title: Lazy sunday afternoons: the negative impact of interruptions in patients' daily routine on adherence to oral antidiabetic medication. A multilevel analysis of electronic monitoring data.
abstract: OBJECTIVE
  Considerable variability in adherence over time exists. The aim of this study was to investigate to what extent deviations from the prescribed regimen in type 2 diabetes patients can be explained by characteristics of the individual 'medication intake moments' and the patient.
  
  
  METHODS
  Medication intake of 104 non-adherent type 2 diabetes patients from 37 community pharmacies was electronically monitored for 6 months. The primary outcome measures were: (1) whether or not the intake occurred and (2) whether or not the intake occurred within the agreed-upon time period (correct timing). Multilevel logistic regression analyses were performed to account for the nested structure of the data.
  
  
  RESULTS
  Medication intakes in the evening and during weekends and holidays were more likely to be incorrectly timed and also more likely to be completely missed. Irrespective of timing, most intakes occurred in the mornings of Monday through Thursday (96 %), and least intakes occurred on Saturday evening (82 %). Correctly timed intakes most often occurred on Monday and Tuesday mornings (61 %) in contrast to Sunday evenings (33 %). A patient's medication regimen was significantly associated with adherence.
  
  
  CONCLUSIONS
  Based on our results, among patients who already have difficulties in taking their oral antidiabetic medication, interruptions in the daily routine negatively influence the intake of their medication. Professionals need to be aware of this variation in adherence within patients. As regular medication intake is important to maintain glycaemic control, healthcare professionals and patients should work together to find strategies that prevent deviations from the prescribed regimen at these problematic dosing times.
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), PO. Box 1568, 3500 BN, Utrecht, The Netherlands. M.Vervloet@nivel.nl
authors.forename: M
authors.initials: M
authors.lastname: Vervloet
authors.forename: P
authors.initials: P
authors.lastname: Spreeuwenberg
authors.forename: M L
authors.initials: ML
authors.lastname: Bouvy
authors.forename: E R
authors.initials: ER
authors.lastname: Heerdink
authors.forename: D H
authors.initials: DH
authors.lastname: de Bakker
authors.forename: L
authors.initials: L
authors.lastname: van Dijk
mesh_terms: D000284:Administration, Oral; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D016903:Drug Monitoring / Q000379:methods*; D055615:Electrical Equipment and Supplies; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D055361:Multilevel Analysis; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents