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Self-Reported Nonadherence Associated with Pharmacy and Home Medication Management Inconvenience Factors in a US Adult Population

Authors Bartlett Ellis RJ, Hertz D, Callahan P, Ruppar TM

Received 17 July 2019

Accepted for publication 4 February 2020

Published 9 March 2020 Volume 2020:14 Pages 529—539


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen

Rebecca J Bartlett Ellis,1 Deanna Hertz,2 Patrick Callahan,3 Todd M Ruppar4

1Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA; 2Ipsos Ltd., South Lake Tahoe, CA, USA; 3Becton, Dickinson and Company, San Diego, CA, USA; 4Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University, Chicago, IL, USA

Correspondence: Rebecca J Bartlett Ellis
Department of Science of Nursing Care, Indiana University School of Nursing, 600 Barnhill Drive, E423, Indianapolis, IN 46202, USA
Tel +1 317 274 0047

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.

Keywords: medication adherence, medication compliance, community pharmaceutic services, outpatient, drug packaging, behavior and behavior mechanisms, MeSH

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