title: Taking less than prescribed: medication nonadherence and provider-patient relationships in lower-income, rural minority adults with hypertension.
abstract: Control of hypertension remains poor, and lack of adherence to medication is considered a primary reason. Few studies have examined the reasons for medication nonadherence in African American, lower-income, rural adults receiving medications at no personal cost. Moreover, our understanding of how the provider-patient relationship influences adherence in this population is limited. In this study, the authors (1) examined reasons for taking less medication than prescribed and (2) examined the association between provider-patient variables and medication adherence. A total of 434 participants (94.8% African American) were included. The most frequently endorsed reasons for taking less medication than prescribed were not having blood pressure medicine when it was time to take a dose (36%), running out of medicine (35%), bothered by side effects (29%), and a change in one's daily routine (27%). Nonadherent individuals were significantly more likely to report discomfort with asking the health provider questions (74% vs 63%), were more likely to report that health care visits were stressful (25% vs 16%), and exhibited more depressive symptoms (58% vs 45%). Adherent patients had lower blood pressure (systolic: 133±15.8 mm Hg vs 138±17.6 mm Hg, P value=.002; diastolic: 80±9.8 mm Hg vs 83±11 mm Hg, P value=.003) than individuals who were less adherent. Clinicians providing care to rural, poor hypertensive patients should routinely assess self-management behaviors, logistical barriers, and emotional health. Creating clinical encounters that minimize the stressful nature of the visit and encourage patient question-asking behavior may also be important for the optimal management of hypertension.
authors.affiliation: Department of Medicine, Division of Preventive Medicine, the School of Public Health, Health Behavior, University of Alabama at Birmingham, Birmingham, AL 35294-4410, USA. mymartin@uab.edu
authors.forename: Michelle Y
authors.initials: MY
authors.lastname: Martin
authors.forename: Connie
authors.initials: C
authors.lastname: Kohler
authors.forename: Young-il
authors.initials: YI
authors.lastname: Kim
authors.forename: Polly
authors.initials: P
authors.lastname: Kratt
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Schoenberger
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litaker
authors.forename: Heather M
authors.initials: HM
authors.lastname: Prayor-Patterson
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Clarke
authors.forename: Shiquina
authors.initials: S
authors.lastname: Andrews
authors.forename: Maria
authors.initials: M
authors.lastname: Pisu
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001294:Attitude to Health / Q000208:ethnology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010817:Physician-Patient Relations; D011203:Poverty; D012424:Rural Population; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents