Nonadherent Behavior Research Articles

Adherence to Oral Anticancer Therapeutics in the Gynecologic Oncology Population.

To gain a better understanding of gynecologic oncology patient adherence to oral anticancer agents through both a cross-sectional survey of adherence and qualitative interviews with patients and clinicians regarding their experience with these medications. Eligible participants completed a survey for this cross-sectional study that included an assessment of adherence, distress, quality of life, and health literacy. Any woman taking an oral anticancer agent for a gynecologic malignancy at a tertiary academic medical center for 30 days or more was eligible. Semi-structured qualitative interviews (n=14) were then conducted to explore experiences with oral anticancer agents. We also conducted a qualitative group interview with physicians and nurse practitioners. One hundred women taking oral anticancer agents were enrolled. Fifty-four percent reported perfect adherence to their medication, 21% reported equivocal adherence (demonstrating at least one nonadherent behavior in the previous 7 days), and 25% reported nonadherence (demonstrating more than one nonadherent behavior in the previous 7 days). Qualitative analysis identified five major themes: ease of use compared with traditional therapy; the mental burden of self-administrated medication; perceived importance of the medication; management of side effects; and the desire for consistent physician communication. Common misperceptions expressed in the health care professional interviews included high adherence to oral medications and a belief that cost was the biggest barrier to adherence. Almost half of the patients surveyed reported equivocal or nonadherence to their oral anticancer agent. The qualitative interviews identified several important themes, many of which were not recognized by physicians and nurse practitioners. These findings highlight the need for patient and health care professional interventions to improve patient adherence.

Prevention, screening, assessing and managing of non-adherent behaviour in people with rheumatic and musculoskeletal diseases: systematic reviews informing the 2020 EULAR points to consider

ObjectiveTo analyse how non-adherence to prescribed treatments might be prevented, screened, assessed and managed in people with rheumatic and musculoskeletal diseases (RMDs).MethodsAn overview of systematic reviews (SR) was performed in...

A community-based Cross-Sectional Survey of Primaquine Adherence in Jambi Province, Indonesia

Background: Plasmodium vivax is one of malaria parasite species that can lead to life-threatening disease. Primaquine is the only known and licensed drug prominently against Plasmodium vivax hypnozoites stage. However, lack studies have demonstrated community adherence information to such particular treatment medication. Material and Method: A cross-sectional community-based study design was used in the study. The study population is the person visiting local primary health care with signs or symptoms related to malaria and detected microscopically with Plasmodium vivax infection. After prescribed with a standard dose of primaquine, adherence was measured by a structured questionnaire at the end of the completion day of the medication course. Results: Malaria caused by Plasmodium vivax in Lembah masurai sub-district started to be prevalent from 2014 to the end of 2017. The data indicated that malaria foci have been maintained in the area in the past five years. A total of 44 individuals were recruited in the study. In total, 11.4 % of the patients were certain non-adherence, 27.3% were probable non-adherence and 61.4% were probable adherence. Primaquine prescription is associated with non-adherence behavior (P-value = 0.044, OR: 8 [CI: 0.81-79.02]). Conclusion: Our study concludes that simplifying primaquine medication therapy by not adding another non-related drug may elevate the adherence level.

Tuberculosis Medication Nonadherence—A Qualitative Case Study

India is grappling with the problem of controlling tuberculosis nearly for the past 50 years. The problem of nonadherence to treatment regimen has also worsened the situation of multidrug resistant tuberculosis (MDR-TB) in India. This article explores the factors behind nonadherence among erstwhile TB defaulters in a rural district in India. In-depth interviews with seven chronic defaulters and with healthcare professionals were conducted at a government-run Chest Clinic. In addition to in-depth interviews with defaulters and healthcare professionals, medical records and government orders related to TB control were examined extensively. Participants were also observed to understand their interaction with healthcare professionals and fellow patients, especially during drug delivery time. Qualitative content analysis is the most appropriate method to analyze the transcribed text and archival records. Qualitative content analysis brought out five major themes responsible for their past nonadherence behavior, namely, (a) Awareness about tuberculosis and treatment, (b) Symptom recognition and self-medication, (c) Family support, (d) Accessibility, and (e) Stigma. Findings are documented according to the major themes and documenting direct quotes from participants and with healthcare professionals wherever appropriate. This case study also provided context-specific recommendations to the healthcare professionals as regards the nonadherence behavior among TB patients. It is hoped these focused recommendations, albeit known to the healthcare professionals, would be extremely useful in making modifications to the existing program to tackle the nonadherence behavior.

Identification of Cardiovascular Patient Groups at Risk for Poor Medication Adherence: A Cluster Analysis.

BackgroundPoor medication adherence limits the secondary prevention of cardiovascular diseases (CVDs) and leads to increased morbidity, mortality, and costs. Identifying groups of patients at risk of poor adherence behavior could enable an intervention to be developed and target patients appropriately.ObjectiveThe first aim of this study was to identify homogeneous subgroups of cardiovascular outpatients based on their cardiovascular risk factors. Subsequently, differences in medication adherence between these groups were examined.MethodsIn this retrospective, observational study, patients with an established CVD were included. Well-known cardiovascular risk factors such as smoking, diet, exercise, blood lipid levels, blood pressure, and body mass index were collected. To identify patient subgroups, a 2-step cluster analytic procedure was performed. Differences between the groups on medication adherence were determined on the outcome of the Modified Morisky Scale. Data collection took place between October 2011 and January 2013.ResultsCardiovascular risk factors of 530 patients were included in the cluster analysis. Three groups were identified. Compared with other clusters (clusters 1 and 2), cluster 3 contained significantly fewer patients who could be classified as highly adherent and more patients classified as medium adherent (23% and 57%, respectively; P = .024). This group was characterized by a younger age (53% were <55 years old) and using a relatively low number of different medications (41% used <4 different medications). Besides, in this subgroup the most smokers (37%), unhealthy alcohol users (27%), and patients with unhealthy eating habits (14%) were present.ConclusionThis study showed that cardiovascular patients who are relatively young and have an unhealthy lifestyle are at risk for nonadherent behavior.

Drug use and antiretroviral therapy (ART) interactions: a qualitative study to explore the knowledge, beliefs, adherence, and quality of life of people living with HIV taking ART and illicit drugs

BackgroundTo explore the use of illicit drugs by people living with HIV (PLHIV) taking antiretroviral therapy (ART) and their relationship with variables relevant to the management of HIV infection, such as knowledge and beliefs about drug–drug interactions (DDIs), ART adherence, quality of life (QoL), and use of health-care resources.Methods21 PLHIV in Spain who concomitantly took illicit drugs and ART participated in this qualitative study. Eight experts collaborated in the design of the semi-structured interview guide which explored the following topics: illicit drug use, knowledge and beliefs about DDIs and their impact on ART adherence, the effects of using illicit drugs on health, QoL, and use of health-care resources. Four of those experts, who were PLHIV and members of the executive boards of non-government organizations (NGOs) from four Spanish regions, recruited the participants through their NGOs and carried out the face-to-face interviews. Content analysis of the qualitative data was conducted with the support of the MAXQDA 12 program.ResultsParticipants were mainly men (85.7%) and only 14.3% of them were heterosexual. Content analysis showed that the most frequently consumed illicit drugs were poppers, cocaine, and cannabis. Participants were polydrug users and this was, in many cases, prior to HIV diagnosis. Most participants presented theoretical potential moderate DDIs that would require monitoring. More than three quarters of them were not aware of these DDIs. Participants reported interactive toxicity beliefs that lead to intentional nonadherence behaviors. In most cases (n = 17), the participant’s doctor knew about their drug use, however only six of them had had an open dialogue with their physician about it. Illicit drug use led to some health-related problems, mainly sexually transmitted infections. A positive QoL’s self-perception was found among several participants that used recreational illicit drugs.ConclusionsAdequate information about DDIs and clues about how to manage ART when PLHIV are using illicit drugs could reduce the negative effects of such interactions and improve ART adherence and QoL.

What Predicts Different Kinds of Nonadherent Behavior in Elderly People With Parkinson's Disease?

Background: Detailed knowledge about nonadherence to medication could improve medical care in elderly patients. We aimed to explore patterns and reasons for nonadherence in people with Parkinson's disease (PD) aged 60 years and older.Methods: Detailed clinical data and adherence (German Stendal Adherence with Medication Score) were assessed in 230 patients with PD (without dementia). Descriptive statistics were used to study reasons for nonadherence in detail, and general linear models were used to study associations between clusters of nonadherence and clinical parameters.Results: Overall, 14.2% (n = 32) of the patients were fully adherent, 66.8% (n = 151) were moderately nonadherent, and 19.0% (n = 43) showed clinically meaningful nonadherence. In the multivariable analysis, nonadherence was associated with a lower education level, higher motor impairment in activities of daily living, higher number of medications per day, and motor complications of PD. Three clusters of nonadherence were observed: 59 (30.4%) patients reported intentional nonadherence by medication modification; in 72 (37.1%) patients, nonadherence was associated with forgetting to take medication; and 63 (32.5%) patients had poor knowledge about the prescribed medication. A lower education level was mainly associated with modification of medication and poorer knowledge about prescribed medication, but not with forgetting to take medication. Patients with motor complications, which frequently occur in those with advanced disease stages, tend to be intentionally nonadherent by modifying their prescribed medication. Increased motor problems and a higher total number of drugs per day were associated with less knowledge about the names, reasons, and dosages of their prescribed medication.Conclusions: Elderly patients with PD report many reasons for intentional and non-intentional nonadherence. Understanding the impact of clinical parameters on different patterns of nonadherence may facilitate tailoring of interventions and counseling to improve outcomes.

Professionalizing Care Workers: Outcomes of a ‘Motivational Interviewing’ Training in Residential Youth Care

ABSTRACT Behavioral change in adolescents is often an important aim of residential youth care, but difficult to achieve. Care workers can increase the intrinsic motivation of adolescents to change their behavior by applying Motivational Interviewing (MI). The aim of this study is to investigate whether there is a difference in workers’ performance vis-à-vis adolescents before and after an MI training course. To measure this difference, we coded transcripts of audio recordings of one-on-one conversations between adolescents and workers, using the MITI 4.2.1 and MISC 2.5. We compared the transcripts made before the MI training course with the transcripts made after the training course. The results show that the 13 workers made significantly more use of MI adherent behaviors after the training course. Moreover, a trend toward using fewer MI non-adherent behaviors after the training was observed. The results suggest that workers are able to evoke more ‘change talk’ with adolescents after a training course. In conclusion, after attending a training course, workers are able to engage in conversations that are more in line with the MI-spirit. However, these are still not “real” MI conversations yet. We recommend to train workers more intensively in how to apply MI.

Assessment of anti-infective medication adherence in pediatric outpatients.

The objective of this pilot study was to assess the overall adherence rate of the pediatric population to anti-infective drugs prescribed for acute infection at hospital discharge and to identify risk factors for non-adherence behavior. Pediatric patients discharged from a French university hospital with at least one oral drug prescription for acute infection were included for 3months. Medication adherence and antibiotic knowledge were assessed through data collected by calling the parents. Overall adherence was assessed according to seven items: medication order filling, administered dose, time of intake, frequency of doses, medication omission, dose modification, and length of treatment. Seventy-five patients were included, and 63 interviews were exploited. The median age was 1.4years, IQR = [0.7; 3.3]. Overall adherence to anti-infective agents concerned 34.9% of patients. The most frequently prescribed antibiotics were amoxicillin (29.3%), amoxicillin associated with clavulanic acid (25.3%), cotrimoxazole (18.7%), and cefixime (12.0%). A lack of parents' anti-infective knowledge was associated with non-adherence to anti-infective drugs.Conclusion: Two-thirds of outpatients were non-adherent to anti-infectives in acute infectious diseases. The misunderstanding of anti-infective treatment could be a risk factor for non-adherence. Implementation of preventive actions such as therapeutic education or pharmaceutical counseling at hospital discharge could improve adherence to anti-infective agents. What Is Known: • Non-adherence to anti-infective drugs involves the emergence and spread of antibiotic resistance. • Very few studies have assessed medication adherence in acute infectious diseases in pediatrics after hospital discharge. What Is New: • Only 35% of children were overall adherent to anti-infective drugs in acute infectious disease after hospital discharge. • Most patients (89%) had a good primary adherence but very few (40%) had good secondary adherence mainly due to dose omission and dose modification.

Beliefs about immunosuppressant medication and correlates in a German kidney transplant population

ObjectiveA common reason for organ rejection after transplantation is the lack of adherence regarding immunosuppressive medication (ISM). A variety of different aspects can promote non-adherent behavior, including the relationship between perceived benefits and concerns regarding ISM (“necessity-concerns-framework”). Little is known about the variables associated with this framework. MethodsAs part of this cross-sectional study, 570 patients after kidney transplantation who participated in a structured multimodal follow-up program (KTx360°) were examined in two transplant centers in Lower Saxony. We used the Beliefs about Medicines Questionnaire (BMQ) to evaluate the patients' believes and concerns regarding their ISM. ResultsThe mean age of the participants was 51.9 (SD 14.17) years, 58.4% were men, and 25.8% had ≥12 years of school attendance. The mean time since transplantation was 65.9 months. In patients undergoing kidney transplantation, the perceived benefit of ISM mostly exceeded the concerns. We found an association between lower perceived benefits and greater concerns and lower adherence. Also, a higher perceived necessity was significantly associated with higher age and lower levels of depression and anxiety. Greater concerns were significantly associated with more symptoms of depression and anxiety, lower perceived social support, and lower kidney functioning (eGFR). ConclusionEven though patients after kidney transplantation usually acknowledge the importance of their ISM, they still have considerable concerns that are associated with less adherence and various psychosocial risk factors. Further longitudinal studies are needed to assess the extent to which beliefs about medication are variable and can be individually addressed to improve adherence.

Decisions for Medication Nonadherence: Stories from Older Adults with Heart Failure

Background More than half of all heart failure (HF) patients do not take medications as prescribed, resulting in substantial negative health outcomes. Research has shown that medication adherence may be more a consequence of individual decisions rather than the ability to follow prescribed regimens, yet very little is known about decision-making regarding nonadherence to medications for HF. Purpose The purpose of this study was to gain understanding and insight into older adults' decision-making experiences and perceptions in choosing to take or not take medications for HF in the community setting. Methods Using a narrative inquiry approach, the personal narratives of eleven adults aged 65 and older who took at least two daily medications for HF were gathered using in-depth, semi-structured interviews. The data in this study were organized and analyzed using Riessman's framework for narrative analysis. Results This study suggests that medication nonadherence in older adults with HF is primarily attributed to intentional decisions, based on personal values, to deviate from the prescribed regimen. When study participants felt that the effects of a medication interfered with their lifestyles, they coped by individualizing their prescribed medication regiment to try and live as comfortably as possible. Although participants made decisions to take medications differently than prescribed, they did not perceive themselves to be nonadherent. Conclusions Participants perceived their decisions for medication nonadherence as logical and necessary to maintain their health which could be seen as practicing self-care as opposed to nonadherent behavior. Thus, assessments should aim to understand actual medication-taking routines. Participants described consulting the Internet and resources other than providers for medication information. The development of interventions that utilize resources that are readily accessible to patients may promote decisions for medication adherence.

Association of Medication Adherence and Clinical Outcomes in Sarcoidosis

Sarcoidosis, one of the most common interstitial lung diseases, has significant health disparities. Approximately 50%of individuals affected with sarcoidosis will undergo spontaneous remission, but those who do not undergo remission often require long-term or lifelong treatment to prevent disease progression. We sought to assess the association between medication adherence and clinical outcomes in sarcoidosis. Adult patients in the Johns Hopkins Sarcoidosis Clinic diagnosed with pulmonary sarcoidosis on treatment were eligible for enrollment. Questionnaires were administered to assess medication adherence, health-related quality of life (HRQoL), health-care utilization, and sociodemographic information. Clinical information was abstracted from medical charts including lung function, disease duration, comorbidities, and sarcoidosis organ involvement. A total of 117 participants were enrolled (57%women; 55%black; median age, 57 years). Within the cohort, 66%of individuals reported at least one nonadherent behavior. Higher medication adherence was associated with better HRQoL (P<.05). There was no association between medication adherence and the odds of health-care utilization, FVC %predicted, FEV1 %predicted, or diffusion capacity of the lungs for carbon monoxide %predicted. Black participants reported lower medication adherence than white participants (P< .05). This is the first observational study of medication adherence in sarcoidosis. We found that higher medication adherence was associated with better HRQoL, with blacks more likely to report nonadherence. Medication adherence may be an important target to improve patient-reported outcomes and health disparities in sarcoidosis.

The my experience of taking medicines (MYMEDS) questionnaire for assessing medicines adherence barriers in post-myocardial infarction patients: development and utility

BackgroundThe ‘My Experience of Taking Medicines’ (MYMEDS) questionnaire is a self-reporting tool for identifying modifiable adherence barriers among individuals prescribed post-myocardial infarction (MI) secondary prevention medicines (SPM) in clinical practice. It was found to be a useful tool to support the conduction of patient-centred consultation in cardiology outpatient leading to improved outcomes including better adherence to SPM and patient satisfaction. This study describes the rationale and development of the MYMEDS tool, its performance and usefulness in identifying modifiable barriers to adherence in cardiology medical practice including user feedback of 204 consecutive post-MI patients who completed an evaluation based on MYMEDS.MethodsModifiable non-adherence factors were initially identified based on literature review and stakeholder feedback. A draft MYMEDS questionnaire was piloted in 10 patients and adapted accordingly. The final version comprises six sections, covering current medicines, understanding and satisfaction with medicines, concerns about medicines, practical adherence barriers, fitting medicines into daily routine, and adherence to individual SPMs. The questionnaire was mailed to post-MI patients who then attended an outpatient medicines optimisation clinic.ResultsMean age was 70.5 years and 67.6% were male. The tool was effective in revealing modifiable adherence barriers that could be addressed during the consultation. There were high rates of concern that SPMs could be harmful (33.2%) or overprescribed (43.2%), practical issues with swallowing medicines (8.2%), opening packaging (7.3%) or accessing repeat prescriptions (5.2%), forgetfulness (19.7%), and concerns about inconvenience (13.5%). Mean number of barriers per patient was 1.8 ± 1.5. The medications most commonly associated with non-adherence were statins (21.5%), angiotensin II receptor blockers (21.1%), and antiplatelet agents (18.5%). In total, 42.5% of patients acknowledged non-adherence behaviour. Patient feedback on MYMEDS was positive, with near-unanimous agreement that it was simple, clear and not too long, and that it enabled them to raise any concerns they had about their medicines. Patients reported that their individual medicines related needs were better addressed.ConclusionsMYMEDS is a practical tool that can successfully identify modifiable barriers to SPM adherence which can be addressed in a clinical setting. It can be easily rolled out in daily clinical practice to enable individualised person-centred medicines optimisation consultation.

Study protocol: CareAvenue program to improve unmet social risk factors and diabetes outcomes- A randomized controlled trial

Despite the burdens costs can place on adults with diabetes, few evidence-based, scalable interventions have been identified that address prevalent health-related financial burdens and unmet social risk factors that serve as major obstacles to effective diabetes management. In this study, we will test the effectiveness of CareAvenue – an automated e-health tool that screens for unmet social risk factors and informs and activates individuals to take steps to connect to resources and engage in self-care. We will determine the effectiveness of CareAvenue relative to standard care with respect to improving glycemic control and patient-centered outcomes such as cost-related non-adherence (CRN) behaviors and perceived financial burden. We will also examine the role of patient risk factors (moderators) and behavioral factors (mediators) on the effectiveness of CareAvenue in improving outcomes. We will recruit 720 patients in a large health system with uncontrolled Type 1 diabetes mellitus (T1DM) or Type 2 diabetes mellitus (T2DM) who engage in CRN or perceive financial burden. Participants will be randomized to one of two arms: 1) receipt of a 15–20 min web-based program with routine follow-up (CareAvenue); or 2) receipt of contact information for existing health system assistance services. Outcomes will be assessed at baseline and 6- and 12-month follow-up.Clinical Trial Registration: ClinicalTrials.gov ID NCT03950973, May 2019

Medication Adherence, Burden and Health-Related Quality of Life in Adults with Predialysis Chronic Kidney Disease: A Prospective Cohort Study.

This study examines the associations between medication adherence and burden, and health-related quality of life (HRQOL) in predialysis chronic kidney disease (CKD). A prospective study targeting adults with advanced CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2) and not receiving renal replacement therapy was conducted in Tasmania, Australia. The actual medication burden was assessed using the 65-item Medication Regimen Complexity Index, whereas perceived burden was self-reported using a brief validated questionnaire. Medication adherence was assessed using a four-item Morisky-Green-Levine Scale (MGLS) and the Tool for Adherence Behaviour Screening (TABS). The Kidney Disease and Quality of Life Short-Form was used to assess HRQOL. Of 464 eligible adults, 101 participated in the baseline interview and 63 completed a follow-up interview at around 14 months. Participants were predominantly men (67%), with a mean age of 72 (SD 11) years and eGFR of 21 (SD 6) mL/min/1.73 m2. Overall, 43% and 60% of participants reported medication nonadherence based on MGLS and TABS, respectively. Higher perceived medication burden and desire for decision-making were associated with nonadherent behaviour. Poorer HRQOL was associated with higher regimen complexity, whereas nonadherence was associated with a decline in physical HRQOL over time. Medication nonadherence, driven by perceived medication burden, was prevalent in this cohort, and was associated with a decline in physical HRQOL over time.

Factors That Influence Changes to Existing Chronic Pain Management Plans.

The objective of this qualitative study is to better understand primary care clinician decision making for managing chronic pain. Specifically, we focus on the factors that influence changes to existing chronic pain management plans. Limitations in guidelines and training leave clinicians to use their own judgment and experience in managing the complexities associated with treating patients with chronic pain. This study provides insight into those judgments based on clinicians' first-person accounts. Insights gleaned from this study could inspire innovations aimed at supporting primary care clinicians (PCCs) in managing chronic pain. We conducted 89 interviews with PCCs to obtain their first-person perspective of the factors that influenced changes in treatment plans for their patients. Interview transcripts were analyzed thematically by a multidisciplinary team of clinicians, cognitive scientists, and public health researchers. Seven themes emerged through our analysis of factors that influenced a change in chronic pain management: 1) change in patient condition; 2) outcomes related to treatment; 3) nonadherent patient behavior; 4) insurance constraints; 5) change in guidelines, laws, or policies; 6) approaches to new patients; and 7) specialist recommendations. Our analysis sheds light on the factors that lead PCCs to change treatment plans for patients with chronic pain. An understanding of these factors can inform the types of innovations needed to support PCCs in providing chronic pain care. We highlight key insights from our analysis and offer ideas for potential practice innovations.

Association between social support and adherence to anti-retroviral treatment in people living with HIV.

To investigate the association between social support, adherence to HIV anti-retroviral therapy, and clinical and sociodemographic factors. A cross-sectional study conducted from July 2016 to August 2018 in a specialized outpatient clinic in southern Brazil. Individual interviews were conducted for the application of the following instruments: Questionnaire for the Evaluation of Adherence to Anti-retroviral Treatment (CEAT-HIV) and Social Support Scale for People Living with HIV/AIDS. The Spearman bivariate correlation test was used for analysis purposes. Among the 168 participants, the mean social support score was 3.53 points (SD = 0.66), and 64.9% (n = 109) of the respondents had insufficient adherence. There was a significant association (p < 0.05) between emotional social support and the following adherence domains: antecedents of non-adherence behaviors and doctor-patient communication. Social support is associated with antecedents of non-adherence behaviors and doctor-patient communication.

A CRITICAL LITERATURE REVIEW AND AUDIT OF REAL WORLD DATA TO INFORM THE RELATIONSHIP BETWEEN MENTAL ILL-HEALTH AND TYPE-2 DIABETES FAVOURABLE PROGNOSIS

Objective: The aim of this scoping study was to identify gaps in the current literature and understand the T2DM and MIH comorbidity trends in the local population from the West Midlands, UK to inform future studies.&#x0D; Methods: This project was a scoping study of two parts; a critical review and a clinical audit. A thematic approach was used to group studies based on their overall study outcome. The clinical audit data was used to compare the local patient population to the patterns identified in the literature reviewed.&#x0D; Results: The reviewed studies reported a relationship between T2DM control and both depression and anxiety, but did not agree on its significance. The clinical audit of 71 patients diagnosed with T2DM showed that 73% of males presented with poor diabetes control (HbA1c&gt;7) compared to females (46%). Conversely, females exhibited a higher prevalence of MIH (45%) compared to males (31%).&#x0D; Conclusion: From both this audit of the literature and local data, it remains unclear whether mental-ill health is a major driver for medication non-adherence behaviour and uncontrolled diabetes. Further studies are recommended to further understand this comorbidity.

Association between non-adherence behaviors, patients’ experience with healthcare and beliefs in medications: a survey of patients with different chronic conditions

Objective: The objective of the current work was to assess the frequency of non-adherence behaviors and potential association with patients’ experience with healthcare and beliefs in medicines self-reported by patients with four different chronic conditions.Methods: Patients responded anonymously to a survey comprising five non-adherence behaviors (based on physician and patient input), an assessment of patients’ experience with healthcare using the validated Instrument to Evaluate the EXperience of PAtients with Chronic diseases (IEXPAC), and a validated Spanish version of the Beliefs about Medicines Questionnaire (BMQ). Associations of non-adherence behavior were analyzed using logistic regression models.Results: Of 1530 respondents, 53.1% reported ≥1 non-adherence behavior. Non-adherence rates were 59.8% in diabetes mellitus (DM), 56.0% in rheumatic disease, 55.6% in inflammatory bowel disease, and 42.8% in human immunodeficiency virus (HIV) infection patients (p < .001). IEXPAC and BMQ scores were higher in adherent vs. non-adherent patients. In multivariate analysis, non-adherence behavior was strongly associated with lower overall BMQ, lower BMQ Necessity scores and higher BMQ Concerns scores (p < .001 for all), and with a lower IEXPAC self-management score (p = .007), but not with the overall IEXPAC score. Non-adherence was more frequent in DM patients compared with HIV infection patients (p < .001).Conclusions: Patients’ beliefs in medicines-a lower perception for the necessity of medication, and higher concerns in taking medication-and low patient self-management experience score were associated with non-adherence behavior. These are modifiable aspects that need to be addressed to increase medication adherence in chronic disease.

Measuring the multiple domains of medication nonadherence: findings from a Delphi survey of adherence experts.

Consensus on a gold-standard measure of patient medication nonadherence has been elusive, in part because medication nonadherence involves multiple, distinct behaviors across three phases (initiation, implementation, and persistence). To assess these behaviors, multiple measurement approaches may be needed. The purpose of this study was to identify expert-recommended approaches to measuring nonadherence behaviors. Thirty medication nonadherence experts were e-mailed two consecutive surveys. In both, respondents rated their agreement with definitions of nonadherence behaviors and measurement approaches. In the second survey, respondents rated the suitability of each measurement approach for assessing each behavior and identified the optimal measurement approach for each behavior. Consensus was achieved for eight patient medication nonadherence behaviors: not filling initial prescription and not taking first dose (noninitiation); refilling prescription late, missing doses, taking extra doses, taking doses at wrong time, and improperly administering medication (incorrect implementation); and discontinuing medication early (nonpersistence). Consensus was achieved for seven measurement approaches: self-report, prescription fill data, pill count, drug levels, electronic drug monitoring (EDM), smart technology, and direct observation. Self-report questionnaires were most commonly rated "at least somewhat suitable" for measuring behaviors. EDM was rated as optimal for measuring missing doses, taking extra doses, and taking doses at the wrong time. Prescription fill data were rated as optimal for not filling initial prescription, refilling late, and discontinuing. Direct observation was rated as optimal for measuring improper administration. Suitable and optimal measurement approaches varied across nonadherence behaviors. Researchers should select the measurement approach best suited to assessing the behavior(s) targeted in their research.