medication adherence is that they have a minimal awareness of some of these diseases and why one should make sure that the medication is taken .
Patel et al. (2015) conducted a study using eighty-six participants to determine drug adherence and awareness among hypertensive patients in Saudi Arabia. The researcher found out that 52 (60.46%) of the patients were illiterate as they came from nearby villages around Riyadh city. Another 45% (52.3%) were involved in smoking, and they cited this was a means through which they eliminated the tensions and stress related to hypertension (Patel et al., 2015). Similarly, the researchers found out that, the patients receive minimal counseling in the health centers where they access the medication. From this study, it is an indication that illiteracy, lack of patient-physician communication and lifestyle habits lead to non-adherence amongst patients. Other reasons that lead to non-adherence included fear of becoming dependent on the treatment, lack of access to drugs and stores, high cost of medication, fear of side effects and forgetfulness (Patel et al.,2015).
More than one billion people suffered from hypertension in 2000, and the numbers are expected to increase to 1.56 billion by 2025 (Alsolami, Correa-Velez & Hou, 2015). In order to ensure that the harmful impacts of hypertension do not affect individuals , it is vital that a patient makes the necessary follow-up visits and take the prescribed medication until the BP goes below 140/90mmHg (Alsolami et al.,2015). It is evident that taking the medicine is a critical long-term approach to eliminating the ailment. Nonetheless , patients with much lower-adherent behavior will have a higher risk of developing cardiovascular events as compared to those who strictly adhere to the medication dosages and intake time intervals. According to a research conducted in Saudi Arabia, it discovered that 43.7% of the 190 participants believed that their blood pressure could be brought down by adhering to the antihypertensive drugs. This is an indication that 56.3% did not believe in adhering to the medication.
Alsolami et al. (2015) state that an absence of information and knowledge related to the cure of illnesses can lead to non-adherence. This brings about patients having negative beliefs regarding the efficacy of the treatments and end up losing trust in the medication leading to a lower adherence level. On the other hand, some patients might believe that particular medication is harmful to their wellbeing. A considerable number of patients taking antihypertensive medication think that it is harmful as it brings about adverse side effects and this is what has brought about a higher non-adherence amongst cardiovascular patients (Alsolami et al., 2015). A cross-sectional research conducted by Alsolami et al. (2015) involving 308 hypertensive patients aged 18 and above from King Fahad General Hospital in Jeddah City, they found out that the non-adherence rate was 72.1% and while the adherence rate was 27.%. The major causing factors for the high non-adherence rates were poor physician-patient affiliations, the absence of co-morbidities and non-formal education.
According to Alsolami et al. (2015), an excellent patient-physician relationship is crucial for higher medication adherence. Nonetheless, in Saudi Arabia, a considerable number of outpatient clinics’ physicians have little to no contact with their patients. In a majority of cases, medical health students assist the patients, and in case a patient would like to see the general practitioner, they are placed on a waiting list. This is what has contributed to the poor relationships between the two parties thus leading to non-adherence.
In the USA, cardiovascular diseases are among the leading death causes (Altuwairqi, 2016). Some of the risks factors associated with the illness include smoking, dyslipidemia, and hypertension. In Saudi Arabia, there have been few studies on the prevalence of cardiovascular disease though the Saudi Project for Assessment of Coronary Events records office and the Heart Function Assessment office trial have tried to study the prevalence of the illness in the nation. (AL Habib et al., 2009; AL Habib et al., 2011) is carrying them out. Nonetheless, according to the World Health Organization, there are about 338 deaths for every 100,000 people in Saudi Arabia. The adherence to medication plays an essential part in reducing mortality rates of cardiovascular disease. More than 50% of patients in developed nations engage in medication non-adherence, and this continues to become a catastrophic foundation for the patients. According to Elsfar (2014), 19% of hospital admissions resulting from heart failure in tertiary care centers in Saudi Arabia are caused by medical non-adherence.
According to Altuwairqi (2016), he conducted a study to determine the medication non-adherence and the barriers in cardiac patients form King Fahad Medical City Cardiology Clinic. The study involved 278 participants out of which males represented 61.2% and. Participants above 60 years were 37.1% and less than 40 years 16.5%. The males’ adherence rates were 27% while the females were 20.4%. The adherence rate in patients aged 60 and above was 30.5%, 21.3 % of patients 40-49 and 15.2% in patients less than 40 years. The researcher found out that the residence of a patient did not have any impact on their adherence rates. However, smoking was closely linked to low adherence rates .
Moreover , the study found out that a substantial number of the patients had positive beliefs about medication and an awareness of their disease. The high rates on non-adherence were linked to forgetfulness by more than 50% of the participants. The number of far appointments and pills also contributed towards non-adherence. Altuwairqi (2016) concluded that medication non-adherence is not only affecting patients and a burden to the health care system in Saudi Arabia but globally.
Mohammed Al Ghobain et al., (2016) carried out a research at the King Abdul-Aziz Medical City, Riyadh, Saudi Arabia to determine the extent of non-adherence among hypertensive patients and the resulting risk factors. Increased rates of non-adherence to hypertension drugs leads to the emergence of uncontrolled blood pressure. For any patient to become considered as being adherent, he/she must take more than 80% of all prescribed medication (Morrison, Stauffer & Kaufman, 2015). The study involved 302 participants whereby 64% represented females and 36% males. The participants’ mean age was 64 years, and 64% were illiterate (Mohammed Al Ghobain et al., 2016). From the study, about 80% of the participants had poor disease knowledge while another 66% had poor disease monitoring. From the study, the factors that lead to an increased non-adherence rate amongst patients was uncontrolled blood pressure, inadequate monitoring and young age. The high rates of poor disease knowledge result from the high illiteracy rates amongst the patients. Sixty-four percent of the participants could not read or write (Mohammed Al Ghobain et al., 2016). This is an indication that it is an important characteristic that deserves special attention. The risk factors resulting from non-adherence is higher readmission rates, higher disease costs, and disease progression.
Work Plan
| Start Date | End Date | Criteria | Remarks |
| February 2019 | March 2019 | Approval of Protocol | Liaise with Supervisor |
| March 2019 | April 2019 | Collection of Data | Resources, Interviews, Inspections and literature review |
| April 2019 | May 2019 | Tabulate Results | Data Entry |
| May 2019 | June 2019 | 1 st Project Draft | Liaise with Supervisor |
| June 2019 | July 2019 | Final Project Draft | Liaise with Supervisor |
| August 2019 | September 2019 | Submission of final project | Nil |
Results
Fifty patients were found to be eligible for the entire study. Out of the total participants, 64% (32) were males while 36% (18) were females. According to the participants, when asked how many days in a week they did not ask medication, 20 (9 males and 11 women adhered to the drug ). However, the reaming participants showed some form of on-adherence with 13 patients (10 males and three females) missing one day, 15 patients (11 males and four females) missing two days and two patients (2 males ) missing three days. The statistics are highlighted in the graph one below;
Graph 1
When asked, “Does your doctor, pharmacist or nurse explain drugs before dispensing to you?” Forty-nine patients (32 males and 17 females) stated yes while one patient (1 female) stated no). When a sked whether “do you know your prescribed medication?’ Fifty participants (32 males and 18 females) stated yes. The participants were also divided into two groups in relation to their employment status; employee and retired.SA seven parameters were used to determine the reasons for non-adherence to medication is highlighted in graph 2 below;
Graph 2
According to two participants (1 employed and one retired), they indicated that they had just forgotten . Nonetheless , 13 participants (8 employees and five retired) stated that they had forgotten, wanted to avoid the drugs side effects, drugs were not dispensed, or they were not in the house during the drug taking time. Six participants (5 employees and one retired) indicated they forgot to take the drugs yet they were in the house in the drug taking time. This was similar to participants who forgot to take drugs ; doctors changed their prescriptions many times and were in the house during the drug taking time. However, only one participant from each of the two groups gave the following reasons; forgot to take drugs , wanted to avoid drugs side effects and was not in the house during the drug-taking time and doctor-changed drug a lot and desire to avoid side effects. From the above results, it shows that a high number of patients engage in no-adherence due to various reasons with the most common one being a desire to avoid side effects and mere ignorance.
Discussion
The effectiveness and efficiency of any medication is highly dependent on the adherence rate of the patient. Cardiovascular diseases have been known to have adverse long-term outcomes in patients. This ash brought about increased research into the drugs and other therapies that can be used in eliminating the adverse results . However, despite there being good emd8ications, the adherence rates of cardiovascular patients have continued to dwindle over the years. In Saudi Arabia, the medication adherence rate was found out to be less than 30% according to a study by Altuwairqi (2016). This is an indication that the non-adherence rate across all populations regardless of their age was 70%. Various researches have been carried out to determine the multiple reasons for medication non-adherence. Some of the results include; losing interest along the way, minimal awareness of the diseases, poor communication between patient and physician, illiteracy and absence of co-morbidities (Alsolami et al., 2015; Patel et al., 2015; Awad et al., 2017). In my study, it found out that there are various reasons that a patient becomes non-adherent. Some of these reasons include fear of side effects, ignorance, and lack of physician-patient communication, frequent medication changes, and poor medication schedule .
However, the most cited reason for medication non-adherence is the fear of side effects. This was found in more than 50% of the participants based on their employment status (employed and retired) . This result of the study was similar to the results from a survey by (Alsolami et al. (2015) who found out that the non-adherence rate amongst hypertensive patients was 72.1% as compared to 27.9% adherence rate form a total of 308 hypertensive patients. The primary reason the patients cited for non-adherence that they believed taking antihypertensive medication to think that it is harmful as it brings about adverse side effects. From the study, it found out that 99% of the patients highlighted having been informed by the physician, nurse or doctor about their medication. This is an indication that despite having an awareness of their medicine , the patients still become non-adherent. This is an indication that an excellent physician and patient communication does not play any role in medication adherence as described in the study by Patel et al. (2015). Therefore, the study found out that patient beliefs, perceptions, attitudes, and values play a vital role in medication adherence. This is similar to the studies by (Awad et al., 2017; Alsolami et al., 2015; Mohammed Al Ghobain et al., 2016).
Use of Results
Patients suffering from chronic illness have been seen to have higher medication non-adherence rates. This leaves them at higher risks of developing more complications, disease progression, and ever-ballooning healthcare expenditure . However, through this research, its findings will be used in;
Educating patients about what to expect
The invention of new therapies indicates that patient health outcomes will be significantly improved . Nonetheless , the physicians have not prepared the patient on all potential issues related to the intended drugs. Some patients may end up taking the drugs when they start feeling better yet the dosage is not completed . Additionally, in case the patient feels worse, he/she may also discontinue taking the medication. However, with the results of the study, it will open the physician's eyes on why there is a need to educate the patient on the medications they take thus boosting adherence rates.
Government Policies
It is also up to the government to set up policies that will boost medication adherence. As seen from the results, a considerable percentage of cardiovascular disease patients do not take their medication, and this affects the nation regarding additional health budgets and patients’ families. The results will act as a wakeup call for the government to start working with various stakeholders such as health care professionals, pharmaceutical companies, insurance companies, not-for-profit organizations, and consumer groups. The improvement of medication adherence is critical to the sustainability and operational growth of Saudi Arabia. The government can set up initiatives and incentives that boost medication adherence. This is by setting laws that eliminate the barriers to medication such as ratifying new health bills or formulating a Refill and save a program that will see patients who seek medication refill after completion get some incentives such as cash prizes or rewarding patients with gift cards.
Customization of Support Tools
The results can also be used in helping patients to tailor their support tools as per their needs. This is by having a comprehension of the various tools used in adherence and how they can be positioned to meet patient needs and wants. This can involve downloading special applications on their phone that will act as a reminder for taking medication or use a daily pillbox. In the end, this will see the patient being fully adherent to their prescribed medication without the tools, as they will have adopted the various tool practices as part of their day-to-day life activities.
Research Structure
Chapter 1 will focus on a brief outline of the entire research. It will include the research background/introduction, research problems, research significance, and research objectives.
Chapter 2 will constitute of the literature review section. In this chapter, it will have extensive use of secondary sources from various journal sites, google books; government records international agency records, etc. The views of other authors and researchers regarding the study topic will be outlined in this chapter in a clear and logical manner.
Chapter 3 will comprise the methods section. This is the most critical section of the entire research process for it explains the research processes engaged by the researcher. It will contain the research design used, the implementation and choice of data gathering technique and the reason for the use, the sampling process for selecting respondents, and the various ethical considerations to be observed by the research.
Chapter 4 will consist of the primary data presentation process collected via a selected data gathering technique. This will also have the data analysis tool used in manipulating and tabulating the data gathered.
Chapter 5 will comprise of the discussion and analysis sections. This chapter highlights the research objectives and determines whether they have been achieved . In this chapter, the primary research findings will be compared with the literature review. An in-depth discussion of the results will also be provided in this section.
Chapter 6 will include the summaries and conclusions of the research. This will also highlight various limitation encountered by the study and highlight scope for future research in the same study area.
Conclusion
Medical non-adherence is a global problem and one of greatest threats to public health. It is estimated that medical non-adherence in treatments used in preventing and managing chronic illnesses is 50%. This is life threatening given the fact that chronic illnesses are on the rise because of the poor lifestyle habits that people have chosen to live. Non-adherence to medication results in increased disease progression rates, higher rates of hospital read-missions, and affects the families of the patients. Medical non-adherence should not be ignored in terms of economic damages, public health status and the resulting ballooning health care costs. Better medical adherence will lead to a more improved quality of life and prevent many other adverse outcome associated with non-adherence. It is high time the federal government reconstructs the healthcare organizations by passing policies, rules and regulations that will support medication adherence. This is by ensuring that there is a platform that support better relationships between the doctor and patient. The healthcare organization should also ensure they have educational and awareness programs that will help in changing patient beliefs, values and culture. As evidenced from the study, these core factors lead to medication non-adherence in patients suffering from cardio-vascular diseases. However, other factors that can contribute to medication non-adherence in cardiovascular patients includes lack of access to drugs and stores, high cost of medication, fear of side effects and forgetfulness. By increasing medication adherence in cardiovascular patients, it will help in reducing the more than 17 million deaths caused by the illness. Correspondingly, it will reduce the incidence of the disease in Saudi Arabia as it account or 46% of all deaths. Moreover, it will eliminate other deaths resulting from cardiovascular risk factors.
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