Content area
Full text
http://crossmark.crossref.org/dialog/?doi=10.1007/s10620-016-4391-z&domain=pdf
Web End = Dig Dis Sci (2017) 62:543549 DOI 10.1007/s10620-016-4391-z
http://crossmark.crossref.org/dialog/?doi=10.1007/s10620-016-4391-z&domain=pdf
Web End = ORIGINAL ARTICLE
Factors Associated with Medication Non-adherence in Patients with End-Stage Liver Disease
Selena Z. Kuo1 Marta Haftek1 Jennifer C. Lai1
Received: 14 August 2016 / Accepted: 22 November 2016 / Published online: 8 December 2016 Springer Science+Business Media New York 2016
AbstractBackground Low medication adherence is known to contribute to worse health outcomes in the general population. Aim We aimed to evaluate the medication regimen and determine the adherence levels among patients with end-stage liver disease.
Methods We measured adherence in patients awaiting liver transplantation at a single center using the 8-item Morisky Medication Adherence Scale (MMAS-8), with a score \8 classied as low adherence. Medication regimen complexity was assessed using the Medication Regimen
Complexity Index (MRCI) tool. Factors associated with low adherence were identied by logistic regression. Results Of 181 patients, 33% were female, median age was 62, and model for end-stage liver disease (MELD) score was 13. The median (IQR) number of medications was 10 (713), and the MRCI was 19 (1327). In total, 54 (30%) were high adherers, and 127 (70%) were low adherers. In total, 42% reported sometimes forgetting to take their medication and 22% reported intermittent adherence within the past 2 weeks. The most common
reasons for low adherence were: forgetfulness (27%) and side effects (14%). Compared to high adherence, low adherence was associated with higher number of medications, medication complexity, and diabetes, but lower rates of hepatocellular carcinoma and self-perceived health. In univariable logistic regression, total medication number (OR 1.08), MRCI (OR 1.04), diabetes (OR 2.38), HCC (OR 0.38), and lower self-perceived health (OR 1.37), were statistically signicant factors associated with non-adherence. In multivariate analysis, only medication number without supplements (OR 1.14) remained signicantly associated with medication non-adherence.
Conclusion A majority of patients awaiting liver transplantation demonstrated low medication adherence. Total number of medications and regimen complexity were strong correlates of low adherence. Our data underscores the need for chronic liver disease management programs to improve medication adherence in this vulnerable population.
Keywords Medication adherence Liver transplantation
End-stage liver disease MMAS-8 Medication
complexity regimen index
Introduction
Poor adherence to medication regimens adversely impacts health outcomes in many chronic conditions. In the USA,...