Taking less than prescribed: medication nonadherence and provider-patient relationships in lower-income, rural minority adults with hypertension.
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.
Martin
Michelle Y
MY
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
Kohler
Connie
C
Kim
Young-il
YI
Kratt
Polly
P
Schoenberger
Yu-Mei
YM
Litaker
Mark S
MS
Prayor-Patterson
Heather M
HM
Clarke
Stephen J
SJ
Andrews
Shiquina
S
Pisu
Maria
M
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
D000959:Antihypertensive Agents