Not Just Being Old Or Forgetful - Measuring And Quantifying Causes Of Medication Non-adherence In Norway

• By: LARSEN, Rønnaug Eline (Oslo Metropolitan University, Norway)
• Co-author(s): Ms Rønnaug Eline Larsen (Oslo Metropolitan University, Oslo, Norway)
  Ms Ala Karimi (Oslo Metropolitan University, Oslo, Norway)
  Associate professor Tonje Krogstad (Oslo Metropolitan University, Oslo, Norway)
  Professor Cecilie Johannessen Landmark (Oslo Metropolitan University, Oslo, Norway / The National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway / Section for Clinical Pharmacology, The National Centre for Epilepsy, Dept of Pharmacology, Oslo University Hospital, Oslo, Norway)
  Associate professor Lene Berge Holm (Oslo Metropolitan University, Oslo, Norway)
  
• Abstract:

  Background information
  
  It is well known that patients not always adhere to medication and that adherence rates range from 0%-100%. It is also known that patients’ reasons for non-adherence could be complex and originate in different causes of medication-taking behaviour, barriers, and beliefs. Literature is however not in agreement on what impact confounding causes like age, gender, education, regularly use, number of drugs and duration of therapy have on adherence.
  Ensuring adherence secures rational use of medicine and patient safety. For health professionals to ensure this, knowledge on causes of non-adherence and patients at risk is imperative.
  To our knowledge little is known in the general Norwegian population about the causes of non-adherence and the impact some confounding causes (age, gender, education, regularly use, number of drugs and duration of drug therapy) have on adherence.
  
  Purpose
  
  To measure and quantify causes of non-adherence in Norway using a non-disease dependent survey tool on self-reported medication-taking behaviour, barriers, and beliefs.
  
  Method
  
  Medication users ≥18 years living in Norway completed anonymously OMAS-37, a new validated non-disease-specific online survey-tool for self-reported medication-taking behaviour, barriers, and beliefs. Recruitment was mainly done via Facebook posts.
  
  Results
  
  812 respondents were found eligible. The mean age was 48 years and 90.6% were women. 517 (64%) scored equivalent with poor adherence.
  Increasing age (18-80 years), higher education, self-perceived adherence, and involvement in decision-making for medication treatment had a significant (p<0.05) positive impact on adherence.
  Of three compared patient groups, the Cardiovascular Diseases (CVD)- patient group demonstrated significantly (p<0.05) better adherence compared to the Mental Health Disorders (MHD)- patient group and the Pain-patient group. Independent of diagnosis and choosing from 37 causes of non-adherence, the three main causes for the whole sample were “Forgetting to take the medication” (42%), “Feeling better” (40%) and “Fearing adverse drug reactions” (39%).
  The main causes of non-adherence varied to some extent between the whole sample, the CVD-patient group, the MHD-patient group, and the Pain-patient group.
  
  Conclusion
  
  Almost two thirds of the whole sample scored equivalent with poor adherence and the main causes for non-adherence were forgetting, feeling better, and fear of adverse drug-reactions.
  Adherence improved with age (until 80 years), higher education, and involvement in medication decision-making.
  The differences in main causes of non-adherence between the whole sample and different patient groups indicates that it could be of importance to differentiate between patient groups when developing adherence enhancing interventions. This study is part of a project aiming to develop a digital patient intervention that improves adherence to medication.
  Further studies are required to test if the results may be generalized for the general Norwegian population.