Primary nonadherence to chronic disease medications: a meta-analysis

Abstract

BackgroundMedication nonadherence is a global problem that requires urgent attention. Primary nonadherence occurs when a patient consults with a medical doctor, receives a referral for medical therapy but never fills the first dispensation for the prescription medication. Nonadherence to chronic disease medications costs the USA ~$290 billion (USD) every year in avoidable health care costs. In Canada, it is estimated that 5.4% of all hospitalizations are due to medication nonadherence.ObjectivesThe objective of this study was to quantify the extent of primary nonadherence for four of the most common chronic disease medications. The second objective was to identify factors associated with primary nonadherence to chronic disease medications.Materials and methodsWe conducted an extensive systematic literature review of eight databases with a wide range of keywords. We identified relevant articles for primary nonadherence to antihypertensives, lipid-lowering agents, hypoglycemics, and antidepressants. After further screening and assessment of methodologic quality, relevant data were extracted and analyzed using a random-effects model.ResultsTwenty-four articles were included for our meta-analysis after full review and assessment for risk of bias. The pooled primary nonadherence rate for the four chronic disease medications was 14.6% (95% CI: 13.1%–16.2%). Primary medication nonadherence was higher for lipid-lowering medications among the four chronic disease medications assessed (20.8%; 95% CI: 16.0%–25.6%). The rates in North America (17.0%; 95% CI: 14.4%–19.5%) were twice those from Europe (8.5%; 95% CI: 7.1%–9.9%). The absence of social support (20%; 95% CI: 14.4%–26.6%) was the most common sociodemographic variable associated with chronic disease medication primary nonadherence.ConclusionEvidence suggests that a considerable percentage of patients do not initially fill their medications for treatable chronic diseases or conditions. This represents a major health care problem that can be successfully addressed. Efforts should be directed toward proper medication counseling, patient social support, and clinical follow-up, especially when the indications for the prescribed medication aim to provide primary prevention.

Prevalence of and factors associated with primary medication non‐adherence in chronic disease: A systematic review and meta‐analysis

“…Our finding is consistent with a recent study in the US, where a PMN prevalence of 18% was reported in 32 586 patients aged ≥65 years with new prescriptions for their chronic disease. However, a review by Lemstra et al reported a lower overall PMN rate of 14.6% . We postulate two reasons that could have resulted in this difference.…”

“…In view of the significance of PMN, there is a need to determine its prevalence and associated factors in different chronic diseases. A recent systematic review and meta‐analysis reported an overall PMN rate of 14.6% across four chronic diseases, namely hypertension, hyperlipidaemia, diabetes mellitus and depression . The review included 24 studies, of which four were randomised controlled trials.…”

Impact Of “eHealth” in Allergic Diseases and Allergic Patients

“…Nonadherence is one area where mHealth may have the most potential to positively impact patient care [25]. It is well established that nonadherence is common among patients managing chronic medical conditions and takes many forms [26]. Patients with poorly controlled asthma often do not use their controller medications consistently or with the proper inhaler technique [27].…”

They just don't take their medicines: Reframing medication adherence in asthma from frustration to opportunity

“…To start, it is important to define medication nonadherence. Adherence is described by WHO as “the extent to which a person's behaviour—taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare provider.” 1 Primary nonadherence is the rate at which the patient fails to fill their medications after having been prescribed by a provider 2 . Primary nonadherence rates in adults with asthma are estimated at 14 to 40% 3 .…”

“…1 Primary nonadherence is the rate at which the patient fails to fill their medications after having been prescribed by a provider. 2 Primary nonadherence rates in adults with asthma are estimated at 14 to 40%. 3 For those patients who take the step of filling their medication and having it in their homes, secondary nonadherence rates can be measured.…”