Intentional and Unintentional Nonadherence to Antihypertensive Medication

Annals of Pharmacotherapy - Tập 39 Số 7-8 - Trang 1198-1203 - 2005
Kathryn P. Lowry1, Tara K. Dudley2, Eugene Ž. Oddone3,4, Hayden B. Bosworth5,6,7
1Kathryn P Lowry, Undergraduate Student, Duke University, Durham, NC
2Tara K Dudley MStat, Statistician, Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham
3Director, Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center
4Eugene Z Oddone MD MHSc, Professor, Department of Medicine, Division of General Internal Medicine, Duke University; Director, Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center
5Associate Director, Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center
6Department of Psychiatry and Behavioral Sciences, and Center for Aging and Human Development, Duke University
7Hayden B Bosworth PhD, Associate Research Professor, Department of Medicine, Division of General Internal Medicine; Department of Psychiatry and Behavioral Sciences, and Center for Aging and Human Development, Duke University; Associate Director, Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center

Tóm tắt

BACKGROUND Hypertension is poorly controlled in the US due to medication nonadherence. Recent evidence suggests that nonadherence can be classified as intentional or unintentional and different patient characteristics, such as the experience of adverse effects, may be associated with each. OBJECTIVE To examine associations between patient characteristics, including reported adverse effects, and both intentional and unintentional nonadherence among 588 hypertensive patients. METHODS Baseline data from a clinical trial, the Veterans' Study To Improve the Control of Hypertension, were examined. Intentional and unintentional nonadherence were assessed using a self-report measure. Participants were presented with a list of adverse effects commonly associated with antihypertensive medication and asked to indicate which symptoms they had experienced. Logistic regression analyses were used to examine adjusted associations between patient characteristics and type of nonadherence. RESULTS Approximately 31% of patients reported unintentional nonadherence and 9% reported intentional nonadherence. Non-white participants, individuals without diabetes mellitus, and individuals reporting ≥5 adverse effects were more likely to report intentional nonadherence than their counterparts. Individuals with less than a 10th-grade education and non-white participants were more likely to report unintentional nonadherence than their counterparts. When symptoms of increased urination and wheezing/shortness of breath were reported, patients were more likely to report intentional and unintentional nonadherence compared with those who were adherent. Unintentional nonadherence was also associated with reports of dizziness and rapid pulse. CONCLUSIONS Both intentional and unintentional nonadherence are common and related to perceived adverse effects. Furthermore, different interventions may be necessary to improve adherence in unintentionally and intentionally nonadherent patients.

Từ khóa


Tài liệu tham khảo

10.1161/01.HYP.18.3_Suppl.I95

10.1001/jama.1996.03530440051036

10.1161/01.HYP.0000142248.54761.56

10.1161/01.HYP.26.1.60

10.1016/S0149-2918(98)80130-6

10.1016/S0895-4356(02)00400-6

10.1007/BF03404494

10.1023/A:1015866415552

10.1111/j.1572-0241.2003.07522.x

10.1016/S0167-5273(00)00374-0

10.1016/j.ahj.2005.01.039

10.1016/j.cct.2004.12.006

10.1136/bmj.321.7258.412

10.1001/archinte.1997.00440420033005

10.1056/NEJM199704173361601

10.1097/00005650-198601000-00007

17. Sheskin DJ. Handbook of parametric and nonparametric statistical procedures. 2nd ed. Boca Raton, FL: Chapman and Hall/CRC, 2000: 881–94.

10.1016/S0022-3999(99)00057-4

10.1093/rheumatology/keh141

10.1016/0021-9681(87)90171-8

10.1097/00005650-199911000-00009

10.1176/appi.ajp.159.10.1653

10.1097/00126334-200011010-00003

Thông tin
Thông tin xuất bản

Annals of Pharmacotherapy

Tập 39 Số 7-8

1198-1203

Thông tin tác giả