Patient and Provider Perspectives on Medication Non-adherence Among Patients with Depression and/or Diabetes in Diverse Community Settings – A Qualitative Analysis

Figures & data

Table 1 Patient Focus Group Questions

Facilitator: We are glad you are attending this focus group. If it is ok with you, we would like to talk with you about your experience taking prescription medications, and specifically about adhering to the medication regimen.  1. Please describe your understanding of the meaning of “medication adherence” also referred to as “medication compliance”  2. Do you believe medication adherence has a positive impact on the symptoms related to your illness or your overall health? Why or why not?  3. Has your medical provider ever discussed medication adherence with you during a clinical appointment or during hospitalization? If yes, describe what you remember your provider telling you about medication adherence or what you remember saying about your adherence. Facilitator: Intentional medication non-adherence occurs when individuals choose not to take their medication as prescribed. You may choose not to take your medication for many different reasons. Common reasons include not liking medication side effects or because you do not think you need the medication.  4. Has there ever been a time when you chose not to take a medication prescribed to you by your medical provider? If yes, please describe why you chose not to take your medication.  5. If you chose not to take a particular medication did you talk with your provider about it?  If yes, please describe what you remember about the conversation. Facilitator: Unintentional medication non-adherence can occur when you forget to take your medication, lose your medication, or did not understand the directions for taking your medication (when to take it and the correct dose).  6. Has there ever been a time when you did not take a medication prescribed to you by your medical provider because you forgot, lost the medication, or did not understand the directions?   If yes, please describe what happened.  7. If you did not to take a particular medication for one of these reasons did you talk with your provider about it? If yes, please describe what you remember about the conversation.  8. Are there any final thoughts you would like to share about medication adherence? For instance, is there anything you hope that researchers studying this problem should know about the day-to-day challenge of adhering to prescribed medications?

Table 2 Provider Focus Group Questions

Facilitator: We are glad you are attending this focus group. If it is ok with you, we would like to talk with you about your experience interacting with patients who are on prescription medications, and specifically about those patients adhering to the medication regimen. Many of the following questions may seem like obvious, basic clinical knowledge, but part of the goal of this study is to assess agreement on these issues between patients and providers.  1. Please describe your understanding of the meaning of “medication adherence” also referred to as “medication compliance.”  2. Do you believe medication adherence has a positive impact on the symptoms related to your patients’ illnesses or your overall health? Why or why not?  3. (a) How often do you discuss medication adherence with your patients?   (b) How do your patients typically describe—in their words—their adherence to their medications? Facilitator: Intentional medication non-adherence occurs when individuals choose not to take their medication as prescribed. Patients may choose not to take your medication for many different reasons. Common reasons include not liking medication side effects or not thinking the medication is necessary.  4. (a) How often do patients admit to you that they have intentionally not taken their medication?   (b) How often do you feel patients have intentionally not taken their medication, but refuse to admit non-adherence during a visit?  5. (a) When patients do admit to intentional non-adherence, how do they typically describe the reasons for non-adherence and the pattern of non-adherence (such as never taking the medication, sometimes not taking it, only taking it based on how they feel, etc.)?   (b) How do you document these types of intentional non-adherence in the electronic medical record? For instance, what key words do you use to describe intentional non-adherence? Facilitator: Unintentional medication non-adherence can occur when you forget to take your medication, lose your medication, or did not understand the directions for taking your medication (when to take it and the correct dose).  6. (a) How often do patients admit to you that they have unintentionally not taken their medication?   (b) How often do you feel patients have unintentionally not taken their medication, but refuse to admit non-adherence during a visit?  7. (a) When patients do admit to unintentional non-adherence, how do they typically describe the reasons for non-adherence and the pattern of non-adherence (such as occasionally forgetting, forgetting on weekends, etc.)?   (b) How do you document these types of unintentional non-adherence in the electronic medical record? For instance, what key words do you use to describe unintentional non-adherence?  8. Are there any final thoughts you would like to share about medication adherence? For instance, is there anything you hope that researchers studying this problem should know information related to medication adherence is recorded (or not recorded) in the electronic health record (EHR)?

Table 3 Focus Group One

Theme	Coder #1 J.H.	Coder #2 K.R.
Patient Provider Communication	24	24
Provider Trust	8	8
Health Literacy	11	11
Perceptual Barriers: Disagreement about Dosing	5	5
Perceptual Barriers: Medication Effectiveness	15	15
Perceptual Barriers: Medication Side Effects	18	18
Practical Barriers: Medication Cost	20	13
Practical Barriers: Homelessness	1	1
Practical Barriers: Forgetting Medication	16	3
Practical Barriers: Losing Medication	3	3
Practical Barriers: Polypharmacy	11	11
Difficult Administration/Use of Depot	4	4
Substance Use	2	2

Table 4 Focus Group Two

Theme	Coder #1 J.H.	Coder #2 K.R.
Patient Provider Communication	10	17
Obtaining detailed information about adherence (Clarifying Patient Definition of Adherence)/Probing Questions	4	2
Consider the Patient’s Definition of Adherence	15	0
Health Literacy	8	8
Complex Directions	3	3
Perceptual Barriers: Medication Effectiveness	9	9
Perceptual Barriers: Side Effects	7	7
Practical Barriers: Stolen Medications	3	5
Practical Barriers: Non-adherence due to not attending out-patient appointments	7	0
Practical Barriers: Medication Cost	6	6
Practical Barriers: Homelessness	3	1
Practical Barriers: Forgetting Medication	6	6
Practical Barriers: Polypharmacy	8	6
Documented Non-Adherence Reasons in EHR (Barriers)	3	1
Family/Caregiver Support	4	4
Family (conflict/communication around adherence)	6	6
Hospital (Re)Admissions and Non-Adherence	11	0
Missing Doses/Stretching Medications	1	1
Substance Use	5	5

Table 5 Focus Group Three

Theme	Coder#1 J.H.	Coder #2 K.R.
Provider Communication	17	13
Language Barriers	6	6
Perceptual Barriers: Side Effects	7	7
Perceptual Barriers: Medication Effectiveness	2	6
Practical Barriers: Medication Cost	4	2
Practical Barriers: Forgetting Medication	5	5
Practical Barriers: Homelessness	2	2
Difficult Administration	4	4
Family/Caregiver Support	3	3
Fully Adherent (Definition of Adherence)	3	5
Lifestyle Changes Along with Medication	9	9
Polypharmacy	3	3
Challenges\being a diabetic	10	2
Health Literacy	11	14
Hospitalization due to adverse outcomes of diabetes	5	5
Blood Sugar Control	9	9

Table 6 Focus Group Four

Theme	Coder #1 J.H.	Coder #2 K.R.
Patient/Provider Communication	14	7
Language Barriers	1	1
Need to ask patients for more/detailed information about adherence (Clarifying Patient Definition of Adherence)/Probing Questions	7	7
Trust in Patient Communication Medication Adherence	14	14
Perceptual Barriers: Side Effects	7	4
Perceptual Barriers: Preferences on Mode of Medication Delivery	3	3
Practical Barriers: Medication Costs	4	4
Practical Barriers: Homelessness	1	1
Practical Barriers: Forgetting Medication	9	9
Practical Barriers: Transportation	3	3
Practical Barriers: Polypharmacy	5	5
Patient Age	2	2
Lifestyle Changes along with Medication	4	4
Documenting Adherence in EHR (Provider Documentation)	8	8
Patient Education	14	14
Family/Caregiver Support	2	2
Substance Use	4	4

Figure 1 Model medication non-adherence.