Medication beliefs predict medication adherence in ambulatory patients with decompensated cirrhosis

doi:10.3748/wjg.v23.i40.7321

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World Journal of Gastroenterology

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World J Gastroenterol. Oct 28, 2017; 23(40): 7321-7331
Published online Oct 28, 2017. doi: 10.3748/wjg.v23.i40.7321

Table 1 Demographic and clinical factors in patients with high, medium and low medication adherence n (%)

Demographic and clinical variables		All patients	Medication adherence ranking			P value
			High	Medium	Low
			(n = 42)	(n = 37)	(n = 21)
Age		58.4 ± 10.2	57.9 ± 10.9	58.2 ± 9.0	57.8 ± 10.8	0.787
Male gender		65 (65.0)	21 (50.0)	30 (81.1)	14 (66.7)	0.015
Primary aetiology	ALD	49 (48.0)	19 (45.2)	19 (51.4)	11 (52.4)	0.842
	HCV	35 (33.0)	14 (33.3)	13 (35.1)	8 (38.1)	0.963
	Other	16 (16.0)	9 (21.5)	5 (13.5)	2 (9.5)	0.383
¹Child-Turcotte Pugh class	A	24 (24.0)	6 (14.3)	12 (32.4)	6 (28.6)	0.684
	B	59 (59.0)	29 (69.0)	21 (56.8)	9 (42.8)
	C	17 (17.0)	7 (16.7)	4 (10.8)	6 (28.6)
MELD score		14.4 ± 5.2	14.6 ± 4.6	14.2 ± 5.1	14.2 ± 6.7	0.936
Ascites at review (incl. suppressed by medication)		80 (80.0)	37 (88.1)	28 (75.7)	15 (71.4)	0.187
Encephalopathy at review (incl. suppressed by medication)		36 (36.0)	12 (28.6)	13 (35.1)	11 (52.4)	0.184
Hepatocellular carcinoma		8 (8.0)	3 (7.1)	3 (8.1)	2 (9.5)	1.00
Number of self-reported medicines		7.1 ± 3.5	7.2 ± 3.7	7.1 ± 3.6	6.9 ± 3.1	0.923
Number of comorbidities		5.5 ± 2.8	5.4 ± 2.8	5.8 ± 3.0	5.2 ± 2.5	0.703
²Unable to afford medicines		19 (20.2)	1 (2.5)	12 (36.4)	6 (28.6)	< 0.001
³Education	Nil, Primary, Middle school	39 (42.4)	14 (34.1)	13 (43.3)	12 (57.1)	0.215
³Education	High school, Trade, University	53 (57.6)	27 (65.9)	17 (56.7)	9 (42.9)	0.215
⁴Employment status	Employed	18 (19.1)	9 (22.0)	6 (18.2)	3 (14.3)	0.842
⁴Employment status	Government welfare	72 (76.6)	30 (73.2)	25 (75.8)	18 (85.7)	0.602
ARIA	Highly accessible	89 (89.0)	36 (85.7)	34 (91.9)	19 (90.5)	0.713
ARIA	Accessible–remote	11 (11.0)	6 (14.3)	3 (8.1)	2 (9.5)	0.713
IRSD	Most disadvantaged	32 (32.0)	16 (38.1)	7 (18.9)	9 (42.9)	0.093
IRSD	Low–moderate disadvantage	68 (68.0)	26 (68.9)	30 (81.1)	12 (57.1)	0.093

Normally distributed data presented as mean ± SD and analysed using one-way ANOVA. Categorical data presented as proportional percent (%) of column (adherence ranking) and analysed using Pearson’s χ² or Fisher’s Exact test unless otherwise noted.

¹Analysed using the Linear-by-Linear Exact Association test for trend;

²Excluding 6 patients for whom data was not available (n = 40 High adherers, n = 33 Medium adherers and n = 21 Low adherers);

³Excluding 8 patients for whom data was not available (n = 41 High adherers, n = 30 Medium adherers and n = 21 Low adherers);

⁴Excluding 5 patients for whom data was not available (n = 41 High adherers, n = 33 Medium adherers and n = 21 Low adherers). P-values represent “Employed” vs “Unemployed” (data not shown), and “Government Welfare” vs “Not receiving Government Welfare” (data not shown) respectively. Two patients reported concurrent part-time employment and Government Welfare support and are represented twice. “Employed” includes full-time, part-time, casual and self-employment. “Government Welfare” includes disability support, aged pension, carer’s pension, total permanent disability, Newstart allowance. Six patients reported no active income (living off savings or financially supported by family). ALD: Alcoholic liver disease; HCV: Hepatitis C virus ARIA: Accessibility/Remoteness Index of Australia; IRSD: Index for relative socioeconomic disadvantage.

Table 2 Responses to the beliefs about medications questionnaires in patients with high, medium and low medication adherence

Medication beliefs domains	All patients(n = 100)	Medication adherence ranking			P value
		High	Medium	Low
		(n = 42)	(n = 37)	(n = 21)
Necessity	19.3 ± 3.8	19.6 ± 3.1	19.9 ± 4.1	17.6 ± 4.0	0.064
Concerns	12.0 ± 3.6	11.2 ± 3.3	12.2 ± 3.3	13.3 ± 4.2	0.074
Necessity-Concerns Differential	7.3 ± 4.7	8.4 ± 4.8	7.6 ± 4.2	4.3 ± 4.2	0.003
Harms	8.3 ± 2.5	7.9 ± 2.8	8.3 ± 2.0	8.8 ± 2.7	0.405
Overuse	10.3 ± 3.1	9.5 ± 3.0	10.7 ± 3.0	11.3 ± 2.9	0.053

Data presented as mean ± SD and analysed using one-way ANOVA. Higher scores indicate stronger medication beliefs within a given domain. Harms and Overuse scores range from 5 to 20. Necessity and Concerns scores range from 5 to 25. The Necessity-Concerns Differential (score range 0 to 20) is calculated by subtracting individual patients’ Concern scores from their Necessity scores.

Table 3 Illness perceptions in patients with high, medium and low medication adherence

Brief illness perception questionnaire items	All patients(n = 100)	Medication adherence ranking			P value
		High	Medium	Low
		(n = 42)	(n = 37)	(n = 21)
Consequences	6.0 ± 3.1	6.1 ± 3.0	6.0 ± 3.1	5.7 ± 3.2	0.846
How much does your liver disease affect your life?
0 = No affect; 10 = Severely affects my life
Timeline	10.0 (0-10)	10 (3-10)	10 (0-10)	10 (3-10)	0.962
How long do you think your liver disease will continue?
0 = Very short time; 10 = Forever
Personal Control	4.8 ± 3.0	4.6 ± 3.2	4.8 ± 2.9	5.0 ± 2.8	0.893
How much control do you feel you have over your liver disease?
0 = Absolutely no control; 10 = Extreme amount of control
Treatment Control	8.0 (0-10)	8 (2-10)	10 (4-10)	7 (0-10)	0.003
How much do you think your treatment can help your liver disease?
0 = Not at all; 10 = Extremely helpful
Identity	5.5 ± 3.0	5.6 ± 3.0	5.5 ± 3.0	5.2 ± 2.9	0.905
How much do you experience symptoms from your liver disease?
0 = No symptoms; 10 = Many severe symptoms
Concern	8.0 (0-10)	8 (0-10)	9 (0-10)	8 (0-10)	0.416
How concerned are you about your liver disease?
0 = Not at all; 10 = Extremely concerned
Coherence	8.0 (0-10)	8 (3-10)	8 (0-10)	7 (2-9)	0.014
How well do you feel you understand your liver disease?
0 = Don’t understand at all; 10 = Understand very clearly
Emotional Representation	4.9 ± 3.4	4.7 ± 3.2	5.1 ± 3.9	4.7 ± 3.1	0.874
How much does your liver disease affect you emotionally?
0 = Not at all; 10 = Extremely affected emotionally

Normally distributed data presented as mean ± SD and analysed using one-way ANOVA. Non-normally distributed data presented as median group score and (range) and analysed using the Kruskal-Wallis H Test.

Table 4 Health-related quality of life in patients with high, medium and low medication adherence

Quality of life domains	All patients(n = 100)	Medication adherence ranking			P value
		High	Medium	Low
		(n = 42)	(n = 37)	(n = 21)
Abdominal symptoms	4.7 ± 1.5	4.6 ± 1.4	5.1 ± 1.4	4.2 ± 1.6	0.063
Abdominal bloating	4.5 ± 2.0	4.3 ± 2.0	4.9 ± 1.8	3.9 ± 2.1	0.109
Abdominal pain	4.9 ± 1.8	4.8 ± 1.7	5.5 ± 1.5	4.1 ± 2.2	0.023
Abdominal discomfort	4.4 ±1.8	4.7 ± 1.8	4.9 ± 1.7	4.6 ± 1.9	0.715
Activity	4.5 ± 1.5	4.6 ± 1.6	4.5 ± 1.3	4.1 ± 1.5	0.377
Not been able to eat as much as you would like	5.1 ± 1.9	5.0 ± 2.0	5.2 ± 1.6	5.0 ± 2.0	0.814
Trouble lifting or carrying heavy objects	3.4 ± 2.1	3.8 ± 2.3	3.3 ± 1.9	2.5 ± 1.9	0.067
Bothered by a limitation of your diet	5.0 ± 1.9	5.0 ± 1.9	5.0 ± 2.0	4.7 ± 2.1	0.824
Emotion	4.3 ± 1.5	4.7 ± 1.3	4.3 ± 1.7	3.7 ± 1.3	0.050
Anxiety	4.4 ± 1.9	4.8 ± 1.6	4.3 ± 2.1	3.8 ± 1.8	0.126
Unhappiness	4.5 ± 1.9	4.8 ± 1.9	4.6 ± 2.1	3.8 ± 1.3	0.125
Irritability	4.7 ± 1.7	5.0 ± 1.6	4.9 ± 1.8	3.8 ± 1.4	0.017
Difficulty sleeping at night	3.6 ± 2.2	4.0 ± 2.1	3.4 ± 2.3	3.1 ± 2.2	0.259
Mood swings	4.7 ± 1.9	5.1 ± 1.7	4.7 ± 2.1	3.8 ± 1.7	0.031
Unable to fall asleep at night	3.9 ± 2.3	4.1 ± 2.3	3.7 ± 2.3	3.7 ± 2.3	0.687
Felt depressed	4.6 ± 1.9	5.1 ± 1.8	4.5 ± 2.1	3.9 ± 1.6	0.058
Problems concentrating	4.3 ± 1.9	4.5 ± 2.0	4.5 ± 1.9	3.7 ± 1.9	0.232
Fatigue	3.2 ± 1.5	3.5 ± 1.6	3.3 ± 1.5	2.9 ± 1.3	0.340
Tired or fatigued	3.0 ± 1.6	3.0 ± 1.6	3.1 ± 1.7	2.7 ± 1.4	0.622
Sleepy during the day	3.2 ± 1.8	3.3 ± 1.9	3.5 ± 2.0	2.7 ± 1.2	0.255
Bothered by having decreased strength	3.6 ± 2.0	3.9 ± 2.0	3.4 ± 2.0	3.1 ± 2.0	0.281
Decreased level of energy	3.0 ± 1.8	3.2 ± 1.7	2.9 ± 1.8	2.6 ± 1.6	0.361
Drowsiness	3.9 ± 1.7	4.1 ± 1.8	3.8 ± 1.7	3.6 ± 1.6	0.466
Systemic symptoms	4.3 ± 1.3	4.3 ± 1.2	4.4 ± 1.4	4.0 ± 1.5	0.519
Bodily pain	4.2 ± 2.0	4.2 ± 1.8	4.7 ± 2.2	3.3 ± 2.0	0.037
Shortness of breath	4.5 ± 1.9	5.0 ± 1.8	4.4 ± 1.9	3.7 ± 1.8	0.030
Muscle cramps	4.2 ± 1.9	4.2 ± 2.0	4.1 ± 1.7	4.2 ± 2.2	0.957
Dry mouth	3.9 ± 2.0	4.0 ± 2.0	3.9 ± 2.0	3.7 ± 1.9	0.833
Itching	4.5 ± 2.1	4.2 ± 2.2	4.6 ± 2.0	5.0 ± 2.1	0.392
Worry	3.9 ± 1.8	4.1 ± 1.8	3.8 ± 2.0	3.6 ± 1.6	0.491
Worry about impact of liver disease has on family/friends	3.9 ± 2.1	4.0 ± 2.0	3.9 ± 2.2	3.7 ± 2.2	0.876
Worried that symptoms will develop into major problems	3.7 ± 2.1	4.0 ± 2.1	3.6 ± 2.2	3.1 ± 2.0	0.357
Worry about condition getting worse	3.9 ± 2.0	4.1 ± 2.0	3.7 ± 2.1	3.6 ± 2.0	0.569
Worry about never feeling any better	4.2 ± 2.2	4.5 ± 2.2	4.2 ± 2.3	3.8 ± 1.8	0.436

Normally distributed data presented as mean ± SD and analysed using one-way ANOVA. Item scores range from 1 to 7 where a lower score indicates lower quality of life (i.e., more frequent symptoms). Domain scores (range from 1 to 7) are calculated averages of items within the domain

Table 5 Crude and multivariable predictors of low medication adherence in patients with decompensated cirrhosis

		Crude		¹Multivariable		P value
		OR	95%CI	OR	95%CI	P value
Age ≥ 60 yr		1.20	0.46-3.16	1.79	0.56-5.70	0.325
Gender, male		1.10	0.40-3.04	0.74	0.21-2.58	0.639
Unable to afford medicines		1.85	0.60-5.66	0.88	0.25-3.44	0.857
N-C Differential	≤ 5	4.79	1.74-13.25	3.66	1.18-11.40	0.025
Overuse	≥ 13	1.69	0.59-4.86	0.85	0.23-3.15	0.813
Brief IPQ- treatment control	≤ 8	3.63	1.21-10.88	3.23	0.92-11.39	0.068
Brief IPQ- coherence	≤ 8	13.62	1.74-106.62	8.15	0.98-67.78	0.052
CLDQ-bodily pain (3)	QoL score ≤ 3	2.72	1.02-7.27	1.69	0.54-5.35	0.369
CLDQ-abdominal pain (5)	QoL score ≤ 3	4.19	1.45-12.09	1.73	0.50-6.05	0.389
CLDQ-shortness of breath (6)	QoL score ≤ 3	3.93	1.44-10.71	3.87	1.22-12.25	0.022
CLDQ-irritability (15)	QoL score ≤ 3	3.12	1.08-9.04	1.70	0.47-6.11	0.416
CLDQ-mood swings (19)	QoL score ≤ 3	2.09	0.75-5.82	0.93	0.24-3.58	0.917

¹Odds ratio adjusted for N-C Differential ≤ 5, Brief IPQ-treatment control score ≤ 8, Brief IPQ-coherence score ≤ 8 and CLDQ-shortness of breath score ≤ 3 (indicative of experiencing the symptom “all the time”, “most of the time” or “a good bit of the time”) in the multivariable logistic regression model.

Citation: Hayward KL, Valery PC, Martin JH, Karmakar A, Patel PJ, Horsfall LU, Tallis CJ, Stuart KA, Wright PL, Smith DD, Irvine KM, Powell EE, Cottrell WN. Medication beliefs predict medication adherence in ambulatory patients with decompensated cirrhosis. World J Gastroenterol 2017; 23(40): 7321-7331
URL: https://www.wjgnet.com/1007-9327/full/v23/i40/7321.htm
DOI: https://dx.doi.org/10.3748/wjg.v23.i40.7321