Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study - 11/06/18
, Melissa A. Greiner, MS a, Paul Muntner, PhD c, Daichi Shimbo, MD d, Mario Sims, PhD, MS e, Tanya M. Spruill, PhD f, Benjamin F. Banahan, PhD g, Wei Wang, PhD e, Stanford Mwasongwe, MPH h, Karen Winters, PhD, RN e, Adolfo Correa, MD, PhD e, Lesley H. Curtis, PhD a, b, Emily C. O'Brien, PhD a, bAbstract |
Background |
Non-adherence to medications is common and leads to suboptimal outcomes. Non-adherence can be intentional (e.g., deciding to skip dosages) or unintentional (e.g., forgetting), yet few studies have distinguished these reasons. An improved understanding of the reasons for non-adherence could inform the development of effective interventions.
Methods and Results |
We analyzed data from African Americans in the Jackson Heart Study who were prescribed medications for one or more chronic conditions. Participants were grouped by patient-reported adherence with non-adherence categorized as being intentional, unintentional or both. We used modified Poisson regression models to examine the factors associated with types of non-adherence. Of 2933 participants taking medication, 2138 (72.9%) reported non-adherence with 754 (35.3%) reporting only unintentional non-adherence, 263 (12.3%) only intentional non-adherence, and 1121 (52.4%) both. Factors independently associated with intentional non-adherence included female sex and depressive symptoms while factors associated with unintentional non-adherence included younger age and separated relationship status. Unintentional and intentional non-adherence was more common among participants taking anti-arrhythmic and anti-asthmatic medications, respectively. Higher levels of global perceived stress was associated with both types of non-adherence. The adjusted models for intentional and unintentional non-adherence had c-statistics of 0.65 and 0.66, respectively, indicating modest discrimination.
Conclusion |
Specific patient factors and individual medication classes were associated with distinct patterns of intentional and unintentional non-adherence, yet the overall modest discrimination of the models suggests contributions from other unmeasured factors. These findings provide a construct for understanding reasons for non-adherence and provide rationale to assess whether personalized interventions can improve adherence.
Le texte complet de cet article est disponible en PDF.Abbreviations : JHS, HF, CAD, COPD
Plan
| Funding: This work was supported by grant R01HL117305, K24 HL125704 and R01HL117323 from the National Heart, Lung, And Blood Institute. The Jackson Heart Study is supported by contracts HHSN268201300046C, HHSN268201300047C, HHSN268201300048C, HHSN268201300049C, HHSN268201300050C from the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities. The authors thank the participants and data collection staff of the Jackson Heart Study. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services. |
Vol 200
P. 51-59 - juin 2018 Retour au numéro
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