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Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study.

Publication ,  Journal Article
Mentz, RJ; Greiner, MA; Muntner, P; Shimbo, D; Sims, M; Spruill, TM; Banahan, BF; Wang, W; Mwasongwe, S; Winters, K; Correa, A; Curtis, LH ...
Published in: Am Heart J
June 2018

BACKGROUND: Non-adherence to medications is common and leads to suboptimal outcomes. Non-adherence can be intentional (e.g., deciding to skip dosages) or unintentional (e.g., forgetting), yet few studies have distinguished these reasons. An improved understanding of the reasons for non-adherence could inform the development of effective interventions. METHODS AND RESULTS: We analyzed data from African Americans in the Jackson Heart Study who were prescribed medications for one or more chronic conditions. Participants were grouped by patient-reported adherence with non-adherence categorized as being intentional, unintentional or both. We used modified Poisson regression models to examine the factors associated with types of non-adherence. Of 2933 participants taking medication, 2138 (72.9%) reported non-adherence with 754 (35.3%) reporting only unintentional non-adherence, 263 (12.3%) only intentional non-adherence, and 1121 (52.4%) both. Factors independently associated with intentional non-adherence included female sex and depressive symptoms while factors associated with unintentional non-adherence included younger age and separated relationship status. Unintentional and intentional non-adherence was more common among participants taking anti-arrhythmic and anti-asthmatic medications, respectively. Higher levels of global perceived stress was associated with both types of non-adherence. The adjusted models for intentional and unintentional non-adherence had c-statistics of 0.65 and 0.66, respectively, indicating modest discrimination. CONCLUSION: Specific patient factors and individual medication classes were associated with distinct patterns of intentional and unintentional non-adherence, yet the overall modest discrimination of the models suggests contributions from other unmeasured factors. These findings provide a construct for understanding reasons for non-adherence and provide rationale to assess whether personalized interventions can improve adherence.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2018

Volume

200

Start / End Page

51 / 59

Location

United States

Related Subject Headings

  • United States
  • Sex Factors
  • Severity of Illness Index
  • Risk Factors
  • Needs Assessment
  • Middle Aged
  • Medication Adherence
  • Male
  • Longitudinal Studies
  • Intention
 

Citation

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Mentz, R. J., Greiner, M. A., Muntner, P., Shimbo, D., Sims, M., Spruill, T. M., … O’Brien, E. C. (2018). Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study. Am Heart J, 200, 51–59. https://doi.org/10.1016/j.ahj.2018.03.007
Mentz, Robert J., Melissa A. Greiner, Paul Muntner, Daichi Shimbo, Mario Sims, Tanya M. Spruill, Benjamin F. Banahan, et al. “Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study.Am Heart J 200 (June 2018): 51–59. https://doi.org/10.1016/j.ahj.2018.03.007.
Mentz RJ, Greiner MA, Muntner P, Shimbo D, Sims M, Spruill TM, et al. Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study. Am Heart J. 2018 Jun;200:51–9.
Mentz, Robert J., et al. “Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study.Am Heart J, vol. 200, June 2018, pp. 51–59. Pubmed, doi:10.1016/j.ahj.2018.03.007.
Mentz RJ, Greiner MA, Muntner P, Shimbo D, Sims M, Spruill TM, Banahan BF, Wang W, Mwasongwe S, Winters K, Correa A, Curtis LH, O’Brien EC. Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study. Am Heart J. 2018 Jun;200:51–59.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2018

Volume

200

Start / End Page

51 / 59

Location

United States

Related Subject Headings

  • United States
  • Sex Factors
  • Severity of Illness Index
  • Risk Factors
  • Needs Assessment
  • Middle Aged
  • Medication Adherence
  • Male
  • Longitudinal Studies
  • Intention