Toward Identifying the Causes and Combinations of Causes Increasing the Risks of Nonadherence to Medical Regimens: Combined Results of Two German Self-Report Surveys

Wilke, Thomas; Müller, Sabrina; Morisky, Donald E.

doi:10.1016/j.jval.2011.06.002

Cited by 31 publications

(29 citation statements)

References 70 publications

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“…In order to improve adherence, it is necessary to understand the reasons behind NA. Previous studies have shown that adherence is affected by sociodemographic (eg, age and sex) and socioeconomic factors, the patient’s attitude towards drugs, their relationship with the health care professional, patient characteristics, the prescribing of complicated dosage regimens, and the development of adverse drug reactions (ADRs) 1,2,4,6–8. Moreover, psychological distress, such as anxiety and depression, which affect cognitive function and health behavior, also influence adherence 9.…”

Section: Introductionmentioning

confidence: 99%

The influence of symptoms of anxiety and depression on medication nonadherence and its causes: a population based survey of prescription drug users in Sweden

Sundbom¹,

Bingefors²

2013

PPA

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PurposeThe purpose of this study was to evaluate the associations between self-reported symptoms of anxiety and/or depression, nonadherent (NA) behaviors, and reasons for NA to medication regimens.MethodsA population based cross-sectional study with questionnaire was performed in the general Swedish population. The participants were 2,802 prescription drug users aged 18–84 years. The questionnaire covered use of prescription drugs, symptoms of anxiety and/or depression, based on the Hospital Anxiety and Depression Scale (HADS), various NA behavior types, intentional and unintentional, and various reasons for NA.ResultsSymptoms of anxiety and depression, independently and in combination, were associated with unintentional and intentional NA, with a stronger association with intentional NA. Regarding the reasons given for NA, for example anxiety, independently or in combination with depression, was associated with a fear of developing adverse drug reactions (ADRs). Depression, independently or in combination with anxiety, on the other hand, was associated with the actual development of ADRs.ConclusionA cross-sectional design such as this does not allow assessment of causality derived from the results. However, the results indicate that patients experiencing symptoms of psychological distress are at increased risk of NA, especially intentional NA, and could therefore benefit from extra attention from the health care professional. Patients with symptoms of anxiety and/or depression should be identified and monitored for the development and/or fear of ADRs, in order to improve adherence to medication regimens.

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Section: Introductionmentioning

confidence: 99%

The influence of symptoms of anxiety and depression on medication nonadherence and its causes: a population based survey of prescription drug users in Sweden

Sundbom¹,

Bingefors²

2013

PPA

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“…Overall, incomplete adherence has been found to occur in 26% to 60% of all patients 13–15. For Germany, the results range between 35% and 50%,16,17 yet to this point, adherence has only been investigated in a few studies. In general, the findings vary depending on sample characteristics and applied measurement instruments 18,19.…”

Section: Introductionmentioning

confidence: 99%

“…Adherence measures include pill count, physical tests, medical records, self-report, collateral report, or electronic monitoring 12. Concerning sample characteristics, the following health-related variables have been found to be statistically significantly associated with incomplete adherence: disease (particularly low subjective severity of the disease to be treated, or low “disease threat”;12 also the occurrence of depression21); low objective severity of disease in patients with less serious conditions as well as a high objective severity of disease in patients with more serious conditions;22 low perceived need for medication;23 lack of social support (including emotional support, family cohesiveness, and marital status);24 poor communication between patient and physician;25 high complexity of a patient’s medication regimen;16,18,26 and low extent of medication information (in this context, medication information means the level to which patients feel they have received enough information about prescribed medication) 27,28. Unfortunately, these health-related factors are not always easy to assess in practice.…”

Section: Introductionmentioning

confidence: 99%

Incomplete medication adherence of chronically ill patients in German primary care

Hüther

Wolff²,

Stange³

et al. 2013

PPA

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BackgroundIncomplete medication adherence is a major problem in health care worldwide. Patients who adhere to medical treatment have a better prognosis and create fewer costs.ObjectiveTo assess the degree of incomplete adherence of chronically ill routine primary care patients in a German setting and analyze the association between incomplete medication adherence, as well as clinical and sociodemographic patient characteristics. Methods: In a cross-sectional survey, chronically ill patients were asked to assess their adherence in primary care retrospectively using the Medication Adherence Report Scale (MARS-D) questionnaire. To investigate the association of incomplete adherence with sociodemographic and clinical data, univariate and multivariate analyses were conducted.ResultsIn total, 62.1% of 190 patients were categorized as incompletely adherent. The mean MARS-D score was 23.5 (standard deviation = 2.7). Analyses revealed no statistically significant associations at P < 0.05 between degree of adherence and patient characteristics. The total explained variance amounted to 11.8% (Nagelkerke’s R2 = 0.118) in the multivariate analysis.ConclusionPreviously reported results regarding associations of sociodemographic and clinical data with incomplete medication adherence could not be confirmed for this sample of chronically ill patients. In order to be able to provide guidelines for the reduction of incomplete medication adherence in German primary care, further research is needed.

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“…Such factors that lead to intentional behaviors are the cost of medication, presence of adverse effects, or a lack of understanding of the seriousness of the disease. The existence of one or more intentional, medication-based causal factors considerably increases the risk of patient nonadherence 15. Intentional barriers have been traditionally addressed through patient assistance or disease state management programs; however, little emphasis has been placed on methods to address unintentional barriers to patient adherence 16.…”

Section: Introductionmentioning

confidence: 99%

Real-world impact of reminder packaging on antihypertensive treatment adherence and persistence

Dupclay

Eaddy²,

Jackson³

et al. 2012

PPA

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BackgroundPatient medication adherence is multidimensional and poses significant concerns to health care professionals. One aspect of adherence is a patient forgetting to take their prescribed medication, which may be improved with reminder packaging (RP). The objective of this analysis was to assess the impact of RP on patient adherence to antihypertensive therapy.MethodsThis retrospective, propensity score-matched study evaluated patients switching to a single-pill combination of valsartan-hydrochlorothiazide in RP compared with patients remaining on the combination without reminder packaging (non-RP). Patients receiving combination therapy between April 1, 2009 and July 31, 2010 were eligible for inclusion. Patients were propensity score-matched on baseline adherence and background demographic variables, including comorbidities. Medication possession ratio, proportion of days covered, time to refill, and time to discontinuation were evaluated as primary measures of subsequent adherence and persistence.ResultsIn a total of 9266 matched patients (4633 participants in both cohorts), adherence was significantly higher in the RP cohort compared with patients in the non-RP cohort (medication possession ratio, RP 80% versus non-RP 73%; proportion of days covered, RP 76% versus non-RP 63%; both P < 0.001). Refill timing was 10 days for RP patients versus 16 days for non-RP patients (P < 0.001). Similar trends were observed with respect to time to discontinuation (RP 196 days, non-RP 174 days; P < 0.001). A higher proportion of RP patients remained on therapy compared with non-RP patients, with patients in the RP group being 17% less likely to discontinue therapy compared with patients in the non-RP group (hazards ratio 0.833; 95% confidence interval 0.793–0.875).ConclusionThis real-world assessment of differences in adherence and persistence rates demonstrated that patients receiving RP were more adherent and persistent with their treatment regimens.

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Toward Identifying the Causes and Combinations of Causes Increasing the Risks of Nonadherence to Medical Regimens: Combined Results of Two German Self-Report Surveys

Abstract: About one-third of patients can be classified as nonadherent. Intentional/medication-based NA causal factors explain the NA considerably better than do socioeconomics. The existence of more than one cause of risk considerably increases the NA risk of a patient.

Cited by 31 publications

References 70 publications

The influence of symptoms of anxiety and depression on medication nonadherence and its causes: a population based survey of prescription drug users in Sweden

The influence of symptoms of anxiety and depression on medication nonadherence and its causes: a population based survey of prescription drug users in Sweden

Incomplete medication adherence of chronically ill patients in German primary care

Real-world impact of reminder packaging on antihypertensive treatment adherence and persistence

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