Taking Less Than Prescribed: Medication Nonadherence and Provider‐Patient Relationships in Lower‐Income, Rural Minority Adults With Hypertension

• Published in: The journal of clinical hypertension (Greenwich, Conn.) Conn.), 2010-09, Vol.12 (9), p.706-713
• Main Authors: Martin, Michelle Y., Kohler, Connie, Kim, Young‐il, Kratt, Polly, Schoenberger, Yu‐Mei, Litaker, Mark S., Prayor‐Patterson, Heather M., Clarke, Stephen J., Andrews, Shiquina, Pisu, Maria
• Format: Article
• Language: English
• Subjects: Adult; African Americans; Aged; Antihypertensive Agents - therapeutic use; Attitude to Health - ethnology; Female; Humans; Hypertension - drug therapy; Hypertension - ethnology; Male; Medication Adherence; Middle Aged; Original Paper; Original Papers; Physician-Patient Relations; Poverty; Rural Population; Treatment Outcome
• ISSN: 1524-6175; 1751-7176
• DOI: 10.1111/j.1751-7176.2010.00321.x

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.