Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Medication beliefs predict medication adherence in ambulatory patients with decompensated cirrhosis
Kelly L Hayward, Patricia C Valery, Jennifer H Martin, Antara Karmakar, Preya J Patel, Leigh U Horsfall, Caroline J Tallis, Katherine A Stuart, Penny L Wright, David D Smith, Katharine M Irvine, Elizabeth E Powell, W Neil Cottrell
Kelly L Hayward, Pharmacy Department, Princess Alexandra Hospital, The Centre for Liver Disease Research, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland 4102, Australia
Patricia C Valery, Cancer and Chronic Disease Research Group, QIMR Berghofer Medical Research Institute, Herston, Queensland 4006, Australia
Jennifer H Martin, School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales 2308, Australia
Antara Karmakar, The Centre for Liver Disease Research, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland 4102, Australia
Preya J Patel, Leigh U Horsfall, Katharine M Irvine, Elizabeth E Powell, Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, The Centre for Liver Disease Research, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland 4102, Australia
Caroline J Tallis, Katherine A Stuart, Penny L Wright, Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia
David D Smith, Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland 4006, Australia
W Neil Cottrell, School of Pharmacy, The University of Queensland, Woolloongabba, Queensland 4102, Australia
Author contributions: Hayward KL, Valery PC, Martin JH, Irvine KM, Powell EE and Cottrell WN contributed to the conception and design of the study; all authors contributed to the study implementation, data acquisition, data analysis and interpretation; Hayward KL wrote the manuscript and all authors contributed to the editing, reviewing and approval of the manuscript in its final form.
Institutional review board statement: This study was conducted in accordance with the National Statement on Ethical Conduct in Human Research 2007 (Updated May 2015) and was approved by the Human Ethics Committees of Metro South Hospital and Health Service HREC/15/QPAH/688 and the University of Queensland, UQ2016000032.
Informed consent statement: Written informed consent was obtained from participants or, where they lacked capacity, assent was obtained from a personal or nominated consultee.
Conflict-of-interest statement: None.
Data sharing statement: Raw data and materials have not been made publically available as participants in the present study did not consent to release of the same. Scientists wishing to access raw data for non-commercial purposes may contact the corresponding author directly.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: W Neil Cottrell, PhD, Associate Professor, Pharmacy Australia Centre of Excellence, School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Queensland 4102, Australia.
n.cottrell@uq.edu.au
Telephone: +61-7-33461977 Fax: +61-7-38461999
Received: April 27, 2017
Peer-review started: May 12, 2017
First decision: June 5, 2017
Revised: July 18, 2017
Accepted: September 5, 2017
Article in press: September 5, 2017
Published online: October 28, 2017
Processing time: 172 Days and 18.8 Hours
AIM
To investigate the impact of medication beliefs, illness perceptions and quality of life on medication adherence in people with decompensated cirrhosis.
METHODS
One hundred adults with decompensated cirrhosis completed a structured questionnaire when they attended for routine outpatient hepatology review. Measures of self-reported medication adherence (Morisky Medication Adherence Scale), beliefs surrounding medications (Beliefs about Medicines Questionnaire), perceptions of illness and medicines (Brief Illness Perception Questionnaire), and quality of life (Chronic Liver Disease Questionnaire) were examined. Clinical data were obtained via patient history and review of medical records. Least absolute shrinkage and selection operator and stepwise backwards regression techniques were used to construct the multivariable logistic regression model. Statistical significance was set at alpha = 0.05.
RESULTS
Medication adherence was “High” in 42% of participants, “Medium” in 37%, and “Low” in 21%. Compared to patients with “High” adherence, those with “Medium” or “Low” adherence were more likely to report difficulty affording their medications (P < 0.001), lower perception of treatment helpfulness (P = 0.003) and stronger medication concerns relative to medication necessity beliefs (P = 0.003). People with “Low” adherence also experienced greater symptom burden and poorer quality of life, including more frequent abdominal pain (P = 0.023), shortness of breath (P = 0.030), and emotional disturbances (P = 0.050). Multivariable analysis identified having stronger medication concerns relative to necessity beliefs (Necessity-Concerns Differential ≤ 5, OR = 3.66, 95%CI: 1.18-11.40) and more frequent shortness of breath (shortness of breath score ≤ 3, OR = 3.87, 95%CI: 1.22-12.25) as independent predictors of “Low”adherence.
CONCLUSION
The association between “Low” adherence and patients having strong concerns or doubting the necessity or helpfulness of their medications should be explored further given the clinical relevance.
Core tip: Medication non-adherence is common in people with decompensated cirrhosis but the impact that patients’ medication beliefs and illness perceptions have on adherence is under-recognised. Clinician engagment with non-adherent patients should include open discussion of medications and liver disease. Acknowledgement of patient concerns surrounding their medicines, with positive reinforcement of medication necessity in terms of disease management may improve adherence behaviour and patients’ quality of life.
