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HOME > J Prev Med Public Health > Volume 56(6); 2023 > Article
Original Article Multilevel Analysis of the Relationship Between Prescribing Institutions and Medication Adherence Among Patients With Hypertension and Diabetes in Korea
Haryeom Ghang1,2corresp_iconorcid , Juhyang Lee1,3orcid
Journal of Preventive Medicine and Public Health 2023;56(6):504-514
Published online: October 5, 2023
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1Health Insurance Research Institute, National Health Insurance Service, Wonju, Korea
2Graduate School of Public Administration, Seoul National University, Seoul, Korea
3Graduate School of Public Health, Seoul National University, Seoul, Korea
Corresponding author:  Haryeom Ghang,
Received: 1 June 2023   • Revised: 15 September 2023   • Accepted: 19 September 2023

This study investigated the relationship between prescribing institutions and medication adherence among patients newly diagnosed with hypertension and diabetes.
This study investigated patients with new prescriptions for hypertension and diabetes in Korea in 2019 with using data collected from general health screenings. A multilevel logistic regression model was applied to explore the relationship between patients’ first prescribing institution and their medication adherence, defined as a medication possession ratio (MPR) over 80%.
The overall adherence rates were 53.7% and 56.0% among patients with hypertension and diabetes, respectively. The intraclass correlation coefficients were 13.2% for hypertension and 13.8% for diabetes (p<0.001), implying that the first prescribing institution had a significant role in medication adherence. With clinics as the reference group, all other types of hospitals showed an odds ratio (OR) less than 1.00, with the lowest for tertiary hospitals (OR, 0.30 for hypertension; 0.45 for diabetes), and the next lowest in health screening specialized clinics (OR, 0.51 for hypertension; 0.46 for diabetes). Among individual-level variables, female sex, older age, higher insurance premium level, and residing in cities were positively associated with adherence in both the hypertension and diabetes samples.
This study showed that the prescribing institution had a significant relationship with medication adherence. When the first prescribing institution was a clinic, newly diagnosed patients were more likely to adhere to their medication. These results highlight the important role played by primary care institutions in managing mild chronic diseases.

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JPMPH : Journal of Preventive Medicine and Public Health