Medication beliefs predict medication adherence in ambulatory patients with decompensated cirrhosis

Abstract

AIMTo investigate the impact of medication beliefs, illness perceptions and quality of life on medication adherence in people with decompensated cirrhosis.METHODSOne hundred adults with decompensated cirrhosis completed a structured questionnaire when they attended for routine outpatient hepatology review. Measures of self-reported medication adherence (Morisky Medication Adherence Scale), beliefs surrounding medications (Beliefs about Medicines Questionnaire), perceptions of illness and medicines (Brief Illness Perception Questionnaire), and quality of life (Chronic Liver Disease Questionnaire) were examined. Clinical data were obtained via patient history and review of medical records. Least absolute shrinkage and selection operator and stepwise backwards regression techniques were used to construct the multivariable logistic regression model. Statistical significance was set at alpha = 0.05.RESULTSMedication adherence was “High” in 42% of participants, “Medium” in 37%, and “Low” in 21%. Compared to patients with “High” adherence, those with “Medium” or “Low” adherence were more likely to report difficulty affording their medications (P < 0.001), lower perception of treatment helpfulness (P = 0.003) and stronger medication concerns relative to medication necessity beliefs (P = 0.003). People with “Low” adherence also experienced greater symptom burden and poorer quality of life, including more frequent abdominal pain (P = 0.023), shortness of breath (P = 0.030), and emotional disturbances (P = 0.050). Multivariable analysis identified having stronger medication concerns relative to necessity beliefs (Necessity-Concerns Differential ≤ 5, OR = 3.66, 95%CI: 1.18-11.40) and more frequent shortness of breath (shortness of breath score ≤ 3, OR = 3.87, 95%CI: 1.22-12.25) as independent predictors of “Low”adherence.CONCLUSIONThe association between “Low” adherence and patients having strong concerns or doubting the necessity or helpfulness of their medications should be explored further given the clinical relevance.

Medication‐Related Problems in Outpatients With Decompensated Cirrhosis: Opportunities for Harm Prevention

“…The most prevalent MRP types were nonadherence and indication issues, which is similar to findings in other studies of community‐based Australians with chronic diseases . Medication nonadherence in people with cirrhosis may be influenced by patients’ perceptions surrounding the severity of their liver disease (symptoms, timeline of progression, development of complications) and the perceived helpfulness and harms of treatment (previous therapy failure, side effects, complexity of therapy, long‐term benefits of treatment) . For example, nonadherence with lactulose and diuretics is often attributed to the prohibitive medication side‐effect profile that can affect patients’ quality of life and freedom to participate in work and leisure activities.…”

“…(6,7,24) Medication nonadherence in people with cirrhosis may be influenced by patients' perceptions surrounding the severity of their liver disease (symptoms, timeline of progression, development of complications) and the perceived helpfulness and harms of treatment (previous therapy failure, side effects, complexity of therapy, long-term benefits of treatment). (25) For example, nonadherence with lactulose and diuretics is often attributed to the prohibitive medication side-effect profile that can affect patients' quality of life and freedom to participate in work and leisure activities. Indeed, lactulose and diuretics were associated with more than one third of all instances of high-risk nonadherence in the present study.…”

Adaptation and validation of the Polish version of the Beliefs about Medicines Questionnaire among cardiovascular patients and medical students

“…Also, studies based on qualitative methods have confirmed the importance of patient concerns about medications as a key barrier to adherence [16][17]. Moreover, acknowledging patient concerns about medications and positive reinforcement of the need for medication have the potential to improve adherence and quality of life among patients [18].…”

Effectiveness of patient‐oriented education and medication management intervention in people with decompensated cirrhosis

“…All patients completed a survey at baseline ( t 0 ) and follow up ( t 3 ) that contained measures for study endpoints, including self‐reported medication adherence (Morisky Medication Adherence Scale), 4–6 medication and illness beliefs (Beliefs about Medicines Questionnaires 7 and Brief‐Illness Perception Questionnaire (Brief‐IPQ) 8 ), health‐related quality of life (QoL) (Chronic Liver Disease Questionnaire (CLDQ), 9 modified to exclude question 29 as previously described 10 ) and knowledge of cirrhosis self‐management tasks (eight ‘knowledge’ questions adapted from Volk et al 2 . by a clinician panel (KH, EP, JM, PV and LH)).…”