Factors Associated with Medication Non-Adherence among Patients with Multimorbidity and Polypharmacy Admitted to an Intermediate Care Center
Open Access
- 12 September 2021
- journal article
- research article
- Published by MDPI AG in International Journal of Environmental Research and Public Health
- Vol. 18 (18), 9606
- https://doi.org/10.3390/ijerph18189606
Abstract
Identifying determinants of medication non-adherence in patients with multimorbidity would provide a step forward in developing patient-centered strategies to optimize their care. Medication appropriateness has been proposed to play a major role in medication non-adherence, reinforcing the importance of interdisciplinary medication review. This study examines factors associated with medication non-adherence among older patients with multimorbidity and polypharmacy. A cross-sectional study of non-institutionalized patients aged ≥65 years with ≥2 chronic conditions and ≥5 long-term medications admitted to an intermediate care center was performed. Ninety-three patients were included (mean age 83.0 ± 6.1 years). The prevalence of non-adherence based on patients’ multiple discretized proportion of days covered was 79.6% (n = 74). According to multivariable analyses, individuals with a suboptimal self-report adherence (by using the Spanish-version Adherence to Refills and Medications Scale) were more likely to be non-adherent to medications (OR = 8.99, 95% CI 2.80–28.84, p < 0.001). Having ≥3 potentially inappropriate prescribing (OR = 3.90, 95% CI 0.95–15.99, p = 0.059) was barely below the level of significance. These two factors seem to capture most of the non-adherence determinants identified in bivariate analyses, including medication burden, medication appropriateness and patients’ experiences related to medication management. Thus, the relationship between patients’ self-reported adherence and medication appropriateness provides a basis to implement targeted strategies to improve effective prescribing in patients with multimorbidity.Keywords
This publication has 50 references indexed in Scilit:
- What are validated self-report adherence scales really measuring?: a systematic reviewBritish Journal of Clinical Pharmacology, 2014
- Optimizing drug therapy in patients with advanced dementia: A patient-centered approachEuropean Geriatric Medicine, 2014
- Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidityAge and Ageing, 2012
- A new taxonomy for describing and defining adherence to medicationsBritish Journal of Clinical Pharmacology, 2012
- Epidemiology and impact of multimorbidity in primary care: a retrospective cohort studyBritish Journal of General Practice, 2011
- Development and Evaluation of the Adherence to Refills and Medications Scale (ARMS) among Low-Literacy Patients with Chronic DiseaseValue in Health, 2009
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational StudiesPLoS Medicine, 2007
- A Drug Burden Index to Define the Functional Burden of Medications in Older PeopleArchives of Internal Medicine, 2007
- Measurement of Adherence in Pharmacy Administrative Databases: A Proposal for Standard Definitions and Preferred MeasuresAnnals of Pharmacotherapy, 2006