title: Patient risk profiles and practice variation in nonadherence to antidepressants, antihypertensives and oral hypoglycemics.
abstract: BACKGROUND
  Many patients experience difficulties in following treatment recommendations. This study's objective is to identify nonadherence risk profiles regarding medication (antidepressants, antihypertensives, and oral hypoglycemics) from a combination of patients' socio-demographic characteristics, morbidity presented within general practice and medication characteristics. An additional objective is to explore differences in nonadherence among patients from different general practices.
  
  
  METHODS
  Data were obtained by linkage of a Dutch general practice registration database to a dispensing registration database from the year 2001. Subjects included in the analyses were users of antidepressants (n = 4,877), antihypertensives (n = 14,219), or oral hypoglycemics (n = 2,428) and their GPs. Outcome variables were: 1) early dropout i.e., a maximum of two prescriptions and 2) refill nonadherence (in patients with 3+ prescriptions); refill adherence < 80% was considered as nonadherence. Multilevel modeling was used for analyses.
  
  
  RESULTS
  Both early dropout and refill nonadherence were highest for antidepressants, followed by antihypertensives. Risk factors appeared medication specific and included: 1) non-western immigrants being more vulnerable for nonadherence to antihypertensives and antidepressants; 2) type of medication influencing nonadherence in both antihypertensives and antidepressants, 3) GP consultations contributing positively to adherence to antihypertensives and 4) somatic co-morbidity influencing adherence to antidepressants negatively. There was a considerable range between general practices in the proportion of patients who were nonadherent.
  
  
  CONCLUSIONS
  No clear risk profiles for nonadherence could be constructed. Characteristics that are correlated with nonadherence vary across different types of medication. Moreover, both patient and prescriber influence adherence. Especially non-western immigrants need more attention with regard to nonadherence, for example by better monitoring or communication. Since it is not clear which prescriber characteristics influence adherence levels of their patients, there is need for further research into the role of the prescriber.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. L.vanDijk@nivel.nl
authors.forename: Liset
authors.initials: L
authors.lastname: van Dijk
authors.forename: Eibert R
authors.initials: ER
authors.lastname: Heerdink
authors.forename: Dinesh
authors.initials: D
authors.lastname: Somai
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dulmen
authors.forename: Emmy M
authors.initials: EM
authors.lastname: Sluijs
authors.forename: Denise T
authors.initials: DT
authors.lastname: de Ridder
authors.forename: Anna M G F
authors.initials: AM
authors.lastname: Griens
authors.forename: Jozien M
authors.initials: JM
authors.lastname: Bensing
mesh_terms: D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D004522:Educational Status; D004641:Emigration and Immigration; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D009426:Netherlands; D012307:Risk Factors; D012737:Sex Factors; D016312:Treatment Refusal
chemical_list: D000928:Antidepressive Agents; D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents