Assessment of Medication Regimen Complexity and Adherence in Chronic Obstructive Pulmonary Disease Patients at a Tertiary Care Teaching Hospital
- 1Department of Pharmacy CiST College Pokhara University Kathmandu Nepal
- 2Pharmacist, Himmat Medical Hall, Kathmandu, Nepal Kathmandu Nepal
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Medication regimen complexity and poor adherence are major barriers to optimal management, yet limited evidence exists in Nepal. This study aimed to assess medication regimen complexity and adherence among COPD patients attending a tertiary care hospital in Nepal.
Methods: A hospital‐based cross‐sectional study was conducted from November 2023 to May 2024 at a tertiary care teaching hospital in Nepal. A total of 174 COPD patients aged ≥40 years were enrolled using convenience sampling. Medication regimen complexity was assessed using the validated 65‐item Medication Regimen Complexity Index (MRCI), and adherence was evaluated with the Nepali version of the Morisky Medication Adherence Scale (MMAS‐8). Pearson's chi‐square test and binary logistic regression were performed at a 5% level of significance to examine factors associated with medication nonadherence.
Results: Of the total, 46.6% demonstrated suboptimal adherence, strongly associated with smoking (adjusted odds ratios [aOR]: 7.5; 95% CI: 2.82–19.90; p < 0.001) and alcohol use (aOR: 3.66; 95% CI: 1.578–8.49; p = 0.003). COPD regimens exhibited higher complexity (mean MRCI: 10.296 ± 5.4) than non‐COPD medications (3.66 ± 3.478). High COPD MRCI (aOR: 25.8; 95% CI: 14.7–38.5; p = 0.03) and high patient‐level MRCI (aOR: 15.6; 95% CI: 6.7–33.9; p < 0.001) were significant predictors of nonadherence.
Conclusion: COPD‐specific regimens were found to be more complex, and higher regimen complexity together with lifestyle factors, such as smoking and alcohol consumption, were strong determinants of nonadherence. Simplifying regimens through fixed‐dose combinations, pharmacist‐led interventions, and behavioral counseling may improve medication adherence and treatment outcomes in COPD patients.
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BibTeX
@article{bhandari2026assessment,
title = {{Assessment of Medication Regimen Complexity and Adherence in Chronic Obstructive Pulmonary Disease Patients at a Tertiary Care Teaching Hospital}},
author = {Kabita Bhandari and Nirmal Raj Marasine and Chakra Dev Bist and Poonam Pant},
journal = {Public Health Challenges},
year = {2026},
month = nov,
doi = {10.1002/puh2.70449},
url = {https://doi.org/10.1002/puh2.70449},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Assessment of Medication Regimen Complexity and Adherence in Chronic Obstructive Pulmonary Disease Patients at a Tertiary Care Teaching Hospital
AU - Kabita Bhandari
AU - Nirmal Raj Marasine
AU - Chakra Dev Bist
AU - Poonam Pant
PY - 2026
DA - 2026/11/07
JO - Public Health Challenges
DO - 10.1002/puh2.70449
UR - https://doi.org/10.1002/puh2.70449
AB - Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Medication regimen complexity and poor adherence are major barriers to optimal management, yet limited evidence exists in Nepal. This study aimed to assess medication regimen complexity and adherence among COPD patients attending a tertiary care hospital in Nepal. Methods: A hospital‐based cross‐sectional study was conducted from November 2023 to May 2024 at a tertiary care teaching hospital in Nepal. A total of 174 COPD patients aged ≥40 years were enrolled using convenience sampling. Medication regimen complexity was assessed using the validated 65‐item Medication Regimen Complexity Index (MRCI), and adherence was evaluated with the Nepali version of the Morisky Medication Adherence Scale (MMAS‐8). Pearson's chi‐square test and binary logistic regression were performed at a 5% level of significance to examine factors associated with medication nonadherence. Results: Of the total, 46.6% demonstrated suboptimal adherence, strongly associated with smoking (adjusted odds ratios [aOR]: 7.5; 95% CI: 2.82–19.90; p < 0.001) and alcohol use (aOR: 3.66; 95% CI: 1.578–8.49; p = 0.003). COPD regimens exhibited higher complexity (mean MRCI: 10.296 ± 5.4) than non‐COPD medications (3.66 ± 3.478). High COPD MRCI (aOR: 25.8; 95% CI: 14.7–38.5; p = 0.03) and high patient‐level MRCI (aOR: 15.6; 95% CI: 6.7–33.9; p < 0.001) were significant predictors of nonadherence. Conclusion: COPD‐specific regimens were found to be more complex, and higher regimen complexity together with lifestyle factors, such as smoking and alcohol consumption, were strong determinants of nonadherence. Simplifying regimens through fixed‐dose combinations, pharmacist‐led interventions, and behavioral counseling may improve medication adherence and treatment outcomes in COPD patients.
SN - 2769-2450
ER -