Unintentional Non-Adherence to Chronic Prescription Medications: How Unintentional Is It Really?

BMC Health Serv Res. 2012 Jun 14;12:98. doi: 10.1186/1472-6963-12-98.

Abstract

Background: Unintentional non-adherence has been characterized as passively inconsistent medication-taking behavior (forgetfulness or carelessness). Our objectives were to: (1) study the prevalence and predictors of unintentional non-adherence; and (2) explore the interrelationship between intentional and unintentional non-adherence in relation to patients' medication beliefs.

Methods: We conducted a cross-sectional survey of adults with asthma, hypertension, diabetes, hyperlipidemia, osteoporosis, or depression from the Harris Interactive Chronic Illness Panel. The analytic sample for this study included 24,017 adults who self-identified themselves as persistent to prescription medications for their index disease. They answered three questions on unintentional non-adherence (forgot, ran out, being careless), 11 questions on intentional non-adherence, and three multi-item scales assessing perceived need for medication (k = 10), perceived medication concerns (k = 6), and perceived medication affordability (k = 4). Logistic regression was used to model predictors of each unintentional non-adherence behavior. Baron and Kenny's regression approach was used to test the mediational effect of unintentional non-adherence on the relationship between medication beliefs and intentional non-adherence. Bootstrapping was employed to confirm the statistical significance of these results.

Results: For the index disease, 62% forgot to take a medication, 37% had run out of the medication, and 23% were careless about taking the medication. Common multivariate predictors (p < .001) of the three behaviors were: (1) lower perceived need for medications; (2) more medication affordability problems; (3) worse self-rated health; (4) diabetes or osteoporosis (relative to hypertension); and (5) younger age. Unique statistically-significant predictors of the three behaviors were: (a) 'forgot to take medications' - greater concerns about the index medication and male gender; (b) 'run out of medications' - non-white race, asthma, and higher number of total prescription medications; (c) 'being careless' - greater medication concerns. Mediational tests confirmed the hypothesis that the effect of medication beliefs (perceived need, concerns, and affordability) on intentional non-adherence is mediated through unintentional non-adherence.

Conclusions: For our study sample, unintentional non-adherence does not appear to be random and is predicted by medication beliefs, chronic disease, and sociodemographics. The data suggests that the importance of unintentional non-adherence may lie in its potential prognostic significance for future intentional non-adherence. Health care providers may consider routinely inquiring about unintentional non-adherence in order to proactively address patients' suboptimal medication beliefs before they choose to discontinue therapy all together.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Asthma / drug therapy
  • Asthma / psychology
  • Chronic Disease / drug therapy*
  • Chronic Disease / psychology
  • Cross-Sectional Studies
  • Depressive Disorder / drug therapy
  • Diabetes Mellitus / drug therapy
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Status
  • Humans
  • Hypertension / drug therapy
  • Logistic Models
  • Male
  • Middle Aged
  • Osteoporosis / drug therapy
  • Patient Compliance / psychology*
  • Patient Compliance / statistics & numerical data
  • Predictive Value of Tests
  • Prevalence
  • Sickness Impact Profile
  • Social Class
  • Surveys and Questionnaires
  • United States