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Abstract
Objective: The objective of the current work was to assess the frequency of non-adherence behaviors and potential association with patients’ experience with healthcare and beliefs in medicines self-reported by patients with four different chronic conditions.
Methods: Patients responded anonymously to a survey comprising five non-adherence behaviors (based on physician and patient input), an assessment of patients’ experience with healthcare using the validated Instrument to Evaluate the EXperience of PAtients with Chronic diseases (IEXPAC), and a validated Spanish version of the Beliefs about Medicines Questionnaire (BMQ). Associations of non-adherence behavior were analyzed using logistic regression models.
Results: Of 1530 respondents, 53.1% reported ≥1 non-adherence behavior. Non-adherence rates were 59.8% in diabetes mellitus (DM), 56.0% in rheumatic disease, 55.6% in inflammatory bowel disease, and 42.8% in human immunodeficiency virus (HIV) infection patients (p < .001). IEXPAC and BMQ scores were higher in adherent vs. non-adherent patients. In multivariate analysis, non-adherence behavior was strongly associated with lower overall BMQ, lower BMQ Necessity scores and higher BMQ Concerns scores (p < .001 for all), and with a lower IEXPAC self-management score (p = .007), but not with the overall IEXPAC score. Non-adherence was more frequent in DM patients compared with HIV infection patients (p < .001).
Conclusions: Patients’ beliefs in medicines-a lower perception for the necessity of medication, and higher concerns in taking medication-and low patient self-management experience score were associated with non-adherence behavior. These are modifiable aspects that need to be addressed to increase medication adherence in chronic disease.
Transparency
Declaration of funding
The current study was funded by Merck Sharp & Dohme Spain, a subsidiary of Merck & Co. Inc, Kenilworth, New Jersey, USA.
Declaration of financial/other relationships
Luis Cea-Calvo: Full-time employee at Merck Sharp & Dohme, Spain.
Ignacio Marín-Jiménez: Board membership or consultancy for AbbVie, Chiesi, FAES Farma, Falk-Pharma, Ferring, Gebro Pharma, Hospira, Janssen, MSD, Otsuka Pharmaceutical, Pfizer, Shire, Takeda, Tillots, and UCB Pharma, payments for lectures from AbbVie, Chiesi, FAES Farma, Falk-Pharma, Ferring, Gebro Pharma, Hospira, Janssen, MSD, Otsuka Pharmaceutical, Pfizer, Shire, Takeda, Tillots, and UCB Pharma.
Javier de Toro: No conflict of interest.
María J. Fuster-RuizdeApodaca: grants (to her institution) from MSD, Spain, Janssen Cilag, Gilead Sciences and ViiV Healthcare; consultancy for Gilead Sciences and ViiV Healthcare; payments for lectures (to her institution) from MSD, Spain, Gilead Sciences and ViiV Healthcare.
Gonzalo Fernández: Full-time employee at Merck Sharp & Dohme, Spain.
Nuria Sánchez-Vega: Full-time employee at Merck Sharp & Dohme, Spain.
Domingo Orozco-Beltrán: Consultancy and lectures for MSD, Sanofi, Novo Nordisk, Mundipharma, Menarini.
CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acknowledgements
The study was reviewed and endorsed by the following patients’ associations: Spanish Association of Patients with Arthritis (CONARTRITIS); Spanish Association of Patients with Crohn’s Disease and Ulcerative Colitis (ACCU); and the Spanish Federation of Patients with Diabetes (FEDE), and by the Spanish AIDS Multidisciplinary Society (SEISIDA). The authors wish to thank all patients who completed the survey and the IEXPAC working group for providing the IEXPAC tool for this study. Medical writing assistance was provided, under the guidance of the authors, by Robert A. Furlong PhD and David P. Figgitt PhD, ISMPP CMPP™ Content Ed Net, with funding from Merck Sharp & Dohme Spain.
