Reasons for primary medication nonadherence : a systematic review and metric analysis
Sesagiri Raamkumar, Aravind
Date of Issue2018
Wee Kim Wee School of Communication and Information
Centre for Health and Sustainable Cities
Background: The behavior of medication nonadherence is distinguished into primary and secondary nonadherence. Primary nonadherence (PNA) is not as thoroughly studied as secondary nonadherence. Objective: To explore and synthesize contributing factors to PNA based on the existing body of literature. Methods: A search was performed on the PubMed, PsycINFO, CINAHL, and ScienceDirect databases to identify previously published scholarly articles that described the “factors,” “reasons,” “determinants” or “facilitators” of PNA. The alternate spelling of “nonadherence” was used as well. The effect that the articles had in the research community, as well as across social media, was also explored. Results: 22 studies met the inclusion criteria for this review. The PNA factors that the studies identified were diverse, spanning economic, social, and medical dimensions. A multilevel classification method was applied to categorize the factors into 5 broad groups—patient, medication, health care provider, health care system, and socioeconomic factors. Patient factors were reported the most. Some groups overlapped and shared a dynamic causal relationship where one group influenced the outcome of the other. Conclusions: Like all nonadherence behaviors, PNA is multifaceted with highly varied contributing factors that are closely associated with one another. Given the multidimensional nature of PNA, future intervention studies should focus on the dynamic relationship between these factor groups for more efficient outcomes.
Journal of Managed Care & Specialty Pharmacy
© 2018 Academy of Managed Care Pharmacy. This paper was published in Journal of Managed Care & Specialty Pharmacy and is made available as an electronic reprint (preprint) with permission of Academy of Managed Care Pharmacy. The published version is available at: [http://dx.doi.org/10.18553/jmcp.2018.24.8.778]. One print or electronic copy may be made for personal use only. Systematic or multiple reproduction, distribution to multiple locations via electronic or other means, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper is prohibited and is subject to penalties under law.