Beruflich Dokumente
Kultur Dokumente
Title:
:Summary
Rational
Because of recent media attention on epidemics in developing countries,
there is an assumption that relatively low-income levels lead to conditions
that promote communicable diseases and allow easily preventable
diseases to persist. However, in Jordan, it is economic growth that has
contributed to a public health crisis, but in chronic, not communicable,
disease. Communicable disease rates in Jordan are low even in
comparison with many developed countries. [1] High vaccination rates
have reduced and eliminated many easily preventable diseases. [2]
However, chronic disease rates have been steadily rising. As a result, the
leading cause of mortality in Jordan is chronic disease. [3] In part, Jordan
has been a victim of its own success. Increased prosperity has brought
electricity, tap water, television and transportation into the home, leading
to a decrease in physical activity. [4] Mechanized agriculture has made
food cheap and abundant. Diets that are oftentimes low in fruits and
vegetables and high in fats and starches have exacerbated the problem.
[5] Obesity, defined as having a body mass index (BMI) over 30, has a
prevalence of nearly 50%. [6] Even improved health care has exacerbated
the problem; as people live longer, the likelihood of chronic disease
increases. [7] For these reasons, chronic disease rates are predicted to
continue on an upward trend. [8] The growth in diabetes rates, oftentimes
thought of as a rich country disease, has been particularly alarming.
From 2002 to 2004, the reported rate of diagnosed diabetes climbed from
6.3% to 7.4%. [9] Current total estimates range from 16% to 30%
depending on the age range and defined glucose levels. [10] The
prevalence of diabetes in Jordan constitutes not only the highest in the
region, but also one of the highest in the world.[11] A Finnish study
estimated that Type 2 diabetes, most commonly known as adult onset, can
be prevented in 58% of cases; [12] a startling statistic indicating the need
for action.
The population explosion and resulting demographic transition currently
underway in Jordan contribute to the sense of urgency surrounding
diabetes. High natural population growth rates mean that a large portion
of the population is young, signaling a future crisis should the cultural
issues identified above not be addressed. According to the Population
Reference Bureaus mid- 2007 statistics, 37% of Jordans total 5.7 million
Dr. Ala Ahmad Shannaq
Research Proposal
1 | Page
Non-adherence and contributing factors for patient's in the outpatient
setting with anti-diabetic medications in public hospital.
Tokyo Medical and Dental University, Japan
Objectives
The objective of this study is to measure the relation between nonadherence among diabetic patients attending the diabetic clinic in
Jordanian Public Hospitals and certain proposed factors.
Methods
This descriptive cross-sectional study is to be conducted among
patients with DM attending the DM clinic of public Referral Hospitals.
One out of every three patients will be selected to collect their data
and in particular their adherence to medication using a structured
survey. The analysis will be through SPSS-16.
Background
The occurrence of DM is growing rapidly worldwide and it is becoming
epidemic.
follow-ups are the main factors observed in poor glycemic control. Nonadherence to prescribed medication plan is a major problem worldwide.
In previous studies, it was found that adherence to diabetes treatment
generally to be suboptimal ranging (23%77%) [14]
There is a need to regularly check the reasons for non-adherence
among patients with diabetes in clinical practice. This is very important
in developing countries in particular, such as Jordan, where poor
economy and lack of proper awareness lead to the increased
occurrence of medication non-adherence. In resource-limited countries
like Jordan, poor economy and lack of awareness lead to the increased
occurrence of medication non-adherence. To the best of our knowledge,
evidence-based research that evaluates medication adherence among
patients with diabetes in Jordanian public hospitals.
Additionally, the following points is to be considered:
1. Extensive studies are usually done in developed countries,
accordingly, some important factors that are restricted to a
country like Jordan are not taken into consideration.
2. Few studies on anti-diabetic medication adherence have been
reported from Jordan.
Objectives
General Objective:
The objective of this study is to measure the relation between nonadherence among diabetic patients attending the diabetic clinic in
Jordanian Public Hospitals and certain proposed factors.
Specific Objective:
The specific objectives are as follows:
1. To assess adherence
patients with diabetes;
to
medication
among
ambulatory
Methodology
Study Design
A proposed cross-sectional study is to be conducted at the
ambulatory diabetic clinic of public hospitals in Jordan.
Study Setting/ Data Collection
Study the samples of all diabetic patients receiving anti-diabetic
medication in the ambulatory diabetic clinic during the study period,
in five Jordanian Public Hospitals in deferent cities in Jordan.
Study Population
Source population is diabetic patients being treated at five public
Hospitals in Jordan, there is no available formal statistics from the
Ministry of Health (MOH). But the expected number from the
Medical records from the 5 hospitals will be more than 5000 diabetic
patients.
Sample Size
The sample size will be calculated using single population proportion
formula as follows:
Sampling Method
A systematic random sampling technique will as used.
Inclusion criteria
Include ambulatory patients who
1. Are on anti-diabetic medications for more than six months;
2. Consented to participating in the study;
3. Will attend the diabetic clinic during the study period.
Exclusion Criteria
Exclusion criteria are as follows:
1. Unconscious patients;
2. Patient age less than 18 years;
3. Very ill patients.
References
1. World Health Organization, Global Health Atlas,
http://www.who.int/GlobalAtlas/
2. World Health Organization, WHO vaccine preventable diseases:
monitoring system, 2007 summary,
http://whqlibdoc.who.int/hq/2007/WHO_IVB_2007_eng.pdf,
3. Meyasser Zindah, et al., Obesity and Diabetes in Jordan, Findings
From the Behavioral Risk Factor Surveillance System, 2004,
Preventing Chronic Disease Public Health Research, Practice and
Policy 5, no. 1. Academic Search via Search Tools,
http://searchtools.lib.umich.edu
4. K. Ajlouni, H. Jaddou, H. and A. Batieha, Obesity in Jordan,
International Journal of Obesity, no. 22 (1998): 627. Academic
Search via Search Tools, http://searchtools.lib.umich.edu.
5. Ibid
6. Ibid
7. Laeth S. Nasir and Arwa K. Nasir, Introducing Arabic language
patient education materials in Jordan, Patient Education and
Counseling, no. 60 (2006): 144. Academic Search via Search Tools,
http://searchtools.lib.umich.edu.
8. Centers for Disease Control and Prevention, Assessing Risk Factors
for Chronic Disease Jordan, 2004,
http://www.cdc.gov/mmwR/preview/mmwrhtml/mm5523a3.htm
9. Centers for Disease Control and Prevention, Assessing Risk Factors
for Chronic Disease Jordan,
Dr. Ala Ahmad Shannaq
Research Proposal
5 | Page
Non-adherence and contributing factors for patient's in the outpatient
setting with anti-diabetic medications in public hospital.
Tokyo Medical and Dental University, Japan
2004,http://www.cdc.gov/mmwR/preview/mmwrhtml/mm5523a3.ht
m
10.Estimate provided by National Center for Diabetes, Endocrinology
and Genetic Diseases.
11.K. Ajlouni, et. al. Diabetes and impaired glucose tolerance in
Jordan: prevalence and associated risk factors, Journal of Internal
Medicine October 1998; 244: 4, pg. 320.
12.J. Tuomilehto J, et al., Prevention of type 2 diabetes mellitus by
changes in lifestyle among subjects with impaired glucose
tolerance, N Engl J Med 2001; 344: 1343.
13.Population Reference Bureau: Statistic on Jordan.
http://www.prb.org/Countries/Jordan.aspx