gallagher r, warwick m, chenoweth l, stein-parbury j & milton-wildey k (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 30–40
Medication knowledge, adherence and predictors among people with heart failure and chronic obstructive pulmonary disease
Background. Although medicines are a key component in the self-management of chronic illness, lack of adherence is a common problem.
Aim. To describe medication adherence and predictors in relation to the Multidimensional Adherence Model among older adults with chronic illness.
Method. During a home interview, we collected data from 118 patients with chronic illnesses (chronic obstructive pulmonary disease and heart failure), following a recent illness exacerbation, to determine self-reported medication adherence, medication knowledge and capacity for self-management of their illness. We used the Medication Adherence Model as an organising framework and performed multivariate analyses to determine the independent predictors. We conducted the study between April 2005–June 2006.
Results. Participants had an average age of 75·54 years (SD 8·38), with marginally more men (56·8%) than women, and were prescribed an average 4·68 (SD 2·11) medications for their primary diagnosis of either chronic obstructive pulmonary disease or heart failure. Most participants (75·2%) were adherent to their prescribed medicines; however, medication knowledge was low [mean score 47·61 (SD 18·73) out of a potential 100]. Predictors of better adherence to medicines were patient-related: female gender and higher self-management capacity, and condition-related: heart failure diagnosis. Socioeconomic and treatment-related factors were not identified as independent predictors of medication adherence. Predictors of better medication knowledge were higher capacity for self-management, more concurrent conditions, younger age and taking fewer medicines.
Conclusion. Assessment of self-management capacity, targeting interventions towards patients with chronic obstructive pulmonary disease and men, rather than relying solely on increasing medication knowledge, is essential to improve medication adherence. The Multidimensional Adherence Model requires further investigation to determine its use in patients with chronic illness in general.
Relevance to clinical practice. The most effective interventions to improve medication adherence are less likely to be those focused on patient education, and more likely to be those tailored to increasing patients’ self-management capacity. Programmes will need to involve formal and informal carers. Simple strategies designed to improve medication adherence, such as medication reminders, daily routines, and multi-dose packs have been reported to be effective in systematic reviews and by patients’ themselves. We recommend all of these strategies to improve medication adherence in persons with chronic illnesses.