Variance and Dissent

Improving the measurement of self-reported medication nonadherence: Response to Authors

Low levels of adherence to asthma medication is reported in many countries worldwide. Improved knowledge of adherence in the Middle East and North Africa (MENA) is needed to address this major public healthcare burden.

Assess the level of adherence in patients attending a routine consultation and the relationship between adherence, patient/disease characteristics, disease control, and quality of life.

A large-scale cross-sectional epidemiological study was performed on adults suffering from asthma for at least 1 year and without an acute asthma episode within 4 weeks. Adherence was assessed using the MMAS-4 questionnaire©. Predictive factors of adherence were analyzed with logistic regressions.

Overall 7203 eligible patients were included in 577 sites. Mean age was 45.4 years (±14.7), 57.2% were female, mean BMI was 28.5 kg/m2 (±6.0), and 11% were active smokers. Good adherence was observed in 23.6% with a country effect (p < 0.001). Higher age, higher SF-8 Mental component score, and high level of control were associated with good adherence (p < 0.001). Patients treated with a fixed combination (ICS + LABA) have better adherence and patients treated with short-acting beta agonist alone have a lower adherence. Good adherence has been noted in 528 uncontrolled patients suggesting the existence of a subgroup difficult to treat and who have severe asthma.

Asthma adherence in the MENA is unsatisfactory with less than one quarter of asthma patients having good adherence. This finding highlights the need to improve access to treatment, ensure better control follow-up and improved education among healthcare providers and patients.

La drépanocytose est la plus fréquente des maladies génétiques graves au monde et en France. Malgré l’amélioration que confère la prise en charge médicale actuelle, le taux de non-adhésion aux traitements reste fort, conduisant au maintien d’un niveau d’hospitalisation élevé. Dans d’autres maladies chroniques, un lien a été montré entre la représentation de la maladie (selon le modèle de Leventhal) et l’observance thérapeutique. Cependant, ce lien n’a pas été montré dans une maladie génétique et aucune donnée n’existe sur la drépanocytose. Dans ce travail, nous avons tenté une première approche des dimensions de la représentation qui pourraient influencer l’observance et l’adhésion thérapeutique. Les analyses effectuées suggèrent un modèle à trois facteurs : la chronicité perçue de la maladie, la perception de l’efficacité des traitements et les émotions négatives associées à la maladie influencent l’observance thérapeutique et expliquent 29,2 % de sa variance. Nos résultats montrent que le modèle de Leventhal peut s’appliquer dans une maladie chronique d’origine génétique dont l’étiologie est connue, permettant de mieux comprendre le rôle de la représentation de la maladie sur différentes dimensions, dont l’observance thérapeutique. Cette recherche exploratoire est un point de départ pour le développement d’autres études afin d’apporter une meilleure connaissance de cette maladie.

Sickle Cell Disease (SCD) is a major healthcare and societal problem that affects millions of people worldwide. In France, SCD is the most common genetic disorder. Although medical care is improving, non-compliance rates are still high leading to a high rate of hospitalization. In other chronic illnesses, compliance has been explained by dimensions of the illness representation (as defined in the Common Sense Model [CSM] of Leventhal). However no such work has been done in genetic disorder nor have data been collected in SCD. Here we show that illness representation influences compliance. Analysis showed that three main factors of representation might have an influence on compliance in SCD and explain 29.2% of the variance. The emotional representation (emotional perception of SCD), treatment control (perceived effectiveness of treatments) and timeline acute/chronic (perceived duration of illness) indicating that patients with negative emotions on SCD are less compliant and those who perceive the effectiveness of their treatment and SCD as a chronic disease are more compliant. Compliance in SCD appears to be influenced by illness representations in the CSM. This give us a theoretical background to understand adaptation to the SCD and to propose psychosocial interventions aiming at a better compliance in people with SCD.

Most research on medication adherence has focused on secondary nonadherence and persistence to therapy. Medication prescriptions that are never filled by patients (primary nonadherence) remain understudied in the general population.

We linked prescribing data from primary care electronic medical records to comprehensive pharmacy dispensing claims between January 2013 and April 2019 in British Columbia (BC) to estimate primary nonadherence, defined as failure to dispense a new medication or its equivalent within 6 months of the prescription date. We used hierarchical multivariable logistic regression to determine prescriber, patient and medication factors associated with primary nonadherence among community-dwelling patients in primary care.

Among 150 565 new prescriptions to 34 243 patients, 17% of prescriptions were never filled. Primary nonadherence was highest for drugs prescribed mostly on an as-needed basis, including topical corticosteroids (35.1%) and antihistamines (23.4%). In multivariable analysis, primary nonadherence was lower for prescriptions issued by male prescribers (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.50–0.88). Primary nonadherence decreased with patient age (OR 0.91, 95% CI 0.90–0.92 for each additional 10 years) but increased with polypharmacy among patients aged 65 years or older. Patients filled more than 82% of their medication prescriptions within 2 weeks after their primary care provider visit.

The prevalence of primary nonadherence to new prescriptions was 17%. Interventions to address primary nonadherence could target older patients with multiple medication use and within the first 2 weeks of the prescription issue date.