Patient Pill Organization Strategies and Adherence Measured in a Cross-Sectional Study of Hypertension

Figures & data

Table 1 Characteristics of Study Population

Study Demographics*	% (N)
Gender (self-report)
Male	38.3% (279)
Female	61.3% (447)
Transgender	0.3% (2)
Non-Binary	0.1% (1)
Age (years)
<45	7.3% (53)
45–54	12.3% (90)
55–64	28.7% (210)
65–74	32.4% (237)
75+	19.3% (141)
Race (self-report)
White or Caucasian	47.1% (344)
Black or African American	52.9% (387)
Highest Level of Education
Less than High School	4.4% (32)
High School Diploma or equivalent	22.3% (162)
Some College, no degree	25.5% (185)
College Degree	47.8% (347)
Employment Status
Employed	37.8% (275)
Unemployed	5.1% (37)
Retired	45.3% (329)
Disabled	11.8% (86)
Insurance Status
Medicaid	16.7% (121)
Medicare	34.3% (248)
Commercial (High-deductible, Self-funded)	36.9% (267)
Uninsured/Self-Pay	0.3% (2)
Other	5.4% (39)
Medicaid and Medicare	6.5% (47)
Marital Status
Married/Partnered	43.3% (311)
Unmarried	56.7% (407)
Living Status
Lives Alone	32.5% (235)
Lives with other(s)	67.5% (488)
Difficulty in Paying for Basic Necessities
Very Difficult	11.1% (77)
Somewhat Difficult	26.5% (184)
Not Difficult at All	62.4% (434)
Number of Blood Pressure Medications
One	54.0% (391)
Two	28.3% (205)
Three	11.7% (85)
Four or more	5.9% (43)
Number of Pill Organization Strategies Used
0	17.5% (128)
1	34.2% (250)
2	37.4% (273)
3	10.3% (75)
4	0.7% (5)

Notes: *Less than 2% of the participants were missing data on gender, highest level of education, employment status, insurance status, marital status, living status, and number of blood pressure medications. “Difficulty paying for basic necessities” is missing for 5% of the participants.

Table 2 Pill Organization Survey Questions and Response Frequency

Pill Organization Strategies	Response Frequency* (N=731)
Finish previous refills first: “I get a new refill but continue taking leftover pills from a previous refill until they are used up before starting the new bottle”	51.7% (378)
Use a pill dispenser: “I move pills into a pill dispenser, sorter, or other container”	46.5% (340)
Combine same prescriptions: “I combine new pills with pills from a prior refill of the same medicine”	38.2% (279)
Combine dissimilar prescriptions: “I combine pills from multiple prescriptions/medicines”	6.0% (44)
Other Factors That May Influence Adherence	Response Frequency* (N=731)
Took pills as needed because of clinician instructions: “My doctor told me to take my pills as needed, or to achieve a specific blood pressure target”	5.6% (41)
Shares pills: “I sometimes share my pills with others”	0.4% (3)
Takes different dose than bottle instructs, doctor’s order: “My doctor told me to take my pills differently than the prescription/pill bottle states (for example, they told me to double the pills or cut pills in half)”	9.3% (68)
Takes different dose than bottle instructs, self-choice: “I typically take a different dose (for example, a different number of pills) than what my doctor told me to take”	3.7% (27)

Notes: *Each participant could select multiple strategies and the frequencies will total over 100%.

Table 3 Adherence by Pill Organization Strategy

Strategies to Organize Pills	Survey Response	Pill Count Median*	Pharmacy- Fill % Adherent^†	Self-Report % Adherent^‡
Combine Same Prescriptions	Yes	0.56	78.1%	63.0%
	No	0.70	74.0%	63.3%
		P = <0.01	P = 0.22	P = 0.93
Finish Previous Pills First	Yes	0.64	74.7%	63.1%
	No	0.67	76.7%	63.3%
		P = 0.81	P = 0.54	P = 0.94
Combine Dissimilar Prescriptions	Yes	0.66	69.8%	54.5%
	No	0.65	76.1%	63.8%
		P = 0.72	P = 0.35	P = 0.22
Move Pills into Pill Dispenser	Yes	0.64	75.9%	65.2%
	No	0.66	75.5%	61.5%
		P = 0.21	P = 0.91	P = 0.30
Other Effects on Adherence Measurement	Survey Response	Pill Count Median*	Pharmacy-Fill % Adherent^†	Self-Report % Adherent^‡
Shares Pills	Yes	0.45	66.7%	50.0%
	No	0.65	75.7%	63.2%
		P = 0.46	P = 0.57	P = >0.99
Takes Pills as Needed, Doctor’s Order	Yes	0.67	74.3%	61.5%
	No	0.64	75.7%	63.3%
		P = 0.68	P = 0.84	P = 0.83
Takes Different Dose Than Bottle Instructs, Doctor’s Order	Yes	0.68	73.4%	68.7%
	No	0.64	75.9%	62.6%
		P = 0.67	P = 0.66	P = 0.33
Takes Different Dose Than Bottle Instructs, Self-Choice	Yes	0.67	54.2%	48.1%
	No	0.65	76.5%	63.8%
		P = 0.45	P = 0.01	P = 0.10

Notes: *Median of group measured 0.0–1.0 calculated as ratio of pills present over predicted. ^†Dichotomous variable of proportion of days covered (PDC), Adherent = ≥90%, non-Adherent = <90%. ^‡Self-report adherence: calculated based on 7-day average adherence to medication, self-reported by 3-question adherence survey (VOILS).