What factors influence concordance with medications? Findings from the UK Asian Diabetes study

• Published in: Diabetic medicine 2014-12, Vol.31 (12), p.1600-1609
• Main Authors: Lloyd, C. E., Mughal, S., Roy, T., Raymond, N. T., O'Hare, J. P., Barnett, A. H., Bellary, S.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Asia, Western - ethnology; Biological and medical sciences; Cardiovascular Diseases - epidemiology; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Longitudinal Studies; Male; Medical sciences; Medication Adherence - ethnology; Medication Adherence - statistics & numerical data; Middle Aged; Mortality; Quality of Life; Statistics as Topic; Studies; United Kingdom - epidemiology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12554

Aims To investigate concordance with medication, as assessed at baseline and at 1‐ and 2‐year follow‐up, and to examine factors associated with non‐concordance in a UK‐resident South‐Asian population. Methods Data from the UK Asian Diabetes Study were analysed. Concordance with medications was assessed and recorded at three time points during the study. Multiple logistic regression was used to investigate the factors associated with non‐concordance; the associations of baseline factors with year 1 concordance and baseline plus year 1 factors with year 2 concordance. Results Data for 403 patients from seven practices participating in the UK Asian Diabetes Study were analysed. The numbers of patients who were non‐concordant were: 63 (16%) at baseline; 101 (25%) at year 1; and 122 (30%) at year 2. The baseline‐measured variables that were significantly associated with year 1 non‐concordance included diabetes duration, history of cardiovascular disease, components of the EuroQol quality of life questionnaire, the EQ‐5D score, and number of medications prescribed. In multivariable analyses, the most important determinant of year 1 non‐concordance was baseline non‐concordance: odds ratio 13.6 (95% confidence limits 4.7, 39.9). Number of medications prescribed for blood pressure control was also significant: odds ratio 1.8 (95% confidence limits 1.4, 2.4). Similar results were observed for year 2 non‐concordance. Conclusions Non‐concordance with medications was common and more likely in people prescribed more medications. The current target‐driven management of risk factor levels may lead to increasing numbers and doses of medications. Considering the high cost of medications and the implications of poor health behaviours on morbidity and mortality, further investigation of prescribing behaviours and the factors affecting patient concordance are required. What's new? This study is one of very few to examine the factors associated with non‐concordance with medications in people with Type 2 diabetes from minority ethnic backgrounds. Our research, in South‐Asian people with diabetes, shows the importance of understanding the range of factors that might influence concordance with medications . Intensification of treatment may be ineffective where there is already poor concordance with prescribed medications, and alternative strategies for improving self‐management need to be identified. Given the huge economic cost of polypharmacy, this issue has important implicatio