Association of age, health literacy, and medication management strategies with cardiovascular medication adherence

Patient Educ Couns. 2010 Nov;81(2):177-81. doi: 10.1016/j.pec.2010.04.030. Epub 2010 Jun 1.


Objective: To examine patients' use of medication management strategies (e.g., reminders, pill boxes), and to determine how their use influences the relationship between patient characteristics and medication adherence.

Methods: Retrospective and cross-sectional study of 434 patients with coronary heart disease, examining both refill adherence and self-reported adherence.

Results: The most common strategy for managing refills was seeing a near empty pill bottle (89.9%), and for managing daily medications, it was associating medications with daily events (80.4%). Age<65 (OR = 1.7), as well as marginal (OR = 2.0) or inadequate health literacy (OR = 1.9), was independently associated with low refill adherence. Patients <65 also had lower self-reported adherence (OR = 1.8). Adjustment for use of medication management strategies did not substantially change these relationships. Reliance on reminders from friends or family to take medications, or waiting to refill a medicine only when the bottle was near empty, each were associated with 3-fold greater odds of non-adherence.

Conclusion: Age <65 and marginal or inadequate health literacy were independently associated with medication non-adherence. Use of medication management strategies did not explain these relationships.

Practice implications: The strategies which patients report using to assist with managing medication refills and daily medication use may be ineffective.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cardiovascular Agents / therapeutic use*
  • Coronary Disease / drug therapy*
  • Cross-Sectional Studies
  • Drug Prescriptions*
  • Educational Status
  • Female
  • Health Literacy*
  • Humans
  • Male
  • Medication Adherence*
  • Middle Aged
  • Physician-Patient Relations
  • Reminder Systems
  • Retrospective Studies
  • Self Administration
  • Socioeconomic Factors
  • Urban Population


  • Cardiovascular Agents