Primary medication adherence in a rural population: the role of the patient-physician relationship and satisfaction with care.

INTRODUCTION Although correlates of overall medication adherence have been studied, little is known about primary medication non-adherence-patients' failing to fill a prescription provided by a practitioner-and whether it relates to how patients view their physician, satisfaction with their care, and how easy or hard it is for them to travel for care. METHODS This study uses telephone survey data from adults in 150 rural counties in 8 southeastern states. Bivariate and multivariable analyses were used to identify factors associated with adults' self-reports of delaying or not filling prescriptions. RESULTS Of the 3926 respondents who had received care in the previous year, 894 (21.6%) reported that they had delayed or did not fill a prescription over that time. In multivariate analysis, delaying or not filling prescriptions was more common among respondents who were under age 65, African American, reported incomes less than 25,000 dollars, and reported fair or poor health. Non-adherence was also more common among patients who reported transportation problems, a lack of confidence in their doctor's ability to help them, a lack of satisfaction with the concern shown them by their physicians, and a lack of satisfaction with how welcome and comfortable they are made to feel by office staff. CONCLUSIONS Prescription primary non-adherence is prevalent in the rural South. Adherence may be improved by remedying patient dissatisfaction and lack of confidence in their physicians as well as addressing transportation barriers.

[1]  Giselle Jones.  Prescribing and taking medicines , 2003, BMJ : British Medical Journal.

[2]  T. Ricketts,et al.  An evaluation of subsidized rural primary care programs: II. The environmental contexts. , 1983, American journal of public health.

[3]  J. Ware,et al.  Linking primary care performance to outcomes of care. , 1998, The Journal of family practice.

[4]  H. Mcdonald,et al.  Interventions to enhance patient adherence to medication prescriptions: scientific review. , 2002, JAMA.

[5]  K. Roberts.  Physician-patient relationships, patient satisfaction, and antiretroviral medication Adherence among HIV-infected adults attending a public health clinic. , 2002, AIDS patient care and STDs.

[6]  S. Coons,et al.  Predictors of medication noncompliance in a sample of older adults. , 1994, Clinical therapeutics.

[7]  S. Burge,et al.  Correlates of medication knowledge and adherence: findings from the residency research network of South Texas. , 2005, Family medicine.

[8]  G. Baliva,et al.  Association of dissatisfaction with care and psychiatric morbidity with poor treatment compliance. , 2002, Archives of dermatology.

[9]  R. Steinbrook.  The prescription-drug problem. , 2002, The New England journal of medicine.

[10]  M. Marinker,et al.  Not to be taken as directed , 2003, BMJ : British Medical Journal.

[11]  T. MacDonald,et al.  Primary non-compliance with prescribed medication in primary care. , 1993, BMJ.

[12]  Ngaire Kerse,et al.  Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation , 2004, The Annals of Family Medicine.

[13]  J. Dowell,et al.  A qualitative study of medication-taking behaviour in primary care. , 1997, Family practice.

[14]  K. Hassell,et al.  Access to medicines: cost as an influence on the views and behaviour of patients. , 2002, Health & social care in the community.

[15]  S. Ettner,et al.  The relationship between continuity of care and the health behaviors of patients: does having a usual physician make a difference? , 1999, Medical care.

[16]  S. Soumerai,et al.  Inadequate Prescription-Drug Coverage for Medicare Enrollees — A Call to Action , 2017 .

[17]  Maryland Metrics.  TECHNICAL INFORMATION and DATA , 2000 .

[18]  E. F. Brooks,et al.  An evaluation of subsidized rural primary care programs: I. A typology of practice organizations. , 1983, American journal of public health.

[19]  Thomas C Ricketts,et al.  How adults' access to outpatient physician services relates to the local supply of primary care physicians in the rural southeast. , 2006, Health services research.

[20]  B. Stuart,et al.  Medication Decisions—Right and Wrong , 2002, Medical care research and review : MCRR.

[21]  M. Dimatteo.  Variations in Patients’ Adherence to Medical Recommendations: A Quantitative Review of 50 Years of Research , 2004, Medical care.

[22]  D. Pathman,et al.  Lessons learned in phase I of the Southern Rural Access Program. , 2003, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[23]  R. Slifkin,et al.  Developing policies responsive to barriers to health care among rural residents: what do we need to know? , 2002, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[24]  C. Salzman,et al.  Medication compliance in the elderly. , 1995, The Journal of clinical psychiatry.

[25]  Eve A Kerr,et al.  The role of patient-physician trust in moderating medication nonadherence due to cost pressures. , 2005, Archives of internal medicine.

[26]  R M Schulz,et al.  Patient compliance—an overview , 1992, Journal of clinical pharmacy and therapeutics.

[27]  John Schneider,et al.  Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection , 2004, Journal of General Internal Medicine.

[28]  R. Balkrishnan,et al.  Predictors of medication adherence in the elderly. , 1998, Clinical therapeutics.

[29]  D. Pathman,et al.  Differences in Access to Outpatient Medical Care for Black and White Adults in the Rural South , 2006, Medical care.

[30]  J Z Ayanian,et al.  Supplemental insurance and use of effective cardiovascular drugs among elderly medicare beneficiaries with coronary heart disease. , 2001, JAMA.