Reasons for medication non-initiation: A qualitative exploration of the patients’ perspective

Gil-Girbau, Montserrat; Aznar-Lou, Ignacio; Peñarrubia-María, Maria Teresa; Moreno-Peral, Patrícia; Fernández, Anna; Jové, Anna Maria; Mendive, Juan Manuel; Fernández‐Vergel, Rita; Figueiras, Adolfo; March-Pujol, Marian; Rubio-Valera, María

doi:10.1016/j.sapharm.2019.08.002

Cited by 17 publications

(32 citation statements)

References 44 publications

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“…As expected, the factors that account for non-initiation of insulins and treatments for cardiovascular disease differ from those identified in the primary study [14] , which explored factors that explained non-initiation of treatments for acute and chronic physical and mental disorders. In line with previous studies focusing on treatments for cardiovascular disease and/or diabetes, younger age, lower socioeconomic status, place of origin, number of concomitant prescriptions, and distrust in the provider (prescription held by a substitute/resident physician) increased the risk of noninitiation [17,18,28,32], while younger age and female gender increased the risk of single dispensing [10,30]. In contrast, this study also identified explanatory factors of non-initiation and single dispensing not described in the literature, such as BMI and concomitant diseases.…”

Section: Discussionsupporting

confidence: 85%

“…The studies that focused on single dispensing of cardiovascular or diabetes medications reported that younger, female patients who visited the physician less frequently had a lower probability of filling a second prescription. Qualitative studies indicate that patients' beliefs and knowledge about the disease and the treatment, emotions, preferences for lifestyle interventions and mistrust of the diagnosis also contribute to non-initiation [17,18].…”

Section: Introductionmentioning

confidence: 99%

“…This analysis included patients who had received a new prescription of a medication contained in the 13 most prescribed and/or costly pharmacotherapeutic subgroups in the public health system, and drugs for acute conditions accounted for over 50% of the prescriptions. Faced with the prescription of a new treatment for a chronic disease, patients may respond with fear or frustration and prefer to delay the start of treatment until they have explored non-pharmacological treatment options [17]. This may delay the start of treatment, which would explain the significant variation observed in the prevalence of non-initiation 1 and 3 months after prescription.…”

Section: Introductionmentioning

confidence: 99%

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Initiation and Single Dispensing in Cardiovascular and Insulin Medications: Prevalence and Explanatory Factors

Vilaplana-Carnerero

Aznar-Lou

Peñarrubia-María

et al. 2020

IJERPH

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Background: Adherence problems have negative effects on health, but there is little information on the magnitude of non-initiation and single dispensing. Objective: The aim of this study was to estimate the prevalence of non-initiation and single dispensation and identify associated predictive factors for the main treatments prescribed in Primary Care (PC) for cardiovascular disease (CVD) and diabetes. Methods: Cohort study with real-world data. Patients who received a first prescription (2013–2014) for insulins, platelet aggregation inhibitors, angiotensin-converting enzyme inhibitors (ACEI) or statins in Catalan PC were included. The prevalence of non-initiation and single dispensation was calculated. Factors that explained these behaviours were explored. Results: At three months, between 5.7% (ACEI) and 9.1% (antiplatelets) of patients did not initiate their treatment and between 10.6% (statins) and 18.4% (ACEI) filled a single prescription. Body mass index, previous CVD, place of origin and having a substitute prescriber, among others, influenced the risk of non-initiation and single dispensation. Conclusions: The prevalence of non-initiation and single dispensation of CVD medications and insulin prescribed in PC in is high. Patient and health-system factors, such as place of origin and type of prescriber, should be taken into consideration when prescribing new medications for CVD and diabetes.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Initiation and Single Dispensing in Cardiovascular and Insulin Medications: Prevalence and Explanatory Factors

Vilaplana-Carnerero

Aznar-Lou

Peñarrubia-María

et al. 2020

IJERPH

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“…Pain is highly disabling (Rice et al, 2016), and some opioids and antiepileptics, which are used in severe cases, are expensive. People with symptomatic and disabling disorders are more motivated to initiate a treatment (Gil-Girbau et al, 2019), which could partially explain why they seek help to cover the treatment expenses when they are experiencing financial hardship. N 2,417 N 3,892,497 N 40,378 N 50,320,043 N 8,228 N 82,689,934 Alimentary tract and metabolism (A) 11.3 (235) 5.22 (203,126) 15.8 (6,161) However, chronic pain is associated with high productivity losses due to sick leave and unemployment, partly due to comorbidity with mood disorders (Dorner et al, 2016), which increases the vulnerability of people suffering from pain (Giladi et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Who Suffers From Pharmaceutical Poverty and What Are Their Needs? Evidence From a Spanish Region

et al. 2021

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Background: Pharmaceutical poverty occurs when a patient cannot afford the cost of prescribed medication and/or medical products. Nonprofit organizations are covering the cost of medication to those patients in some contexts. The aim of the study was to describe the population of beneficiaries of the PB, a nongovernmental organization based on the primary healthcare system, which provides free-of-charge access to medicines and their utilization pattern of medicines and healthcare products.Methods: This was an observational study using PB beneficiary data collected between November 2017 and December 2018 in Catalonia. The Catalan Health Service provided information from the general population. A descriptive analysis of the beneficiaries’ characteristics was conducted and compared to the general population.Results: The beneficiaries (N = 1,206) were mainly adults with a low level of education, unemployed, with functional disability, and with ≥1 child. Compared with the general population, the beneficiaries were older, had a lower level of education, showed a higher prevalence of functional disability, were less likely to be Spanish, and were more likely to be divorced and unemployed. The beneficiaries were polymedicated, and most were using medication related to the nervous (79%), musculoskeletal (68%), and cardiovascular system (56%) and alimentary tract and metabolism (68%). Almost 19% of beneficiaries used healthcare products. Female beneficiaries were older and more likely to be divorced or widowed, employed, and with children. Compared to men, women were more likely to use medicines for pain and mental disorders. The pediatric group used medications for severe, chronic conditions (heart diseases, autoimmune diseases, conduct disorders, and attention deficit hyperactivity disorder).Conclusion: Patients with severe, chronic, and disabling conditions are affected by pharmaceutical poverty. While the system of copayment remains unchanged, family physicians and pediatricians should explore economic barriers to treatment and direct their patients to resources that help to cover the cost of treatment.

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“…Pain is highly disabling [37] and some opioids and antiepileptics, which are used in severe cases, are expensive. People with symptomatic and disabling disorders are more motivated to initiate a treatment [38], which could partially explain why they seek help to cover the treatment expenses when they are experiencing nancial hardship. However, chronic pain is associated with high productivity losses due to sick leave and unemployment, partly due to comorbidity with mood disorders [39], which increases the vulnerability of people suffering from pain [40].…”

Section: Discussionmentioning

confidence: 99%

Who suffers from pharmaceutical poverty and what are their needs? Evidence from a Spanish region.

Rubio-Valera¹,

Marqués-Ercilla

Peñarrubia-María

et al. 2020

Preprint

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Background Pharmaceutical poverty occurs when a patient cannot afford the cost of prescribed medication and/or medical products. Non-profit organisations are covering the cost of medication to those patients in some contexts. The aim of the study was to describe the population of beneficiaries of the PB, a non-governmental organization which provides free of charge access to medicines, and their utilization pattern of medicines and healthcare products. Methods This was an observational study using PB beneficiary data collected between November 2017 and December 2018 in Catalonia. The Catalan Health Service provided information from the general population. A descriptive analysis of the beneficiaries’ characteristics was conducted and compared to general population. Results The beneficiaries (N = 1206) were mainly adults with a low level of education, unemployed, with functional disability and with ≥ 1 children. Compared with the general population, the beneficiaries were older, had a lower level of education, showed a higher prevalence of functional disability, were less likely to be Spanish, and more likely to be divorced and unemployed. The beneficiaries were polymedicated and most were using medication related to the nervous (79%), musculo-skeletal (68%) and cardiovascular system (56%) and alimentary tract and metabolism (68%). Almost 19% of beneficiaries used healthcare products. Female beneficiaries were older and more likely to be divorced or widowed, employed and with children. Compared to men, women were more likely to use medicines for pain and mental disorders. The paediatric group used medications for severe, chronic conditions (heart diseases, autoimmune diseases, conduct disorders and attention deficit hyperactivity disorder). Conclusions Patients with severe, chronic and disabling conditions are affected by pharmaceutical poverty. While the system of co-payment remains unchanged, physicians and paediatricians should explore economic barriers to treatment and direct their patients to resources that help to cover the cost of treatment.

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Reasons for medication non-initiation: A qualitative exploration of the patients’ perspective

Cited by 17 publications

References 44 publications

Initiation and Single Dispensing in Cardiovascular and Insulin Medications: Prevalence and Explanatory Factors

Initiation and Single Dispensing in Cardiovascular and Insulin Medications: Prevalence and Explanatory Factors

Who Suffers From Pharmaceutical Poverty and What Are Their Needs? Evidence From a Spanish Region

Who suffers from pharmaceutical poverty and what are their needs? Evidence from a Spanish region.

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