Demographic, socioeconomic, and psychological factors related to medication non-adherence among emergency department patients.
BACKGROUND
Many Emergency Department (ED) visits are related to medication non-adherence; however, the contributing factors are poorly understood.


OBJECTIVE
To explore the relative contributions of demographic, socioeconomic, and psychological factors to medication non-adherence in an ED population.


METHODS
This was a cross-sectional analysis enrolling patients with one of three illnesses requiring chronic medication usage (hypertension, diabetes, or seizures). Trained research associates administered a 60-item survey that assessed demographic and socioeconomic information, as well as a variety of psychological factors potentially relevant to adherence (health attitudes, health beliefs, depression, anxiety, social support, and locus of control). Patients rated their overall prescription medication adherence and estimated the number of days in the preceding month on which doses were missed. In addition, treating physicians estimated the degree to which the ED visit was related to medication non-adherence; clinical data were abstracted to help validate patient and physician assessments. The relationships between non-adherence and demographic, socioeconomic, and psychological variables were explored using multivariate statistics and logistic regression. Covariance analysis was performed to validate subscales, and receiver-operator curves were used to define optimal threshold values.


RESULTS
A total of 472 patients consented to participate, with good representation for various demographic and socioeconomic groups. Each psychological factor related significantly to both patient and physician ratings of non-adherence (p < 0.05). Of all demographic and socioeconomic factors examined, only current or historical drug use predicted non-adherence.


CONCLUSIONS
Psychological factors seem to be important determinants of medication non-adherence among ED patients. These data may help define future research directions and interventions.
Davis
Daniel P
DP
Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California 92103-8240, USA.
Jandrisevits
Matthew D
MD
Iles
Stacy
S
Weber
Tory R
TR
Gallo
Linda C
LC
D000328:Adult; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000188:drug therapy; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007389:Internal-External Control; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D015203:Reproducibility of Results; D012307:Risk Factors; D012640:Seizures / Q000188:drug therapy; D012959:Socioeconomic Factors; D016903:Drug Monitoring