title: Older patients' perceptions of medication importance and worth: an exploratory pilot study.
abstract: BACKGROUND
  Cost-related medication non-adherence may be influenced by patients' perceived importance of their medications.
  
  
  OBJECTIVE
  This exploratory pilot study addresses three related but distinct questions: Do patients perceive different levels of importance among their medications? What factors influence perceptions of medication importance? Is perceived importance associated with perceived worth of medications, and does expense impact on that association?
  
  
  METHODS
  Study participants included individuals aged >or=60 years who were taking three or more prescription drugs. Semi-structured, in-person interviews were conducted to measure how patients rated their medications in terms of importance, expense and worth. Factors that influenced medication importance were identified using qualitative analysis. Ordinal logistic regression analyses were employed to examine the association between perceived importance and perceived worth of medications, and the impact of expense on that association.
  
  
  RESULTS
  For 143 prescription drugs reported by 20 participants, the weighted mean rating of medication importance was 8.2 (SD 1.04) on a scale from 0 (not important at all) to 10 (most important). Patients considered 38% of these medications to be expensive. The weighted mean rating of worth was 8.4 (SD 1.46) on a scale from 0 (not worth it at all) to 10 (most worth). Three major factors influenced medication importance: drug-related (characteristics, indications, effects and alternatives); patient-related (knowledge, attitudes and health); and external (the media, healthcare and family caregivers, and peers). Regression analyses showed an association between perceived importance and perceived worth for inexpensive medications (odds ratio [OR] 2.23; p = 0.002) and an even greater association between perceived importance and perceived worth for expensive medications (OR 4.29; p < 0.001).
  
  
  CONCLUSIONS
  This study provides preliminary evidence that elderly patients perceive different levels of importance for their medications based on factors beyond clinical efficacy. Their perception of importance influences how they perceive their medications' worth, especially for medications of high costs. Understanding how patients perceive medication importance may help in the development of interventions to reduce cost-related non-adherence.
authors.affiliation: Buehler Center on Aging, Health & Society, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. D-Lau@northwestern.edu
authors.forename: Denys T
authors.initials: DT
authors.lastname: Lau
authors.forename: Becky A
authors.initials: BA
authors.lastname: Briesacher
authors.forename: Nathaniel D
authors.initials: ND
authors.lastname: Mercaldo
authors.forename: Leslie
authors.initials: L
authors.lastname: Halpern
authors.forename: E Charles
authors.initials: EC
authors.lastname: Osterberg
authors.forename: Mary
authors.initials: M
authors.lastname: Jarzebowski
authors.forename: June M
authors.initials: JM
authors.lastname: McKoy
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mazor
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001290:Attitude; D016527:Drug Costs; D004358:Drug Therapy / Q000191:economics / Q000523:psychology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010865:Pilot Projects; D055553:Prescription Drugs; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D055553:Prescription Drugs