Taking Less Than Prescribed: Medication Nonadherence and Provider-Patient Relationships in Lower-Income, Rural Minority Adults With Hypertension
Article first published online: 26 MAY 2010
© 2010 Wiley Periodicals, Inc.
The Journal of Clinical Hypertension
Volume 12, Issue 9, pages 706–713, September 2010
How to Cite
Martin, M. Y., Kohler, C., Kim, Y.-i., Kratt, P., Schoenberger, Y.-M., Litaker, M. S., Prayor-Patterson, H. M., Clarke, S. J., Andrews, S. and Pisu, M. (2010), Taking Less Than Prescribed: Medication Nonadherence and Provider-Patient Relationships in Lower-Income, Rural Minority Adults With Hypertension. The Journal of Clinical Hypertension, 12: 706–713. doi: 10.1111/j.1751-7176.2010.00321.x
- Issue published online: 1 SEP 2010
- Article first published online: 26 MAY 2010
- Manuscript received October 30, 2009; revised March 16, 2010; accepted March 21, 2010
J Clin Hypertens (Greenwich). 2010;12:706–713. ©2010 Wiley Periodicals, Inc.
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.