title: Patient-reported medication adherence barriers among patients with cardiovascular risk factors.
abstract: BACKGROUND
  Many patients experience barriers that make it difficult to take cardiovascular disease (CVD)-related medications as prescribed. The Cardiovascular Intervention Improvement Telemedicine Study (CITIES) was a tailored behavioral pharmacist-administered and telephone-based intervention for reducing CVD risk.
  
  
  OBJECTIVE
  To (a) describe patient-reported barriers to taking their medication as prescribed and (b) evaluate patient-level characteristics associated with reporting medication barriers.
  
  
  METHODS
  We recruited patients receiving care at primary care clinics affiliated with Durham Veterans Affairs Medical Center. Eligible patients were diagnosed with hypertension and/or hyperlipidemia that were poorly controlled (blood pressure of > 150/100 mmHg and/or low-density lipoprotein value > 130 mg/dL). At the time of enrollment, patients completed an interview with 7 questions derived from a validated medication barriers measure. Patient characteristics and individual medication treatment barriers are described. Multivariable linear regression was used to examine the association between a medication barrier score and patient characteristics.
  
  
  RESULTS
  Most patients (n = 428) were married or living with their partners (57%) and were men (85%) who were diagnosed with hypertension and hyperlipidemia (64%). The most commonly reported barriers were having too much medication to take (31%) and forgetting whether medication was taken at a particular time (24%). In adjusted analysis, those who were not employed (1.32, 95% CI = 0.50-2.14) or did not have someone to help with tasks, if needed (1.66, 95% CI = 0.42-2.89), reported higher medication barrier scores. Compared with those diagnosed with hypertension and hyperlipidemia, those with only hypertension (0.91, 95% CI = 0.04-1.79) reported higher medication barrier scores.
  
  
  CONCLUSIONS
  Barriers to medication adherence are common. Evaluating and addressing barriers may increase medication adherence.
authors.affiliation: Duke University Medical Center, 411 W. Chapel Hill St., Ste. 600, Durham, NC 27701. hayden.bosworth@duke.edu.
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.forename: Karen M
authors.initials: KM
authors.lastname: Stechuchak
authors.forename: Karen M
authors.initials: KM
authors.lastname: Goldstein
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: Felicia M
authors.initials: FM
authors.lastname: McCant
authors.forename: Susanne
authors.initials: S
authors.lastname: Danus
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Crowley
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010595:Pharmacists / Q000458:organization & administration; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration; D012307:Risk Factors; D013689:Telephone; D016903:Drug Monitoring