Factors Associated with Non-Adherence to Drugs in Patients with Chronic Diseases Who Go to Pharmacies in Spain

Abstract

Background. Pharmacological non-adherence in chronic diseases is 40–65%. No predictive profile of non-adherence exists in patients with multiple chronic diseases. Our study aimed to quantify the prevalence of non-adherence to pharmacological treatment and its associated factors in patients who visit pharmacies in Spain. Methods. This observational cross-sectional study included patients with one or more chronic diseases. The variables analyzed were demographics, diseases involved, self-medication, information about disease, and lifestyle. The main variable was adherence using the Morisky–Green test. A total of 132 pharmacies collaborated, providing 6327 patients representing all Spain regions (April–December 2016). Bivariate and multivariate analyses were performed and the area under the receiver operating characteristic (ROC) curve was calculated. Results. Non-adherence was 48.4% (95% confidence interval (CI): 47.2–49.7%). The variables that reached significance in the multivariate model were: difficulty in taking medication, self-medication, desire for more information, smoking, lower physical activity, younger age and number of chronic treatments. Discrimination was satisfactory (area under the ROC curve = 70%). Our study found that 50% patients was non-adherent and we obtained a profile of variables associated with therapeutic non-adherence. Conclusions. It is cause for concern that in patients with multiple diseases and taking multiple medications, there is an association between non-adherence, self-medication and worse lifestyle.

Medication Adherence in Chronic Older Patients: An Italian Observational Study Using Medication Adherence Report Scale (MARS-5I)

“…Regarding age, Llorca et al reported that in elderly patients (with multiple diseases and multiple medications), there is an association among non-adherence, self-medication, and worse lifestyle [34]. In our results, patients under 75 appeared to adhere slightly more than patients over 75, but the difference was not significant.…”

Validation of the Turkish version of the DOSE‐Nonadherence measure among patients with cardiometabolic conditions

“…In our study, having multiple chronic diseases and receiving multiple medications were associated with nonadherence, which is similar to a study of Spanish patients with chronic disease in community pharmacy. 3 In other work, pill burden has been associated with nonadherence in patient with diabetes mellitus and/or hypertension in community pharmacies. 25 Voils et al 21 determined forgetfulness of medication and being busy as the most common reasons for nonadherence in patients prescribed antihypertensive medications.…”

“…2 Another study carried out in community pharmacies in Spain revealed that almost half of the patients with chronic diseases were nonadherent to their medications. 3 Adherence is defined by WHO as 'the extent to which a person's behaviour (including taking medication, following a diet program, and/or executing lifestyle changes) corresponds with agreed recommendations from a health care provider'. 4,5 Vrijens et al 5 recently defined medication adherence as 'the process by which patients take their medications as prescribed, composed of initiation, implementation and discontinuation'.…”

“…A study conducted in community pharmacy settings in Turkey determined that only one‐fourth of patients prescribed oral chronic medication regimens were highly adherent to their medications 2 . Another study carried out in community pharmacies in Spain revealed that almost half of the patients with chronic diseases were nonadherent to their medications 3 …”

A systematic review on experimental studies about patient adherence to treatment

“…This SR also identified scientific evidence on the effect of patients' lifestyle on treatment adherence. The lifestyle factors with a reported significant effect are substance use and abuse (Meggetto et al, 2017;Sieben et al, 2021;Llorca et al, 2021) and physical activity (Nascimento et al, 2016;Shankari, 2020). Among the studies reviewed, no reference was made to the study of the effect of the social situation of the patient in adherence to treatment.…”