https://orcid.org/0000-0001-5990-3595
Abstract
Purpose
Medication nonadherence is a significant and multidimensional problem contributing to an increased risk of morbidity and mortality. Inconveniences in pharmacy and home contexts may increase nonadherence. This research examined inconveniences in pharmacy and home contexts associated with self-reported nonadherence, controlling for demographic and medication-taking covariates.
Methods
Data from 4682 individuals who reported self-managing medications in an online marketing survey between October and December 2017 were analyzed in this secondary analysis. Nonadherence was dichotomized using a single question about likelihood to take medications as prescribed (adherence=always; nonadherence=most of the time, some of the time, never). Multivariable logistic regression with backwards elimination was used to examine the pharmacy (use of home delivery, number prescriptions picked up and visits to pharmacy) and home context (method used to organize/manage medications, satisfaction, and bother with management) variables and the demographic (age, sex, race/ethnicity, education, income, insurance) and medication (number of oral medications, medication changes and frequency of taking) covariates associated with nonadherence.
Results
Overall, 25.8% of the responses indicated nonadherence. Nonadherence was more likely for individuals making fewer separate pharmacy trips (OR 0.98; 95% CI 0.97–0.99); picking up fewer prescriptions (OR 0.96; 95% CI 0.93–0.99); never, rarely or sometimes using mail order compared with always (OR 1.71; 95% CI 1.30–2.26); not satisfied with managing medications (OR 2.13; 95% CI 1.42–3.19); and using pill pouches and being bothered by them (OR 8.28; 95% CI 1.83–37.31). Using pill pouches or a pillbox and not being bothered by them significantly decreased nonadherence likelihood. Younger and female respondents and those reporting medication changes in the last year were also more likely to report nonadherence.
Conclusion
Though reasons for nonadherence are multidimensional, this study suggests that inconveniences in both the pharmacy and home context are important. Improving adherence requires addressing issues of inconvenience across the care continuum.
Acknowledgments
The authors thank the Becton, Dickinson and Company and Ipsos teams for their assistance in developing the larger study in which the data reported here was collected. In addition, we express appreciation to Kari Meyers, Yan Xiong, and Sneh Ringwala (Becton, Dickinson and Company) for their critical reading of and helpful commentary on earlier drafts of this paper. Becton, Dickinson and Company funded this research.
Disclosure
Rebecca J Bartlett Ellis and Todd Ruppar received consulting fees from Becton, Dickinson and Company for this research. Ellis has a patent method and system for autonomously measuring, recording, and reporting changes in the interior content of containers (AKA “Smart Pillbox”) pending. Deanna Hertz is an employee of Ipsos, the consultancy that received a fee from Becton Dickinson for this research. Patrick Callahan was an employee of Becton, Dickinson and Company at the time the manuscript was prepared. The authors report no other conflicts of interest in this work.