title: Association of age, health literacy, and medication management strategies with cardiovascular medication adherence.
abstract: OBJECTIVE
  To examine patients' use of medication management strategies (e.g., reminders, pill boxes), and to determine how their use influences the relationship between patient characteristics and medication adherence.
  
  
  METHODS
  Retrospective and cross-sectional study of 434 patients with coronary heart disease, examining both refill adherence and self-reported adherence.
  
  
  RESULTS
  The most common strategy for managing refills was seeing a near empty pill bottle (89.9%), and for managing daily medications, it was associating medications with daily events (80.4%). Age<65 (OR = 1.7), as well as marginal (OR = 2.0) or inadequate health literacy (OR = 1.9), was independently associated with low refill adherence. Patients <65 also had lower self-reported adherence (OR = 1.8). Adjustment for use of medication management strategies did not substantially change these relationships. Reliance on reminders from friends or family to take medications, or waiting to refill a medicine only when the bottle was near empty, each were associated with 3-fold greater odds of non-adherence.
  
  
  CONCLUSIONS
  Age <65 and marginal or inadequate health literacy were independently associated with medication non-adherence. Use of medication management strategies did not explain these relationships.
  
  
  CONCLUSIONS
  The strategies which patients report using to assist with managing medication refills and daily medication use may be ineffective.
authors.affiliation: Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, TN 37232, USA. sunil.kripalani@vanderbilt.edu
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Gatti
authors.forename: Terry A
authors.initials: TA
authors.lastname: Jacobson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003327:Coronary Disease / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D004522:Educational Status; D005260:Female; D057220:Health Literacy; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010817:Physician-Patient Relations; D017010:Reminder Systems; D012189:Retrospective Studies; D012646:Self Administration; D012959:Socioeconomic Factors; D014505:Urban Population
chemical_list: D002317:Cardiovascular Agents