Medication-taking Behavior Research Articles

Enablers and barriers affecting medication-taking behaviour in aging men with benign prostatic hyperplasia

Objectives: To identify the enablers and barriers affecting medication-taking behaviour in aging men with benign prostatic hyperplasia.Methods: A total of 40 patients attending the urology outpatient clinic in Melbourne in 2012 were screened. Patients who successfully met the inclusion criteria were interviewed using a structured interview schedule. Information regarding the patient’s medication, demographic data and presence of co-morbidities was collected. Content analysis was compared with patient demographic and medical data, contributing to the analysis.Results: Problems with medication-taking were reported in 58% of patients. All patients without co-morbidities reported issues regarding their medications, whereas only 27% of patients with co-morbidities reported concerns regarding their medications. Statistical analysis revealed that patients without co-morbidities were significantly more likely (p = 0.002) to have complaints with their medications compared to those with co-morbidities. Furthermore, patients with co-morbidities who required help of caregivers to assist with their medication-taking were significantly less likely (p = 0.05) to have complaints with their medications compared to patients who self-managed.Conclusions: Older patients with caregivers who assisted managing their medication-taking had better adherence. Those receiving aid from their caregivers were significantly less likely to have complaints regarding their medications as opposed to those not requiring a caregiver. This highlights the importance of having support for medication-taking in patients with co-morbidities to assist with better adherence.

Improving adherence in paediatric respiratory disease

<h3>Educational aims</h3> To review the evidence on determinants of adherence in children with chronic respiratory disease. To discuss the “common sense model” as a method to understand medication-taking behaviour in children. To review the importance of illness perceptions and medication beliefs in determining adherence to maintenance medication in children with chronic respiratory disease. To present recommendations to optimise adherence through enhancing involvement of patients and parents in consultations of children with chronic respiratory disease. <h3>Summary</h3> In children with chronic respiratory disease, nonadherence to maintenance medication is common. Observational studies, however, show that good adherence can be achieved and maintained. This review will discuss the current state of the evidence on adherence and its determinants in children with chronic respiratory disease. It will highlight the importance of illness perceptions and medication beliefs as strong drivers of adherence, based on the common sense model of how people deal with a chronic illness. Exploring such cognitions by interested enquiry of the patient9s perspective will help the clinician to identify and overcome barriers to adherence. When decisions on treatment are made according to the principle of shared decision making, concordance between patient and healthcare provider is aided, which improves adherence.

Atrial fibrillation and the 'other drug problem': reducing non-adherence with technology

The terms compliance, adherence, concordance, and persistence are used to characterize important aspects of medication-taking behaviour. According to the International Society for Pharmacoeconomics and Outcomes Research Medication Compliance and Persistence Work Group, medication compliance (or adherence) is defined as ‘the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen’; while medication persistence is ‘the duration of time from initiation to discontinuation of therapy’.1 The medical profession is well aware that non-adherence to recommended medications represents a worldwide problem, encompassing a large variety of illnesses, treatments, and age groups. Non-adherence leads to worrying consequences, for patients, health professionals, and healthcare systems. According to the World Health Organization (WHO), almost 50% of patients do not take medications as prescribed,2 and evidence shows that non-compliance with medications leads to an inadequate control of the illness, placing patients at a higher risk for complications and adverse outcomes.3–5 Expenditure on direct and indirect consequences of non-adherence to treatment (e.g. hospital admissions, underutilized drugs, and disease progression) represents a substantial burden for healthcare systems.6 Indeed, in 2003 the WHO called for initiatives to improve adherence in chronic conditions, claiming that ‘increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatment’.2 Non-adherence is a frequent phenomenon: approximately only one-third of patients fully comply with prescribed treatment.6 For long-term therapies, adherence begins to decline within the first 10 days. Clinical and economic consequences are huge: in the USA 43% of the general population, 55% of the elderly, and 54% of teenagers are not compliant with their treatment causing 10–25% of hospital and nursing home admissions as well as 125 000 deaths annually. The costs for the …

Using patient-reported measurement to pave the path towards personalized medicine

Given the potential and importance of personalized or individualized medicine for health care delivery and its effects on patients' quality of life, a plenary session was devoted to personalized medicine during the 19th Annual Conference of the International Society for Quality of Life Research held in October 2012 in Budapest, Hungary. This paper summarizes the three presentations and discusses their implications for quality-of-life research. Reviews of the literature and presentation of empirical studies. Personalized screening for breast cancer. To individualize screening and only target those women with an increased risk for breast cancer, researchers at the Karolinska Institutet in Stockholm perform a large population-based study to identify high-risk women based on lifestyle, genetics, mammographic morphology, and other markers as well as quality of life. Personalized support for treatment adherence. Inclusion of a simple, brief adherence measure into the clinical visit has demonstrated significant improvement in medication-taking behaviour and resultant improvement in health status. Personalized diagnosis of mental disorders. The DSM-5, the current manual for mental disorders, contains patient-based symptom and diagnosis severity measures that allow more individualized diagnosis than was hitherto possible. Personalized medicine will continue to be increasingly applied and holds the potential to improve health outcomes including quality of life. At the same time, it will invite a host of new ethical, practical, and psychosocial questions. Further reflection and discussion of how our field can embrace and address these emerging challenges is needed.

Expanding the Framework of Assessing Adherence and Medication-Taking Behavior

ABSTRACTThis analysis critiques recently published concepts of medication adherence assessment and elucidates the importance of finding new measures of adherence. Improving concepts and methods of adherence assessment is key to improving adherence outcomes. It proposes a new framework that contains more inclusive concepts and more standardized terminology. These new concepts and terms not only describe adherence and its specific measures in more detail, but also describe all medication-taking behavior. It argues for the integration of and measurement of behavior associated with specific dose times, types, or schedules. Last, it describes promising research enabled by the new framework that, if implemented, might lead to improved adherence.

Preventing Prescription Opioid Overdose Deaths

Preventing Prescription Opioid Overdose Deaths

Medication adherence issues in patients: focus on cost

Correspondence: Doreen Matsui Children’s Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6C 2V5 Canada, Tel +1 519 685 8268 Fax +1 519 684 8156 Email dmatsui@uwo.ca Abstract: Advances in drug therapy have resulted in efficacious treatments being available; however, the benefit may be lost if prescribed medications are not taken properly. Unfortunately, poor medication adherence is common and widespread, affecting all age groups and disease conditions. Adherence is a factor in health outcomes of pharmacotherapy with possible failure to achieve therapeutic goals and worsening of illness. Higher health care costs may result from more frequent physician and emergency department visits and increased hospitalization rates. The cost of medications may play a role in whether patients do or do not take their medication with increased cost sharing leading to poorer adherence with prescription drugs. Given the possible adverse consequences of nonadherence, interventions to improve medication-taking behavior are encouraged although not consistently successful. Surprisingly, there is relatively little information on the cost-effectiveness of these interventions and more methodologically sound research is needed in this area. Alternative strategies that have been proposed are valuebased insurance design and the use of financial incentives, although the former has not been widely accepted, and the latter is ethically controversial. This article reviews some of the main issues with regards to adherence with drug therapy including some of the cost implications of less than optimal medication adherence.

Smartphone medication adherence apps: Potential benefits to patients and providers

To provide an overview of medication adherence, discuss the potential for smartphone medication adherence applications (adherence apps) to improve medication nonadherence, evaluate features of adherence apps across operating systems (OSs), and identify future opportunities and barriers facing adherence apps. Medication nonadherence is a common, complex, and costly problem that contributes to poor treatment outcomes and consumes health care resources. Nonadherence is difficult to measure precisely, and interventions to mitigate it have been largely unsuccessful. Using smartphone adherence apps represents a novel approach to improving adherence. This readily available technology offers many features that can be designed to help patients and health care providers improve medication-taking behavior. Currently available apps were identified from the three main smartphone OSs (Apple, Android, and Blackberry). In addition, desirable features for adherence apps were identified and ranked by perceived importance to user desirability using a three-point rating system: 1, modest; 2, moderate; or 3, high. The 10 highest-rated apps were installed and subjected to user testing to assess app attributes using a standard medication regimen. RESULTS 160 adherence apps were identified and ranked. These apps were most prevalent for the Android OS. Adherence apps with advanced functionality were more prevalent on the Apple iPhone OS. Among all apps, MyMedSchedule, MyMeds, and RxmindMe rated the highest because of their basic medication reminder features coupled with their enhanced levels of functionality. Despite being untested, medication apps represent a possible strategy that pharmacists can recommend to nonadherent patients and incorporate into their practice.

Medication Beliefs and Self-Reported Adherence Among Community-Dwelling Older Adults

BackgroundNonadherence to medications among older adults can compromise quality care. Among older adults with chronic diseases, nonadherence rates can reach 50%. Individual-level obstacles to full adherence may come from psychological, illness (and disability due to aging or other impairments), and tangible barriers. In this study, we examine the barriers associated with nonadherence among community-dwelling older persons participating in Aging Service Network nutrition programs. ObjectiveThe goal of this study was to examine the relation of psychological, illness, and tangible barriers to reported medication adherence among older adults in a community, nonmedical setting. MethodsOlder adults (N = 299) receiving congregate meals participated in a study of factors associated with medication-taking behaviors and adherence. Self-reported medication nonadherence was measured by using the Morisky Medication Adherence Scale. Psychological barriers were assessed by using a risk/benefit score (perceived concerns vs necessity of medications). Illness barriers reviewed included overall cognitive functioning, disability, medical burden, and depression. Tangible barriers included number of medications, difficulty handling medication, and perceived cost. ResultsMost participants took multiple medications (mean, 4.8) each day, and 4 of 10 older adults (41% [122 of 299]) reported at least 1 nonadherent behavior. The psychological barrier of a low risk/benefit score (odds ratio = 0.73 [95% CI, 0.6–0.94]) and the tangible barrier of difficulty opening the medication bottle (odds ratio = 2.16 [95% CI, 1.3–3.6]) were independently associated with nonadherence. ConclusionsIn a community-dwelling sample of older adults, nonadherence to medication was associated with both tangible and psychological barriers. Beliefs about medication can be powerful barriers to a successful adherence strategy. Adherence interventions should address the multilevel barriers (psychological, illness, and tangible) to adherence among older adults.

The Nigerian antihypertensive adherence trial

Research in industrialized countries has demonstrated that a key factor limiting the control of hypertension is poor patient adherence and that the most successful interventions for long-term adherence employ multiple strategies. Very little data exist on this question in low-income countries, wherein medication-taking behavior may be less well developed. We conducted a treatment adherence trial of 544 patients [mean age ∼63 years, mean blood pressure (BP) ∼168/92 mmHg] with previously untreated hypertension in urban and rural Nigeria. Eligible participants were randomized to one of two arms: clinic management only, or clinic management and home visits. Both interventions included three elements: a community based, nurse-led treatment program with physician backup; facilitation of clinic visits and health education; and the use of diuretics and a β blocker as needed. After initial diagnosis, the management protocol was implemented by a nurse with physician backup. Participants were evaluated monthly for 6 months. Medication adherence was assessed with pill count and urine testing. Drop-out rates, by treatment group, ranged from 12 to 28%. Among participants who completed the 6-month trial, overall adherence was high (∼77% of participants took >98% of prescribed pills). Adherence did not differ by treatment arm, but was better at the rural than the urban site and among those with higher baseline BP. Hypertension control (BP <140/90 mmHg) was achieved in approximately 66% of participants at 6 months. This community-based intervention confirms relatively modest default rates compared with industrialized societies, and suggests that medication adherence can be high in developing world settings in clinic attenders.

Missing signposts on the roadmap to quality: a call to improve medication adherence indicators in data collection for population research

Purpose: Poor adherence to prescribed medicines is associated with increased rates of poor outcomes, including hospitalization, serious adverse events, and death, and is also associated with increased healthcare costs. However, current approaches to evaluation of medication adherence using real-world electronic health records (EHRs) or claims data may miss critical opportunities for data capture and fall short in modeling and representing the full complexity of the healthcare environment. We sought to explore a framework for understanding and improving data capture for medication adherence in a population-based intervention in four U.S. counties.Approach: We posited that application of a data model and a process matrix when designing data collection for medication adherence would improve identification of variables and data accessibility, and could support future research on medication-taking behaviors. We then constructed a use case in which data related to medication adherence would be leveraged to support improved healthcare quality, clinical outcomes, and efficiency of healthcare delivery in a population-based intervention for persons with diabetes. Because EHRs in use at participating sites were deemed incapable of supplying the needed data, we applied a taxonomic approach to identify and define variables of interest. We then applied a process matrix methodology, in which we identified key research goals and chose optimal data domains and their respective data elements, to instantiate the resulting data model.Conclusions: Combining a taxonomic approach with a process matrix methodology may afford significant benefits when designing data collection for clinical and population-based research in the arena of medication adherence. Such an approach can effectively depict complex real-world concepts and domains by “mapping” the relationships between disparate contributors to medication adherence and describing their relative contributions to the shared goals of improved healthcare quality, outcomes, and cost.

Abstract P2-13-05: A pilot prospective study of adherence to aromatase inhibitor adjuvant therapy in patients with stage 1–3 breast carcinoma.

Abstract Introduction: The most practical approach to assessment of medication adherence in clinical practice is via patient self-reporting, which can be measured using the 8-item Morisky Medication Adherence Scale (MMAS). The 8-item MMAS was developed from a previously validated 4-item scale by supplementing additional items measuring specific medication-taking behaviors to better capture barriers surrounding adherence behavior and has been determined to have better reliability than 4-item scale. Validated medication adherence surveys such as an 8-item MMAS, are untested in oncology, but have been validated in HTN, HIV, DM and other disorders in the setting of multiple chronic medications. Thus this study will serve as a pilot study of the MMAS in the oncology population. Methods: This is a prospective study conducted at the University of Maryland Greenebaum Cancer Center (UMGCC). The primary objective was to identify the adherence level (high, medium, low) to adjuvant (AI) in early stage (1–3) breast cancer (BC) patients in order to identify predictors of adherence. Subjects were stratified according to duration of therapy with AI (≤ 2 yrs or &amp;gt;2 yrs) at the time of the survey. The secondary objective was to identify baseline predictors for adherence. Patients received a maximum 8 points for maximum adherence to medication treatment or high adherence, 6–7 points for medium adherence and &amp;lt; 6 points for low adherence. Eligibility: Adult females, postmenopausal, signed consent, hormone receptor-positive BC (ER and/or PR &amp;gt;=1%), pathologically confirmed Stage 1–3 BC, completed surgery, adjuvant chemotherapy, and/or radiation therapy, and were recommended by their medical oncologist to take adjuvant AI for 5 years. Pts received a prescription for adjuvant AIs (anastrozole, letrozole or exemestane) after completion of adjuvant chemotherapy. Results: Patient characteristics: 73 BC pts were sequentially accrued so far at the UMGCC and filled out the self-reported questionnaire; Causcasian-62%, African American (AAF)-37%, Asian-1%, median age at diagnosis-54 (range33-84); stage 1–36%, stage 2–47%, stage 3–17%; mastectomy-61%; lumpectomy-39%; local radiation therapy 62%; ER+ 95%; PR+ 78%, HER2+ 17 %; tumor type ductal-75%; lobular-20%; mixed ductal/lobular-5%; tumor grade-1–46%, 2–41%,3–12%; adjuvant chemotherapy- 63%. Educational level- N/A- 3%, &amp;lt;high school- 11%, high school grad- 12%, some college- 34%, bachelor's degree- 18%, graduate school- 22%; marital status-single- 19%, married- 52%, divorced/separated- 19%, widowed- 10%; median number of medications- 5 (range 1–19); median number of comorbidities-3 (range 0–9). Conclusions: Overall adherence to AI treatment measured by MMAS was High in 50.7%, Medium in 35.6% and Low in 13.7% pts; there was no difference in adherence by duration of treatment with AI ≤ 2 vs. &amp;gt; 2 years. Univariable regression models for continuous predictors and rxc contingency tables for categorical ones revealed that the adherence to AI therapy is not affected by age, marital status, education, prior cancer therapy, tumor stage, and concurrent medication. However, there was a trend for better adherence to AI therapy in Caucasian women vs. AAF (p = 0.013). The study is ongoing. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-13-05.

Adherence to antihypertensives: feasibility of two self-report instruments to investigate medication-taking behaviour in German community pharmacies

To design and test the feasibility of two questionnaires in German community pharmacies exploring self-reported adherence to antihypertensives. Two self-report questionnaires were designed for patients treated with antihypertensives. The 29-item-questionnaire (long form, LF) was completed by pharmacists interviewing patients who were on the premises filling a prescription. The short form (SF; 19 items) was sent by pharmacies to patients via mail. The acceptance of the instruments by patients and pharmacists as well as the feasibility to measure medication-taking behaviour was investigated. Adherence was investigated by using a modified 5-(LF) or 6-item (SF) Morisky score. Of 44 community pharmacies contacted, 18 agreed to participate. Patients' response rates were 428/915 (46.8%) for the SF and 249/760 (32.8%) for the LF. One hundred and seventy-nine patients (41.8%) and 70 patients (28.1%) reported adherence problems according to the SF and LF respectively. To our knowledge, this is the first attempt to develop a self-report instrument for the detection of non-adherence in patients taking antihypertensives in this setting in Germany. Patients were willing to provide detailed information about their medication-taking behaviour. Underestimation of non-adherence may be more pronounced when applying the questionnaire in the pharmacy.

The association of ethnicity with electronically measured adherence to inhaled corticosteroids in children

To investigate the association of ethnicity with objectively, electronically measured adherence to inhaled corticosteroids (ICS) in a multicultural population of children with asthma in the city of Amsterdam. The study was designed as a prospective, observational multicenter study in which adherence to ICS and potential risk factors for adherence to ICS were measured in a cohort of Moroccan and native Dutch children with asthma. Electronic adherence measurements were performed for 3 months per patient using a Real Time Medication Monitoring (RTMM) system. Ethnicity and other potential risk factors, such as socio-economic status, asthma control and parental medication beliefs, were extracted from medical records or parent interviews. The association between adherence and ethnicity was analysed using multivariate linear regression analysis. A total of 90 children (aged 1-11 years) were included in the study and data of 87 children were used for analysis. Average adherence to ICS was 49.3 %. Native Dutch children showed higher adherence to ICS than Moroccan children (55.9 vs. 42.5 %, respectively; p = 0.044, univariate analysis). After correction for confounders (>3 annual visits to the paediatric outpatient clinic, regular use of a spacer during inhalation), the final regression model showed that ethnicity was independently associated with adherence (p = 0.028). In our Western European population of inner city children with asthma, poor adherence to ICS was a serious problem, and even somewhat more so in ethnic minorities. Paediatricians involved in asthma treatment should be aware of these cultural differences in medication-taking behaviour, but further studies are needed to elucidate the causal mechanism.

Use of and Adherence to Antiretroviral Therapy in a Large U.S. Sample of HIV-infected Adults in Care, 2007-2008

Background:Antiretroviral therapy (ART) is the cornerstone of HIV clinical care and is increasingly recognized as a key component of HIV prevention. However, the benefits of ART can be realized only if HIV-infected persons maintain high levels of adherence.Methods:We present interview data (collected from June 2007 through September 2008) from a national HIV surveillance system in the United States—the Medical Monitoring Project (MMP)—to describe persons taking ART. We used multivariate logistic regression to assess behavioral, sociodemographic, and medication regimen factors associated with three measures that capture different dimensions of nonadherence to ART: dose, schedule, and instruction.Results:The use of ART among HIV-infected adults in care was high (85%), but adherence to ART was suboptimal and varied across the three measures of nonadherence. Of MMP participants currently taking ART, the following reported nonadherence during the past 48 hours: 13% to dose, 27% to schedule, and 30% to instruction. The determinants of the three measures also varied, although younger age and binge drinking were associated with all aspects of nonadherence.Conclusion:Our results support the measurement of multiple dimensions of medication-taking behavior in order to avoid overestimating adherence to ART.

The roles of past behavior and health beliefs in predicting medication adherence to a statin regimen

Purpose:Current medication-adherence predictive tools are based on patient medication-taking beliefs, but studying past behavior may now be a more explanatory and accessible method. This study will evaluate if past medication-refill behavior for a statin regimen is more predictive of medication adherence than patient medication-taking health beliefs.Patients and methods:This prospective longitudinal study was implemented in a national managed care plan in the United States. A group of 1433 statin patients were identified and followed for 6 months. Medication-taking health beliefs, collected from self-reported mail questionnaires, and past medication-refill behavior, using proportion of days covered (PDC), were collected prior to 6-month follow-up. Outcomes were measured using categorical PDC variable (of adherence, PDC ≥ 85%, versus nonadherence, PDC < 85%), with model fit estimated using receiver operator characteristic analysis.Results:The area under the receiver operator characteristic curve for past behavior (Az = 0.78) was significantly greater (P < 0.05) than for patient health beliefs (Az = 0.69), indicating that past prescription-refill behavior is a better predictor of medication adherence than prospective health beliefs. Among health beliefs, the factor most related to medication adherence was behavioral intent (odds ratio, 5.12; 95% confidence interval, 1.84 to 15.06). The factor most strongly related to behavioral intent was impact of regimen on daily routine (odds ratio, 3.3; 95% confidence interval, 1.41 to 7.74).Conclusion:Electronic medical records and community health-information networks may make past prescription-refill rates more accessible and assist physicians with managing medication-regimen adherence. Health beliefs, however, may still play an important role in influencing medication-taking behaviors.

Medication effectiveness may not be the major reason for accepting cardiovascular preventive medication: a population-based survey.

BackgroundShared decision-making and patients’ choice of interventions are areas of increasing importance, not least seen in the light of the fact that chronic conditions are increasing, interventions considered important for public health, and still non-acceptance of especially risk-reducing treatments of cardiovascular diseases (CVD) is prevalent. A better understanding of patients’ medication-taking behavior is needed and may be reached by studying the reasons why people accept or decline medication recommendations. The aim of this paper was to identify factors that may influence people’s decisions and reasoning for accepting or declining a cardiovascular preventive medication offer.MethodsFrom a random sample of 4,000 people aged 40–59 years in a Danish population, 1,169 participants were asked to imagine being at increased risk of cardiovascular disease and being offered a preventive medication. After receiving ‘complete’ information about effectiveness of the medication they were asked whether they would accept medication. Finally, they were asked about reasons for the decision.ResultsA total of 725 (67%) of 1,082 participants accepted the medication offer. Even quite large effects of medication (up to 8 percentage points absolute risk reduction) had a smaller impact on acceptance to medication than personal experience with cardiovascular disease. Furthermore, increasing age of the participant and living with a partner were significantly associated with acceptance. Some 45% of the respondents accepting justified their choice as being for health reasons, and they were more likely to be women, live alone, have higher income and higher education levels. Among those who did not accept the medication offer, 56% indicated that they would rather prefer to change lifestyle.ConclusionsMedication effectiveness seems to have a moderate influence on people’s decisions to accept preventive medication, while factors such as personal experience with cardiovascular disease may have an equally strong or stronger influence, indicating that practitioners could do well to carefully identify the reasons for their patients’ treatment decisions.

Educational Needs for Improving Self-Care in Heart Failure Patients With Diabetes

To explore the need for self-monitoring and self-care education in heart failure patients with diabetes (HF- DM patients) by describing cognitive and affective factors to provide guidance in developing effective self-management education. A cross-sectional correlation design was employed using baseline patient data from a study testing a 12-week patient and family dyad intervention to improve dietary and medication-taking self-management behaviors in HF patients. Data from 116 participants recruited from metropolitan Atlanta area were used. Demographic and comorbidities, physical function, psychological distress, relationship with health care provider, self-efficacy (medication taking and low sodium diet), and behavioral outcomes (medications, dietary habits) were assessed. Descriptive statistics and a series of chi-square tests, t tests, or Mann-Whitney tests were performed to compare HF patients with and without DM. HF-DM patients were older and heavier, had more comorbidities, and took more daily medications than HF patients. High self-efficacy on medication and low-sodium diet was reported in both groups with no significant difference. Although HF-DM patients took more daily medications than HF, both groups exhibited high HF medication-taking behaviors. The HF-DM patients consumed significantly lower total sugar than HF patients but clinically higher levels of sodium. Diabetes educators need to be aware of potential conflicts of treatment regimens to manage 2 chronic diseases. Special and integrated diabetes self-management education programs that incorporate principles of HF self-management should be developed to improve self-management behavior in HF-DM patients.

Unintentional non-adherence to chronic prescription medications: How unintentional is it really?

BackgroundUnintentional non-adherence has been characterized as passively inconsistent medication-taking behavior (forgetfulness or carelessness). Our objectives were to: (1) study the prevalence and predictors of unintentional non-adherence; and (2) explore the interrelationship between intentional and unintentional non-adherence in relation to patients’ medication beliefs.MethodsWe conducted a cross-sectional survey of adults with asthma, hypertension, diabetes, hyperlipidemia, osteoporosis, or depression from the Harris Interactive Chronic Illness Panel. The analytic sample for this study included 24,017 adults who self-identified themselves as persistent to prescription medications for their index disease. They answered three questions on unintentional non-adherence (forgot, ran out, being careless), 11 questions on intentional non-adherence, and three multi-item scales assessing perceived need for medication (k = 10), perceived medication concerns (k = 6), and perceived medication affordability (k = 4). Logistic regression was used to model predictors of each unintentional non-adherence behavior. Baron and Kenny’s regression approach was used to test the mediational effect of unintentional non-adherence on the relationship between medication beliefs and intentional non-adherence. Bootstrapping was employed to confirm the statistical significance of these results.ResultsFor the index disease, 62% forgot to take a medication, 37% had run out of the medication, and 23% were careless about taking the medication. Common multivariate predictors (p < .001) of the three behaviors were: (1) lower perceived need for medications; (2) more medication affordability problems; (3) worse self-rated health; (4) diabetes or osteoporosis (relative to hypertension); and (5) younger age. Unique statistically-significant predictors of the three behaviors were: (a) ‘forgot to take medications’ - greater concerns about the index medication and male gender; (b) ‘run out of medications’ - non-white race, asthma, and higher number of total prescription medications; (c) ‘being careless’ - greater medication concerns. Mediational tests confirmed the hypothesis that the effect of medication beliefs (perceived need, concerns, and affordability) on intentional non-adherence is mediated through unintentional non-adherence.ConclusionsFor our study sample, unintentional non-adherence does not appear to be random and is predicted by medication beliefs, chronic disease, and sociodemographics. The data suggests that the importance of unintentional non-adherence may lie in its potential prognostic significance for future intentional non-adherence. Health care providers may consider routinely inquiring about unintentional non-adherence in order to proactively address patients’ suboptimal medication beliefs before they choose to discontinue therapy all together.

Exploring barriers to optimal anticoagulation for atrial fibrillation: interviews with clinicians.

BackgroundWarfarin, the most commonly used antithrombotic agent for stroke prophylaxis in atrial fibrillation (AF), requires regular monitoring, frequent dosage adjustments, and dietary restrictions. Clinicians’ perceptions of barriers to optimal AF management are an important factor in treatment. Anticoagulation management for AF is overseen by both cardiology and internal medicine (IM) practices. Thus, gaining the perspective of specialists and generalists is essential in understanding barriers to treatment. We used qualitative research methods to define key issues in the prescription of warfarin therapy for AF by cardiology specialists and IM physicians.Methods and resultsClinicians were interviewed to identify barriers to warfarin treatment in a large Midwestern city. Interviews were conducted until thematic saturation occurred. Content analysis yielded several themes. The most salient theme that emerged from clinician interviews was use of characteristics other than the patient’s CHADS2 score to enact a treatment plan, such as the patient’s social situation and past medication-taking behavior. Other themes included patient knowledge, real-world problems, breakdown in communication, and clinician reluctance.ConclusionWarfarin treatment is associated with many challenges. The barriers identified by clinicians highlight the unmet need associated with stroke prophylaxis in AF and the opportunity to improve anticoagulation treatment in AF. Social and lifestyle factors were important considerations in determining treatment.