The roles of past behavior and health beliefs in predicting medication adherence to a statin regimen

Todd D Molfenter, Abhik Bhattacharya, David H Gustafson, Todd D Molfenter, Abhik Bhattacharya, David H Gustafson

Abstract

Purpose: Current medication-adherence predictive tools are based on patient medication-taking beliefs, but studying past behavior may now be a more explanatory and accessible method. This study will evaluate if past medication-refill behavior for a statin regimen is more predictive of medication adherence than patient medication-taking health beliefs.

Patients and methods: This prospective longitudinal study was implemented in a national managed care plan in the United States. A group of 1433 statin patients were identified and followed for 6 months. Medication-taking health beliefs, collected from self-reported mail questionnaires, and past medication-refill behavior, using proportion of days covered (PDC), were collected prior to 6-month follow-up. Outcomes were measured using categorical PDC variable (of adherence, PDC ≥ 85%, versus nonadherence, PDC < 85%), with model fit estimated using receiver operator characteristic analysis.

Results: The area under the receiver operator characteristic curve for past behavior (A(z) = 0.78) was significantly greater (P < 0.05) than for patient health beliefs (A(z) = 0.69), indicating that past prescription-refill behavior is a better predictor of medication adherence than prospective health beliefs. Among health beliefs, the factor most related to medication adherence was behavioral intent (odds ratio, 5.12; 95% confidence interval, 1.84 to 15.06). The factor most strongly related to behavioral intent was impact of regimen on daily routine (odds ratio, 3.3; 95% confidence interval, 1.41 to 7.74).

Conclusion: Electronic medical records and community health-information networks may make past prescription-refill rates more accessible and assist physicians with managing medication-regimen adherence. Health beliefs, however, may still play an important role in influencing medication-taking behaviors.

Keywords: habit; health beliefs; medication adherence.

Figures

Figure 1
Figure 1
Receiver operator characteristic (ROC) curves illustrating the predictive accuracy of beliefs and past behavior for medication adherence.

References

    1. World Health Organization . The Global Burden of Disease: 2004 Update. Geneva, Switzerland: WHO Press; 2008.
    1. Stampfer MJ, Krauss RM, Ma J, et al. A prospective study of triglyceride level, low-density lipoprotein particle diameter, and risk of myocardial infarction. JAMA. 1996;276(11):882–888.
    1. Manninen V, Tenkanen L, Koskinen P, et al. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment. Circulation. 1992;85(1):37–45.
    1. [homepage on the Internet] Drug therapy for cholesterol. Dallas, TX: American Heart Association, Inc; 2012. [updated June 14, 2012]. Available from: . Accessed July 25, 2011.
    1. Cholesterol Treatment Trialists’ Collaboration (CTT) Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366(9493):1267–1278.
    1. Huser MA, Evans TS, Berger V. Medication adherence trends with statins. Adv Ther. 2005;22(2):163–171.
    1. Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA. 2002;288(4):462–467.
    1. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009;119(23):3028–3035.
    1. LaRosa JH, LaRosa JC. Enhancing drug compliance in lipid-lowering treatment. Arch Fam Med. 2000;9(10):1169–1175.
    1. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331–342.
    1. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.
    1. Svarstad BI, Chewning BA, Sleath BL, Claesson C. The brief medication questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999;37(2):113–124.
    1. McHorney CA. The adherence estimator: a brief, proximal screener for patient propensity to adhere to prescription medications for chronic disease. Curr Med Res Opin. 2009;25(1):215–238.
    1. Mahler C, Hermann K, Horne R, et al. Assessing reported adherence to pharmacological treatment recommendations. Translation and evaluation of the Medication Adherence Report Scale (MARS) in Germany. J Eval Clin Pract. 2010;16(3):574–579.
    1. Rosenstock IM. The health belief model and preventive health behavior. Health Educ Monogr. 1974;2:354–386.
    1. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):33–48.
    1. Ajzen I, Fishbein M. Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1980.
    1. Ajzen I. From intention to actions: a theory of planned behavior. In: Kuhl J, Beckmann J, editors. Action-control: From Cognition to Behaviour. Heidelberg: Springer; 1985. pp. 11–39.
    1. O’Carroll R, Whittaker J, Hamilton B, Johnston M, Sudlow C, Dennis M. Predictors of adherence to secondary preventive medication in stroke patients. Ann Behav Med. 2010;41(3):383–390.
    1. Mann DM, Allegrante JP, Natarajan S, Halm EA, Charlson M. Predictors of adherence to statins for primary prevention. Cardiovasc Drugs Ther. 2007;21(4):311–316.
    1. Ellis JJ, Erickson SR, Stevenson JG, Bernstein SJ, Stiles RA, Fendrick AM. Suboptimal statin adherence and discontinuation in primary and secondary prevention populations. J Gen Intern Med. 2004;19(6):638–645.
    1. Bosworth HB. Improving Patient Treatment Adherence: A Clinician’s Guide. New York: Springer; 2010.
    1. Doshi JA, Zhu J, Lee BY, Kimmel SE, Volpp KG. Impact of a prescription copayment increase on lipid-lowering medication adherence in veterans. Circulation. 2009;119(3):390–397.
    1. Zolnierek KBH, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–834.
    1. DiMatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol. 2004;23(2):207–218.
    1. Johnson VR, Jacobson KL, Gazmararian JA, Blake SC. Does social support help limited-literacy patients with medication adherence? A mixed methods study of patients in the Pharmacy Intervention for Limited Literacy (PILL) study. Patient Educ Couns. 2010;79(1):14–24.
    1. McGinnis B, Olson KL, Magid D, et al. Factors related to adherence to statin therapy. Ann Pharmacother. 2007;41(11):1805–1811.
    1. Kaplan SH, Greenfield S, Ware JE., Jr Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(3):110–127.
    1. Cegala DJ, Marinelli T, Post D. The effects of patient communication skills training on compliance. Arch Fam Med. 2000;9(1):57.
    1. Martin LR, Di Matteo MR, Lepper HS. Facilitation of patient involvement in care: development and validation of a scale. Behav Med. 2001;27(3):111–120.
    1. Greenfield S, Kaplan S, Ware JE. Expanding patient involvement in care. Ann Intern Med. 1985;102(4):520–528.
    1. DiMatteo MR. Enhancing patient adherence to medical recommendations. JAMA. 1994;271(1):79–83.
    1. Maly RC, Leake B, Frank JC, DiMatteo MR, Reuben DB. Implementation of consultative geriatric recommendations: the role of patient–primary care physician concordance. J Am Geriatr Soc. 2002;50(8):1372–1380.
    1. James M, Turner DA, Broadbent DM, Vora J, Harding SP. Cost effectiveness analysis of screening for sight threatening diabetic eye disease. Br Med J. 2000;320:1627–1631.
    1. Divertie V. Strategies to promote medication adherence in children with asthma. MCN Am J Matern Child Nurs. 2002;27(1):10–18.
    1. Stevens VJ, Glasgow RE, Toobert DJ, Karanja N, Smith KS. One-year results from a brief, computer-assisted intervention to decrease consumption of fat and increase consumption of fruits and vegetables. Am J Health Promo. 2002;16(3):129–134.
    1. Sykes TA, Venkatesh V, Rai A. Explaining physicians’ use of EMR systems and performance in the shakedown phase. J Am Med Inform Assn. 2011;18(2):125–130.
    1. Schectman JM, Schorling JB, Nadkarni MM, Voss JD. Determinants of physician use of an ambulatory prescription expert system. Int J Med Inf. 2005;74(9):711–717.
    1. Ouellette JA, Wood W. Habit and intention in everyday life: the multiple processes by which past behavior predicts future behavior. Psychol Bull. 1998;124(1):54–74.
    1. Aarts H, Dijksterhuis A. Habits as knowledge structures: automaticity in goal-directed behavior. J Pers Soc Psychol. 2000;78(1):53–63.
    1. Bamberg S, Ajzen I, Schmidt P. Choice of travel mode in the theory of planned behavior: the roles of past behavior, habit, and reasoned action. Basic Appl Soc Psych. 2003;25(3):175–187.
    1. Levin AM, Dato-on MC, Manolis C. Deterring illegal downloading: the effects of threat appeals, past behavior, subjective norms, and attributions of harm. J Consum Behav. 2007;6(2–3):111–122.
    1. Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002;288(4):455–461.
    1. Jonikas MA, Mandl KD. Surveillance of medication use: early identification of poor adherence. J Am Med Inform Assoc. Epub 2011 Nov 19.
    1. Tamblyn R, Reidel K, Huang A, et al. Increasing the detection and response to adherence problems with cardiovascular medication in primary care through computerized drug management systems: a randomized controlled trial. Med Decis Making. 2010;30(2):176–188.
    1. Choo PW, Rand CS, Inui TS, et al. Validation of patient reports, automated pharmacy records, and pill counts with electronic monitoring of adherence to antihypertensive therapy. Med Care. 1999;37(9):846–857.
    1. Hess LM, Raebel MA, Conner DA, Malone DC. Measurement of adherence in pharmacy administrative databases: a proposal for standard definitions and preferred measures. Ann Pharmacother. 2006;40(7/8):1280–1288.
    1. Gustafson DH, Johnson PR, Molfenter TD, Patton T, Shaw BR, Owens BH. Development and test of a model to predict adherence to a medical regimen. J Pharm Technol. 2001;17(5):198–208.
    1. Ajzen I. Residual effects of past on later behavior: habituation and reasoned action perspectives. Pers Soc Psychol Rev. 2002;6(2):107–122.
    1. Wetzels G, Nelemans P, Schouten J, van Wijk B, Prins M. All that glisters is not gold: a comparison of electronic monitoring versus filled prescriptions – an observational study. BMC Health Serv Res. 2006;6(1):8.
    1. DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40(9):794–811.
    1. Monane M, Bohn RL, Gurwitz JH, Glynn RJ, Levin R, Avorn J. Compliance with antihypertensive therapy among elderly Medicaid enrollees: the roles of age, gender, and race. Am J Public Health. 1996;86(12):1805–1808.
    1. Simpson SH, Johnson JA, Farris KB, Tsuyuki RT. Development and validation of a survey to assess barriers to drug use in patients with chronic heart failure. Pharmacotherapy. 2002;22(9):1163–1172.
    1. Steiner JF, Prochazka AV. The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol. 1997;50(1):105–116.
    1. Valenstein M, Copeland LA, Blow FC, et al. Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission. Med Care. 2002;40(8):630–639.
    1. Christensen DB, Williams B, Goldberg HI, Martin DP, Engelberg R, LoGerfo JP. Assessing compliance to antihypertensive medications using computer-based pharmacy records. Med Care. 1997;35(11):1164–1170.
    1. McNeil BJ, Hanley JA. Statistical approaches to the analysis of receiver operating characteristic (ROC) curves. Med Decis Making. 1984;4(2):137–150.
    1. Rice ME, Harris GT. Comparing effect sizes in follow-up studies: ROC area, Cohen’s d, and r. Law Hum Behav. 2005;29(5):615–620.
    1. Beech AR, Craig LA, Browne KD, editors. Assessment and Treatment of Sex Offenders: A Handbook. UK: Wiley-Blackwell; 2009.
    1. Bultman DC, Svarstad BL. Effects of pharmacist monitoring on patient satisfaction with antidepressant medications therapy. J Am Pharm Assoc. 2002;42(1):36–43.
    1. Buntin MB, Jain AK, Mattke S, Lurie N. Who gets disease management? J Gen Intern Med. 2009;24(5):649–655.
    1. Mattke S, Seid M, Ma S. Evidence for the effect of disease management: is $1 billion a year a good investment? Am J Manag Care. 2007;13(12):670–676.
    1. Verplanken B, Orbell S. Reflections on past behavior: a self-report index of habit strength. J Appl Soc Psychol. 2003;33(6):1313–1330.
    1. Taitel M, Jiang J, Rudkin K, Ewing S, Duncan I. The impact of pharmacist face-to-face counseling to improve medication adherence among patients initiating statin therapy. Patient Prefer Adherence. 2012;6:323–329.
    1. Courneya KS, Plotnikoff RC, Hotz SB, Birkett NJ. Social support and the theory of planned behavior in the exercise domain. Am J Health Behav. 2000;24(4):300–308.
    1. Hsiao CJ, Hing E, Socey TC, Cai B. Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2009 and Preliminary 2010 State Estimates. Hyattsville, MD: National Center for Health Statistics; 2010.
    1. Hsiao CJ, Hing E, Socey TC, Cai B. Electronic Medical Record/Electronic Health Record Systems of Office-Based Physicians: United States, 2009 and Preliminary 2010 State Estimates Health E Stat. National Center for Health Statistics, Centers for Disease Control; 2010.
    1. Kuperman GJ. Health-information exchange: why are we doing it, and what are we doing? J Am Med Inform Assoc. 2011;18:678–682.
    1. Gooch P, Roudsari A. Computerization of workflows, guidelines, and care pathways: a review of implementation challenges for process-oriented health information systems. J Am Med Inform Assoc. 2011;18:738–748.

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