Clusters of non-adherence to medication in neurological patients

Prell, Tino; Großkreutz, Julian; Mendorf, Sarah; Franke, Gabriele Helga; Witte, Otto W.; Kunze, Anja

doi:10.1016/j.sapharm.2019.01.001

Cited by 29 publications

(41 citation statements)

References 26 publications

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“…Based on our previous work, each patient was categorized into one cluster of nonadherence: modifications, lack of knowledge, and forgetfulness (14). In the cluster "modifications, " for example, medications were adjusted by patients without consulting their doctor on either experiencing side effects or improvement in health.…”

Section: Discussionmentioning

confidence: 99%

“…This observational study was approved by the local ethics committee of the Jena University Hospital (4572-10/15 (17). It allows the assessments of three common reasons/cluster of nonadherence: modifications of medication, forgetting to take the medication, and lack of knowledge about medications (14). The full SAMS is available online (CC BY NC 3.0 license): https://data.mendeley.com/ datasets/ny2krr3vgg/1 (18).…”

Section: Participants and Assessmentsmentioning

confidence: 99%

“…The full SAMS is available online (CC BY NC 3.0 license): https://data.mendeley.com/ datasets/ny2krr3vgg/1 (18). It was so far not explicitly used in patients with PD, but in a mixed cohort of patients with different neurological disorders (also including people with PD) (14). The total number of patients recruited for the study was 300.…”

Section: Participants and Assessmentsmentioning

confidence: 99%

“…For example, do patients with higher functional impairment more frequently modify or forget their prescribed medication than those with better motor performance? (14).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Participants and Assessmentsmentioning

confidence: 99%

Section: Participants and Assessmentsmentioning

confidence: 99%

“…For example, do patients with higher functional impairment more frequently modify or forget their prescribed medication than those with better motor performance? (14).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2020

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“…The sum of scores ranged from 0 (fully adherent) to 72 (fully nonadherent). Moreover, it allows the assessment of three common reasons for/clusters of nonadherence: modification of medications, forgetting to take the medications, and lack of knowledge about the medications (23). The whole copy of SAMS is available online (CC BY NC 3.0 license; https://data.mendeley.…”

Section: Participants and Assessmentsmentioning

confidence: 99%

Association Between Nonmotor Symptoms and Nonadherence to Medication in Parkinson's Disease

et al. 2020

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Background: Nonadherence to medication is a common and serious issue in the treatment of patients with Parkinson's disease (PD). Among others, distinct nonmotor symptoms (NMS) were found to be associated with nonadherence in PD. Here, we aimed to confirm the association between NMS and adherence. Methods: In this observational study, the following data were collected: sociodemographic data, the German versions of the Movement Disorder Society-sponsored revision of the unified Parkinson's disease rating scale for motor function (MDS-UPDRS III), Hoehn and Yahr (H&Y) stage, levodopa equivalent daily dose (LEDD), Becks depression inventory II (BDI-II), nonmotor symptoms questionnaire (NMSQ), and the Stendal adherence to medication score (SAMS). Results: The final sample included 137 people with PD [54 (39.4%) females] with a mean age of 71.3 ± 8.2 years. According to SAMS, 10.9% of the patients were fully adherent, 73% were moderately nonadherent, and 16.1% showed clinically significant nonadherence. Nonadherence was associated with LEDD, BDI-II, education level, MDS-UPDRS III, and the NMSQ. The number of NMS was higher in nonadherent patients than in adherent patients. In the multiple stepwise regression analysis, the items 5 (constipation), 17 (anxiety), and 21 (falls) predicted nonadherence to medication. These NMSQ items also remained significant predictors for SAMS after correction for LEDD, MDS-UPDRS III, BDI-II, age, education level, gender, and disease duration. Conclusion: Our study, in principle, confirms the association between NMS burden and nonadherence in PD. However, in contrast to other clinical factors, the relevance of NMSQ in terms of nonadherence is low. More studies with larger sample sizes are necessary to explore the impact of distinct NMS on adherence.

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