Abstract
BackgroundIn the United States, more than 25 million people have diabetes. Medication adherence is known to be important for disease control. However, factors that consistently predict medication adherence are unclear and the literature lacks patient perspectives on how health care systems affect adherence to oral hypoglycemic agents (OHAs). This study explored facilitators and barriers to OHA adherence by obtaining the perspectives of Veterans Affairs (VA) patients with OHA prescriptions.MethodsA total of 45 patients participated in 12 focus groups that explored a wide range of issues that might affect medication adherence. Participants were patients at clinics in Seattle, Washington; San Antonio, Texas; Portland, Oregon; Salem, Oregon, and Warrenton, Oregon.ResultsKey system-level facilitators of OHA adherence included good overall pharmacy service and several specific mechanisms for ordering and delivering medications (automated phone refill service, Web-based prescription ordering), as well as providing pillboxes and printed lists of current medications to patients. Barriers mirrored many of the facilitators. Poor pharmacy service quality and difficulty coordinating multiple prescriptions emerged as key barriers.ConclusionsVA patient focus groups provided insights on how care delivery systems can encourage diabetes medication adherence by minimizing the barriers and enhancing the facilitators at both the patient and system levels. Major system-level factors that facilitated adherence were overall pharmacy service quality, availability of multiple systems for reordering medications, having a person to call when questions arose, counseling about the importance of adherence and providing tools such as pillboxes and updated medication lists.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0533-1) contains supplementary material, which is available to authorized users.
Highlights
In the United States, more than 25 million people have diabetes
A few qualitative studies have focused on diabetes medication adherence; their findings are generally consistent with the larger body of qualitative work on overall diabetes selfmanagement [21,22,23,24,25]
Our study examined the experiences and perspectives of Veterans Affairs (VA) patients who take oral hypoglycemic agent (OHA) to elicit organizational facilitators and barriers that contribute to their medication adherence
Summary
In the United States, more than 25 million people have diabetes. Medication adherence is known to be important for disease control. Factors that consistently predict medication adherence are unclear and the literature lacks patient perspectives on how health care systems affect adherence to oral hypoglycemic agents (OHAs). This study explored facilitators and barriers to OHA adherence by obtaining the perspectives of Veterans Affairs (VA) patients with OHA prescriptions. Within the Veterans Affairs (VA) health care system, diabetes is even more common, affecting 25% of VA patients in 2010 [1]. Successful management of this complex disease requires a long-term and multipronged approach. A few qualitative studies have focused on diabetes medication adherence; their findings are generally consistent with the larger body of qualitative work on overall diabetes selfmanagement [21,22,23,24,25]
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