Abstract 1114: Medication Adherence and Decision Making Processes in Patients With Coexisting Diabetes, Dyslipidemia and Hypertension
Background: As treatment guidelines for hypertension (HTN), diabetes mellitus (DM) and dyslipidemia (DYSLIP) have evolved, they have advocated for more aggressive treatment targets. More aggressive therapy may increase drug regimen complexity for patients with multiple conditions and have the unintended consequence of poor adherence. The purpose of this study was to exam the drug adherence patterns and drivers of adherence for patients with all 3 conditions.
Methods: An online survey was administered in Dec 2008 to patients identified within the iGuard.org database, a patient-driven, online medication safety monitoring service. Patients taking at least 1 drug for HTN, DM and DYSLIP were sent the survey (n=2150). A sample size of 278 was required for a confidence interval and level of 5% and 95%. Survey items included demographics, the Medication Adherence Report Scale (MARS) - score = 5 to 25, potential adherence barriers and adherence trade-off scenarios. Unadjusted and adjusted MARS scores were analyzed via ANOVA and post-hoc tests; multivariate linear regression was used to identify factors associated with adherence.
Results: A total of 325 patients completed the survey. Adherence as measured by the MARS was significantly better for HTN drugs than for DM or DYSLIP drugs. (p<0.05; unadjusted & adjusted) Factors that impacted adherence included number of drugs, costs and side effects. Complete adherence (MARS=25) was observed with HTN, DM and DYSLIP drugs in 47%, 35% and 42% of patients, respectively. Only 32% of patients reported complete adherence across all 3 drug classes; 48% had complete nonadherence. In trade-off scenarios, patients consistently stated they would choose taking DM drugs over HTN and DYSLIP drugs. (p<0.01)
Conclusion: Nonadherence to drug therapy is a barrier to optimal treatment of HTN, DM and DYSLIP as it occurred in over two-thirds of the respondents. Patient actions did differ from stated intentions, as evidenced by the results that patient reported adherence was highest for HTN drugs but patients consistently chose DM drugs in forced choice trade-off scenarios. These insights could be considered by clinicians in tailoring individualized drug education that improves adherence and ultimately maximizes patient outcomes.