PIH29 - Patient-Centered Reasons for Primary Non-Adherence as Derived from the Peer-Reviewed Literature

Abstract

Primary non-adherence (PNA) has been found to range from 1% to 57% with a mean and median of 16.4% and 15.0%, respectively. We abstracted patient-centered reasons for PNA and their prevalence from the peer-reviewed literature. A systematic review using PubMed was conducted. A backward search of each abstracted article was performed as well as a review of each abstracted article’s reference list. Patient-provided reasons for PNA were abstracted from each reviewed article A total of 131 articles met search-term criteria, and 19 contained patient-provided reasons for PNA. Eleven additional articles were identified from backward citation searches and/or review of the 19 article’s reference list for a total of 30 studies. Fifty unique reasons for PNA were abstracted. After qualitative analysis, they were reduced to seven mutually-exclusive reasons. Prescription-medication affordability was the most common reason for PNA (80% of studies), followed by lack of perceived need for the medication (67% of studies), perceived medication concerns (53% of studies), lack of perceived drug efficacy (33% of studies), forgetfulness (33% of studies), access barriers (33% of studies), and patient knowledge (27% of studies). PNA is common both. Few adherence interventions have been developed and evaluated for PNA. The first step in developing adherence interventions for PNA is to gain an understanding of patient-centered reasons for PNA. This review identified the seven foremost reasons for PNA from 30 published studies. These seven reasons were: prescription-medication affordability, lack of perceived need for the medication, perceived medication concerns, lack of perceived drug efficacy, forgetfulness, access barriers, and patient knowledge. Researchers should standardize the content of PNA reasons to facilitate comparisons across patient samples. Many of the reasons for PNA can be addressed with patient-centered counselling at the time of prescribing. If we are to reduce PNA, doctor-patient communication must be improved to address patients beliefs about the need for the medication and their concerns about it.