Abstract
Introduction: Patients with multimorbidity are expected to adhere to complex medication regimens in order to manage their multiple chronic conditions. It has been reported the likelihood of adherence decreases as patients are prescribed more medications. Much medication adherence research to date is dominated by a single-disease focus, which is at odds with the rising prevalence of multimorbidity and may artificially underestimate the complexity of managing chronic illness. This review aims to describe the prevalence of medication non-adherence among patients with multimorbidity, and to identify potential predictors of non-adherence in this population. Methods: A systematic review will be conducted and reported according to PRISMA guidelines. PubMed, EMBASE, CINAHL and PsycINFO will be searched using a predefined search strategy from 2009-2019. Quantitative studies will be considered eligible for review if prevalence of medication non-adherence among adults with two or more chronic conditions is reported. Studies will be included in the review if available in English full text. Titles and abstracts will be screened by single review, with 20% of screening cross-checked by a second reviewer. Full-text articles will be screened by two independent reviewers, noting reasons for exclusions. Data extraction will be performed using a predefined extraction form. Quality and risk of bias assessment will be conducted using criteria for observational studies outlined by Sanderson et al. (2007). A narrative synthesis and, if feasible, meta-analysis will be conducted. Discussion: By exploring medication non-adherence from a multimorbidity perspective, the review aims to inform an evidence base for intervention development which accounts for the rising prevalence of patients with multiple chronic conditions. Study registration: The systematic review is prospectively registered in PROSPERO ( CRD42019133849); registered on 12 June 2019.
Highlights
Patients with multimorbidity are expected to adhere to complex medication regimens in order to manage their multiple chronic conditions
One existing systematic review has evaluated medication adherence in older adults with polypharmacy, a phenomenon closely associated with multimorbidity (Zelko et al, 2016)
Understanding non-adherence to prescribed medications among patients with multiple chronic conditions will provide insight which goes beyond the single-disease focus currently dominating adherence research
Summary
In the context of multiple conditions, the likelihood of medication non-adherence increases as patients are prescribed more medications (Benner et al, 2009), with associated risks to health outcomes (DiMatteo et al, 2002). One existing systematic review has evaluated medication adherence in older adults with polypharmacy, a phenomenon closely associated with multimorbidity (Zelko et al, 2016) They cite caregiver burden, impaired hearing, poor cognition and greater number of drugs as predictors of non-adherence in that population (Zelko et al, 2016). Quantitative studies have reported prevalence rates and predictors of medication non-adherence in adult patients with two or more chronic conditions, to our knowledge no synthesis of this evidence exists to date. Understanding non-adherence to prescribed medications among patients with multiple chronic conditions will provide insight which goes beyond the single-disease focus currently dominating adherence research. Is the method of medication adherence measurement a moderator of non-adherence estimates in multimorbidity?
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