Adherence to Medication Regimens among Low-Income Patients with Multiple Comorbid Chronic Conditions

Abstract

This qualitative study sought to explore facilitators and barriers to adherence to multiple medications among low-income patients with comorbid chronic physical and mental health conditions. The 50 focus group participants identified personal/contextual and health system factors as major impediments to adherence to multiple medications. These factors included medication side effects, fear of harm from medication, fear of dependence on medication, complex instructions, suboptimal communications with doctor, suspicion about doctors’ and pharmaceutical companies’ motives in prescribing medication, and the high cost of medications. Participants also identified motivators, both internal (self-initiated) and external (initiated by family, doctor, support groups), to ensure adherence to multiple medications. These motivators included self-discipline, sense of personal responsibility, faith, support from family members and doctors, and focused health education and self-management support. Three themes emerged that enhanced understanding of the complexity of adherence to multiple medications: (1) reaching one’s own threshold for medication adherence, (2) lack of shared information and decision making, and (3) taking less than the prescribed medication. Further analysis of the data revealed that the patients perceived a lack of shared decision making in the management of their comorbid chronic conditions and their medication regimen.

Fatores associados a baixa adesao ao tratamento medicamentoso em idosos

“…This reinforces that simultaneously being treated for various chronic conditions, the lack of sharing in the management of chronic morbidities and in the medicine regime may predispose the older individual to low adherence. 13,15,27 Cognitive impairment is one of the most significant risk factors for low adherence to treatment in older adults, 23 above all the inability to prioritize, plan and organize, as well as the inability to remember information. 9,20 Difficulties in remembering to take medicines and using various medicines at the same time were obstacles reported by older adults in following treatment.…”

Effect of multimorbidity on health service utilisation and health care experiences

“…it is well established that multimorbidity can have significant financial implications for patients and their families, and that financial constraints can act as a barrier to effective management. 33,34 This is especially important given the higher prevalence of multimorbidity in lower-income individuals. 20,35,36 The co-payment funding model in NZ has been identified by GPs as a barrier to effective management of patients with multimorbidity, as it discourages sequential consultations.…”

Preferential adherence to antiretroviral therapy over tuberculosis treatment: A qualitative study of drug-resistant TB/HIV co-infected patients in South Africa

“…Studies conducted with individuals affected by multiple chronic co–morbidities show that differential adherence to particular medications may be influenced by their perceived side effects and perceived contribution to their overall wellbeing (Mishra, Gioia, Childress, Barnet, & Webster, 2011; Stack, Elliott, Noyce, & Bundy, 2008; Williams & Manias, 2014). Accounts from this study suggest that challenges to adherence for HIV and drug–resistant TB treatment are likely more complex.…”