Polypharmacy and medication adherence in patients with type 2 diabetes.

OBJECTIVE To determine medication adherence and predictors of suboptimal adherence in a community cohort of patients with diabetes and to test the hypothesis that adherence decreases with increased number of medicines prescribed. RESEARCH DESIGN AND METHODS A total of 128 randomly selected patients with type 2 diabetes from a single community health center responded to a pharmacist-administered questionnaire regarding medication use. Survey data were linked to clinical data available from the electronic medical record. We assessed self-reported adherence rates for each diabetes-related medicine, barriers and attitudes regarding medication use, and HbA(1c), total cholesterol, and blood pressure levels. RESULTS Patients were taking a mean of 4.1 (+/-1.9) diabetes-related medicines. The average 7-day adherence was 6.7 +/- 1.1 days. Total number of medicines prescribed was not correlated with medication adherence. Adherence was significantly lower for medicines not felt to be improving current or future health (6.1 vs. 6.9 days out of 7, P < 0.001). Among patients on three or more medicines, 71% (15 of 21 patients) with suboptimal adherence were perfectly adherent with all but one medicine. Side effects were the most commonly reported problem with medication use. Of 29 medicines causing side effects that interfered with adherence, 24 (83%) did so for >1 month, and only 7 (24%) were reported to the patient's primary care physician. CONCLUSIONS In this sample, patients reported very high medication adherence rates regardless of number of medicines prescribed. Among patients on multiple medicines, most patients with suboptimal adherence were perfectly adherent to all but one medicine. Unreported side effects and a lack of confidence in immediate or future benefits were significant predictors of suboptimal adherence. Physicians should not feel deterred from prescribing multiple agents in order to achieve adequate control of hyperglycemia, hypertension, and hyperlipidemia.

[1]  D. Sackett,et al.  Can Simple Clinical Measurements Detect Patient Noncompliance? , 1980, Hypertension.

[2]  I. Rosenstock.  Understanding and Enhancing Patient Compliance with Diabetic Regimens , 1985, Diabetes Care.

[3]  K. Kroenke,et al.  Polypharmacy. Causes, consequences, and cure. , 1985, The American journal of medicine.

[4]  R. Glasgow,et al.  Patient Perspective on Factors Contributing to Nonadherence to Diabetes Regimen , 1986, Diabetes Care.

[5]  Mickey C. Smith,et al.  Meta-Analysis of Correlates of Diabetes Patients' Compliance With Prescribed Medications , 1990, The Diabetes educator.

[6]  Self-Care Predictors of Metabolic Control in NIDDM Patients , 1990, Diabetes Care.

[7]  S. Johnson.  Methodological Issues in Diabetes Research: Measuring adherence , 1992, Diabetes Care.

[8]  Robert M. Anderson,et al.  The Relationship Between Diabetes-Related Attitudes and Patients' Self- Reported Adherence , 1993, The Diabetes educator.

[9]  R. Haynes,et al.  Is this patient taking the treatment as prescribed , 1993 .

[10]  I. Rosenstock,et al.  Can we build on, or must we replace, the theories and models in health education? , 1994, Health education research.

[11]  A. Paes,et al.  Impact of Dosage Frequency on Patient Compliance , 1997, Diabetes Care.

[12]  N. Miller,et al.  Compliance with treatment regimens in chronic asymptomatic diseases. , 1997, The American journal of medicine.

[13]  J. Halter,et al.  Characteristics Related to Poor Glycemic Control in NIDDM Patients in Community Practice , 1997, Diabetes Care.

[14]  T. Frieden,et al.  Nonadherence in tuberculosis treatment: predictors and consequences in New York City. , 1997, The American journal of medicine.

[15]  W L McNabb,et al.  Adherence in Diabetes: Can We Define It and Can We Measure It? , 1997, Diabetes Care.

[16]  P. Garner,et al.  Systematic review of randomised controlled trials of strategies to promote adherence to tuberculosis treatment , 1997, BMJ.

[17]  N. Ray,et al.  Economic Consequences of Diabetes Mellitus in the U.S. in 1997 , 1998, Diabetes Care.

[18]  D. Matthews.  The natural history of diabetes‐related complications: the UKPDS experience , 1999, Diabetes, obesity & metabolism.

[19]  R. Glasgow,et al.  The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. , 2000, Diabetes care.

[20]  J E Winland-Brown,et al.  Effectiveness of different medication management approaches on elders' medication adherence. , 2000, Outcomes management for nursing practice.

[21]  Teven,et al.  MORTALITY FROM CORONARY HEART DISEASE IN SUBJECTS WITH TYPE 2 DIABETES AND IN NONDIABETIC SUBJECTS WITH AND WITHOUT PRIOR MYOCARDIAL INFARCTION , 2000 .

[22]  William Branch,et al.  Clinical Inertia , 2001, Annals of Internal Medicine.

[23]  J. Dunbar-Jacob,et al.  Treatment adherence in chronic disease. , 2001, Journal of clinical epidemiology.

[24]  M. Sprangers,et al.  Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study. , 2001, Archives of internal medicine.

[25]  A. Zolopa,et al.  Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. , 2001, AIDS.

[26]  N. Ampel,et al.  Barriers to Use of Electronic Adherence Monitoring in an HIV Clinic , 2001, The Annals of pharmacotherapy.

[27]  R. Hays,et al.  A Comparison Study of Multiple Measures of Adherence to HIV Protease Inhibitors , 2001, Annals of Internal Medicine.

[28]  R. Grant,et al.  Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[29]  J. Wogen,et al.  Utilization of oral hypoglycemic agents in a drug-insured U.S. population. , 2001, Diabetes care.

[30]  K. Kroenke,et al.  Polypharmacy and medication adherence: small steps on a long road. , 2001, Journal of general internal medicine.

[31]  P. Donnan,et al.  Adherence to prescribed oral hypoglycaemic medication in a population of patients with Type 2 diabetes: a retrospective cohort study , 2002, Diabetic medicine : a journal of the British Diabetic Association.

[32]  M. Engelgau,et al.  A Diabetes Report Card for the United States: Quality of Care in the 1990s , 2002, Annals of Internal Medicine.

[33]  Peter J. Neumann,et al.  Long-term persistence in use of statin therapy in elderly patients. , 2002, JAMA.

[34]  Richard W Grant,et al.  Comparison of hyperglycemia, hypertension, and hypercholesterolemia management in patients with type 2 diabetes. , 2002, The American journal of medicine.

[35]  R. Grant,et al.  Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users , 2002, Journal of General Internal Medicine.

[36]  Muhammad Mamdani,et al.  Adherence with statin therapy in elderly patients with and without acute coronary syndromes. , 2002, JAMA.

[37]  D. Cabrol,et al.  [Clinical practice recommendations. Risk of premature birth with intact membranes. Conclusions (2002)]. , 2003, Gynecologie, obstetrique & fertilite.