Factors affecting medication adherence: patient perspectives from five veterans affairs facilities.
BACKGROUND
In the United States, more than 25 million people have diabetes. Medication adherence is known to be important for disease control. However, factors that consistently predict medication adherence are unclear and the literature lacks patient perspectives on how health care systems affect adherence to oral hypoglycemic agents (OHAs). This study explored facilitators and barriers to OHA adherence by obtaining the perspectives of Veterans Affairs (VA) patients with OHA prescriptions.


METHODS
A total of 45 patients participated in 12 focus groups that explored a wide range of issues that might affect medication adherence. Participants were patients at clinics in Seattle, Washington; San Antonio, Texas; Portland, Oregon; Salem, Oregon, and Warrenton, Oregon.


RESULTS
Key system-level facilitators of OHA adherence included good overall pharmacy service and several specific mechanisms for ordering and delivering medications (automated phone refill service, Web-based prescription ordering), as well as providing pillboxes and printed lists of current medications to patients. Barriers mirrored many of the facilitators. Poor pharmacy service quality and difficulty coordinating multiple prescriptions emerged as key barriers.


CONCLUSIONS
VA patient focus groups provided insights on how care delivery systems can encourage diabetes medication adherence by minimizing the barriers and enhancing the facilitators at both the patient and system levels. Major system-level factors that facilitated adherence were overall pharmacy service quality, availability of multiple systems for reordering medications, having a person to call when questions arose, counseling about the importance of adherence and providing tools such as pillboxes and updated medication lists.
Center for Community Health and Evaluation, Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1448, USA. hsu.c@ghc.org.|Department of Health Services, School of Public Health and Community Medicine, University of Washington, 1959 NE Pacific St. Magnuson Health Sciences Center, Box 357660, Seattle, WA, 98195, USA. hsu.c@ghc.org.
Clarissa
C
Hsu
VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA. lemonj@u.washington.edu.
Jaclyn M
JM
Lemon
VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA. edwin.wong@va.gov.|Department of Health Services, School of Public Health and Community Medicine, University of Washington, 1959 NE Pacific St. Magnuson Health Sciences Center, Box 357660, Seattle, WA, 98195, USA. edwin.wong@va.gov.
Edwin S
ES
Wong
Center for Community Health and Evaluation, Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1448, USA. eli_carson@yahoo.com.
Elizabeth
E
Carson-Cheng
VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA. mark.perkins2@va.gov.
Mark
M
Perkins
VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA. margaretnordstrom@gmail.com.
Margaret S
MS
Nordstrom
VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA. chaun-fen.liu@va.gov.|Department of Health Services, School of Public Health and Community Medicine, University of Washington, 1959 NE Pacific St. Magnuson Health Sciences Center, Box 357660, Seattle, WA, 98195, USA. chaun-fen.liu@va.gov.
Chuan-Fen
CF
Liu
Portland VA Medical Center, 3710 SW U.S. Veterans Hospital Road, Portland, OR, 97239, USA. carol.sprague@va.gov.|Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239-3098, USA. carol.sprague@va.gov.
Carol
C
Sprague
VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA. Christopher.bryson@va.gov.|Department of Medicine, University of Washington, Box 356420, , 1959 NE Pacific Street, Seattle, WA, 98195, USA. Christopher.bryson@va.gov.
Christopher L
CL
Bryson
D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009922:Oregon; D010361:Patients / Q000523:psychology* / Q000706:statistics & numerical data*; D013781:Texas; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*; D014861:Washington; D016903:Drug Monitoring
D007004:Hypoglycemic Agents