Sociobehavioral Determinants of Compliance with Health and Medical Care Recommendations

Becker, Marshall H.; Maiman, Lois A.

doi:10.1097/00005650-197501000-00002

Cited by 1,365 publications

(667 citation statements)

References 78 publications

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“…A similar result has also been reported by other researchers (27). This result is consistent with the Health Belief Model, which suggests that beliefs about a disease and its treatment predispose individuals to adhere to their drug treatment (28,29).…”

Section: Discussionsupporting

confidence: 91%

Predictors of self-reported noncompliance with antihypertensive drug treatment: A prospective cohort study

Grégoire

Moisan

Guibert

et al. 2006

Canadian Journal of Cardiology

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C ardiovascular disease remains the leading cause of mortality in the developed world. Despite evidence that blood pressure control may reduce premature cardiovascular mortality (1,2) and despite the availability of effective treatment for high blood pressure, a large proportion of identified hypertensive individuals do not have his or her blood pressure controlled (ie, diastolic blood pressure is greater than 90 mmHg or systolic blood pressure is greater than 140 mmgHg) (3-5).Poor adherence to the recommended drug regimen constitutes a major barrier to adequate control of high blood pressure (3). Three different aspects can be differentiated within the broader concept of adherence (6). The first aspect is acceptance, BACKGROUND: Persistence and compliance are different aspects of the broader concept of adherence to drug treatment. In a prior study, determinants of nonpersistence in a group of patients newly prescribed antihypertensive medications were examined. OBJECTIVE: To determine noncompliance among those who were persistent with therapy. METHODS: A prospective cohort study was conducted, in which individuals prescribed a new antihypertensive monotherapy were identified through a network of 173 pharmacies. Participants were interviewed by telephone twice during a three-month period. At the end of this period, individuals who reported still taking the medication initially prescribed were included in the analysis. Self-reported noncompliance was measured at three months. Data were analyzed using a multivariate logistic regression model. RESULTS: Of 509 eligible participants, 118 (23.2%) reported noncompliance with their drug treatment. Noncompliance was significantly associated with the use of angiotensin-converting enzyme inhibitors (adjusted OR [AOR] 3.0; 95% CI 1.17 to 7.92) compared with the angiotensin II receptor blocker losartan, and with the belief that hypertension is not a risk factor for cardiovascular diseases (AOR 2.0; 95% CI 1.21 to 3.33). On the other hand, noncompliance was inversely associated with the use of more than four pills of medication per day (AOR 0.3; 95% CI 0.15 to 0.64). CONCLUSIONS: Compliance with drug treatment could be improved by proper selection of medication, and by attempts to correct the false perceptions patients may have about hypertension. Further research is needed to better understand the clinical significance of a higher number of pills as a predictor of good compliance. Further research is also needed using different means of measuring noncompliance.

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Section: Discussionsupporting

confidence: 91%

Predictors of self-reported noncompliance with antihypertensive drug treatment: A prospective cohort study

Grégoire

Moisan

Guibert

et al. 2006

Canadian Journal of Cardiology

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“…The SPRITE intervention was based on the Health Belief Model, 8 which posits that "modifying factors" affect patient engagement in healthful behaviors such as medication adherence. We sought to address limitations in current evidence by exploring associations between self-reported cardiovascular disease medication adherence and potential modifying factors from the SPRITE baseline survey.…”

Section: Patient Factors Evaluatedmentioning

confidence: 99%

“…For this analysis, we used Health Belief Model principles and other literature to organize potential modifying factors into four categories: demographics/patient characteristics, medical comorbidities, psychosocial factors, and health belief-related factors. 8,14 (See Appendix, Table 4 for additional information regarding these factors, including question wording, relevant scale ranges, and dichotomization thresholds.) Demographics/patient characteristics included age, sex, race, education level, marital status, and employment status.…”

Section: Patient Factors Evaluatedmentioning

confidence: 99%

“…8 In order to inform the development of strategies to enhance cardiovascular disease medication adherence, studies have sought to identify factors associated with non-adherence. Known correlates of suboptimal medication adherence among patients with cardiovascular disease include demographic factors, 5,9-12 certain socioeconomic factors (e.g., under-insurance, education level), 9,10 and medical comorbidities.…”

Section: Introductionmentioning

confidence: 99%

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Medication Non-Adherence After Myocardial Infarction: An Exploration of Modifying Factors

et al. 2014

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BACKGROUND: Medication non-adherence is a major impediment to the management of cardiovascular disease risk factors. A better understanding of the modifying factors underlying medication non-adherence among individuals with known cardiovascular disease may inform approaches for addressing non-adherence. OBJECTIVE: The purpose of this study was to identify demographic and patient characteristics, medical comorbidities, psychosocial factors, and health belief-related factors associated with medication non-adherence among patients with known cardiovascular disease. DESIGN: We performed secondary analysis of baseline data from a randomized trial. PATIENTS: The study included 405 patients with a diagnosis of hypertension and history of acute myocardial infarction that was diagnosed within a three-year period prior to enrollment. MAIN MEASURES: Baseline demographics and patient characteristics, medical comorbidities, psychosocial factors, health belief-related factors, and patient-reported medication non-adherence were analyzed. KEY RESULTS: Of 405 patients, 173 (42.7 %) reported medication non-adherence. Factors associated with nonadherence in bivariate analysis included younger age, non-white race, having less than 12 years of education, smoking, financial insecurity, identifying as nervous or tense, higher life chaos score, greater worry about having a myocardial infarction, and greater worry about having a stroke. Using multivariable modeling, we determined that age (OR 0.97 per additional year, 95 % CI, 0.95-0.99), life chaos (OR 1.06 per additional point, 95 % CI, 1.00-1.11), and worry about stroke (OR 1.12 per additional point, 95 % CI, 1.01-1.25) remained significantly associated with self-reported medication non-adherence. CONCLUSIONS: We found that worry about having a stroke, higher life chaos, and younger age were all significantly associated with self-reported medication nonadherence in patients with cardiovascular disease and a history of myocardial infarction. Further research exploring these factors as targets for intervention is needed, as is additional research examining modifiable causes of medication non-adherence among patients with cardiovascular disease.KEY WORDS: cardiovascular disease; medication non-adherence; psychosocial; health beliefs.

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“…11 However, the scientific literature is confounded by a variation in the explanatory factors of appropriate consumption and a wide range in the measured extent of their impact. 12,13 Publications from controlled clinical trials with robust internal validity are likely needed to ascertain predictive characteristics. Individuals who are not able to receive needed medications are at risk for diminished management of their syndrome.…”

Section: Introductionmentioning

confidence: 99%

Association of increased emergency rooms costs for patients without access to necessary medications

Watanabe

Ney

2015

Research in Social and Administrative Pharmacy

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Background: Prescription medications are an important component of chronic disease management. They are vital in preventing unnecessary ER visits. However, few studies have examined the association between patients' self-reported inability to receive necessary medications and emergency room costs. Objectives: The study objectives were to: 1) determine differences in ER costs based on self-reported ability to obtain necessary medications. 2) identify differences in ER costs based on self-reported ability to obtain necessary medications among medication users. The association was also examined by insurance category. Methods: Respondent data from 10 years (2002-2011) of the U.S. Medical Expenditure Panel Survey was analyzed. The models employed estimated the association of respondents reporting being 'unable to receive necessary medications' on ER expenditures. Secondarily, the relationship was assessed by insurance category: private, public, and uninsured. Two-part cost regression models with bootstrapped estimates to produce 95% confidence intervals of cost differences were applied for these analyses. Significance was set at a ¼ 0.05. Analyses were completed using SAS 9.4 (Cary, NC) and Stata 13 (College Station, TX). Estimates were in 2011 US dollars. Results: People unable to receive necessary medications experienced increased average annual ER costs of $46.62 with 95% a confidence interval [CI] of 34.76-58.49) compared to patients able to receive necessary medications. By insurance category, respondents unable to receive necessary medications experienced increased ER costs ), for Publically Insured, Privately Insured, and Uninsured, respectively. Findings were similar for those already using medications. Conclusions: Inability to obtain necessary medications is associated with increased emergency room costs. Those with public insurance have a larger increase in ER costs if they are without necessary medications compared to those insured privately or without insurance.

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Sociobehavioral Determinants of Compliance with Health and Medical Care Recommendations

Cited by 1,365 publications

References 78 publications

Predictors of self-reported noncompliance with antihypertensive drug treatment: A prospective cohort study

Predictors of self-reported noncompliance with antihypertensive drug treatment: A prospective cohort study

Medication Non-Adherence After Myocardial Infarction: An Exploration of Modifying Factors

Association of increased emergency rooms costs for patients without access to necessary medications

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