Comparing patient dissatisfaction and rational judgment in intentional medication non-adherence versus unintentional non-adherence

WHAT IS KNOWN AND OBJECTIVE

Patients' poor adherence to medications is reported to be related to the individual patients' beliefs and cognitions and their trust of the medical staff. However, the causes of the two forms of non-adherence, intentional and unintentional behaviours, have yet to be clarified. This study compared psychological latent factors associated with intentional and unintentional non-adherence to chronic medication regimens, focusing on the potential effects of (i) patients' dissatisfaction with treatment and their relationships with the medical staff and (ii) patients' subliminal rational thinking processes, which weighed the positive values such as their expectations of benefits from treatment against negative values such as their dissatisfaction.

METHODS

Two cross-sectional surveys were undertaken of patients given medications for chronic diseases, using a questionnaire developed and validated in this study. One survey was undertaken in three hospitals and the other survey, online throughout Japan. We scored the individual latent factors using the questionnaire and calculated the differential score between two negatively correlated latent factors to quantify patients' subliminal rational thinking process. We compared the adjusted odds ratio (OR) of latent factors between intentional and unintentional non-adherence to medication in both surveys.

RESULTS AND DISCUSSION

Of the eligible subjects, 149 hospitalized patients and 524 survey participants completed the questionnaire. Intentional non-adherence was associated with patient dissatisfaction with treatment including interpersonal relationships with medical staff in both hospitalized patients and online survey participants (95% confidence interval of adjusted OR for Dissatisfaction, 1·20-16·26 in the hospital-based survey and 1·33-3·45 in the online survey). In both surveys, intentional non-adherence was significantly associated with the differential score between two negatively correlated latent factors, Willingness and Dissatisfaction (P = 0·02 in the hospital-based survey and P < 0·001 in the online survey). However, these associations were not evident in unintentionally non-adherent patients.

WHAT IS NEW AND CONCLUSIONS

Patients' dissatisfaction and their resulting rational judgments are unique, consistent determinants of intentional non-adherence to medications, but not of unintentional non-adherence.

Beliefs of chronically ill Japanese patients that lead to intentional non-adherence to medication

OBJECTIVE

To identify factors, associated with personal beliefs, involved in intentional non-adherence to prescribed medication of Japanese patients with chronic diseases.

METHODS

A cross-sectional study of Japanese subjects with chronic, primarily liver, gastrointestinal, or nervous system diseases who had been prescribed oral medicines for regular use, was performed. The subjects were admitted to a university hospital and were interviewed face-to-face on admission. Intentional non-adherence was defined as experience of deliberate adjustment of self-managed prescription medicines during the few months prior to hospital admission. Patients' beliefs about taking medicines were assessed from the perspective of what the patient valued in order to take medicines without anxiety; whether the patient valued information about the medication such as its function and side-effects and/or mutual reliance on doctors. Using logistic multivariate regression analyses, factors associated with intentional non-adherence were identified.

RESULTS

Among 154 subjects, 51 showed intentional non-adherence. Intentional non-adherence was associated with the following three factors: (a) the patients' beliefs with respect to taking medicines without anxiety, especially putting no value on mutual reliance on the patient-doctor relationship (P < 0.001) and putting great value on knowing the drug's side-effects (P < 0.001), (b) poor comprehension of general aspects of medication (P for trend < 0.001), and (c) being in the prime of life (40-59 years) (P = 0.011). Comprehension of the function of each medicine, experience of side-effects, anxiety about taking medicines, and the number of types of medicines taken, were not associated with non-adherence.

CONCLUSIONS

Beliefs on which individual Japanese patients with chronic diseases attach value in order to take medicines without anxiety were potential factors for intentional non-adherence. This emphasizes the necessity of a patient-oriented approach to take account of patients' personal beliefs about medicines to increase adherence rate in Japan.

Hypoglycaemia in patients with liver diseases administered levothyroxine

OBJECTIVE

Experience of a few hypoglycaemic patients with liver disease and receiving levothyroxine suggested to us that the prevalence of hypoglycaemia might be higher in such patients. The purpose of this study was to ascertain whether the prevalence of hypoglycaemia this was actually the case.

METHODS

This study was a retrospective, cross-sectional analysis of a medical computerized database and/or written reports from our university hospital. Patients with primary liver disease who were admitted to our hospital between April 1998 and August 2000 were divided into two groups; the first group received levothyroxine and the second group did not. The patients in the second group were selected from three different time periods within the period shown. The prevalence of hypoglycaemia (blood glucose level <70 mg/dL) was compared between the two groups.

RESULTS

The prevalence of hypoglycaemia was significantly higher in the group receiving levothyroxine compared with the group not receiving levothyroxine (four of eight patients (50.0%) vs. three of 59 (5.1%), P = 0.003, Fisher's exact test).

CONCLUSIONS

The results suggest that levothyroxine may be a risk factor for hypoglycaemia in patients with liver disease. While a larger study, perhaps with an alternative study design is needed to confirm this, and to investigate possible mechanisms of effect, it would be prudent to monitor the blood glucose level of such patients closely.

[Analysis of factors influencing the self-regulation of medication and construction of an educational program for patients with chronic hepatic diseases]

The purpose of this study is to construct an educational program for patients with chronic hepatic diseases to avoid self-regulation of medication. We have statistically analyzed the influencing factors of self-regulation from the following 3 viewpoints. First, in the investigation of the number of and the kind of prescribed medicines, it was found that the number of prescribed medicines increased sharply at the stage of Liver Cirrhosis b. Secondly, in the survey of patients' awareness of medication, it was found that self-regulation was influenced by lack of understanding the effects of medicines and the necessity of medication, and by lack of understanding the clinical conditions. Especially, at the stage of Liver Cirrhosis b, self-regulation was strongly influenced by lack of understanding the clinical conditions. Lastly, in the evaluation of patients' characteristics by pharmacists, self-regulation was also strongly influenced by the level of understanding the necessity of medication, understanding the clinical conditions, a patient-doctor relationship, and anxiety about side-effects of medicines. Therefore we have constructed an educational program for patients from the viewpoint of medication. The information consists of two articles; one is the action mechanism of the medicine connected with the clinical conditions to help the patients understand the necessity of medication; the other is how to check the effect and adverse reaction of the medication by themselves to decrease the anxiety about side-effects. Consequently, the medication management and the consultation for inpatients with chronic hepatic diseases were standardized by incorporating the education with the information described above.