Cristina M Lozano-Hernández1,2,3,4, Juan A López-Rodríguez1,3,4,5,6, Francisca Leiva-Fernández3,7,8, Amaia Calderón-Larrañaga3,9,10,11, Jaime Barrio-Cortes1,4, Luis A Gimeno-Feliu3,11,12,13, Beatriz Poblador-Plou3,11,14, Isabel Del Cura-González1,3,5. 1. Research Unit, Primary Health Care Management, Madrid, Spain. 2. Interuniversity Doctoral Program in Epidemiology and Public Health, Rey Juan Carlos University, Alcorcon, Madrid, Spain. 3. Research Network in Health Services in Chronic Diseases (REDISSEC) ISCIII, Madrid, Spain. 4. Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain. 5. Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain. 6. General Ricardos Primary Health Care Centre, Madrid, Spain. 7. Multiprofessional Teaching Unit for Family and Community Care Primary Care District Málaga-Guadarhorce, Málaga, Spain. 8. Biomedical Research Institute of Malaga-IBIMA, Andalusian Health Service, Málaga, Spain. 9. Joint Action on Chronic Diseases (JA-CHRODIS) European Commission, Brussels, Belgium. 10. Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institute & Stockholm University, Stockholm, Sweden. 11. EpiChron Research Group on Chronic Diseases, Aragonese Institute of Health Sciences (IACS), IIS Aragón, Zaragoza, Spain. 12. San Pablo Primary Health Care Centre, Aragon Health Service, Zaragoza, Spain. 13. Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain. 14. Miguel Servet University Hospital, Zaragoza, Spain.
Abstract
OBJECTIVE: To estimate the prevalence of nonadherence to treatment and its relationship with social support and social context in patients with multimorbidity and polypharmacy followed-up in primary care. METHODS: This was an observational, descriptive, cross-sectional, multicenter study with an analytical approach. A total of 593 patients between 65-74 years of age with multimorbidity (≥3 diseases) and polypharmacy (≥5 drugs) during the last three months and agreed to participate in the MULTIPAP Study. The main variable was adherence (Morisky-Green). The predictors were social support (structural support and functional support (DUFSS)); sociodemographic variables; indicators of urban objective vulnerability; health-related quality of life (EQ-5D-5L-VAS & QALY); and clinical variables. Descriptive, bivariate and multivariate analyses with logistic regression models and robust estimators were performed. RESULTS: Four out of ten patients were nonadherent, 47% had not completed primary education, 28.7% had an income ≤1050 €/month, 35% reported four or more IUVs, and the average perceived health-related quality of life (HRQOL) EQ-5D-5L-VAS was 65.5. The items that measure functional support, with significantly different means between nonadherent and adherent patients were receiving love and affection (-0.23; 95%CI: -0.40;-0.06), help when ill (-0.25; 95%CI: -0.42;-0.08), useful advice (-0.20; 95%CI: -0.37;-0.02), social invitations (-0.22; 95%CI:-0.44;-0.01), and recognition (-0.29; 95%CI:-0.50;-0.08). Factors associated with nonadherence were belonging to the medium vs. low tertile of functional support (0.62; 95%CI: 0.42;0.94), reporting less than four IUVs (0.69; 95%CI: 0.46;1.02) and higher HRQOL perception (0.98; 95%CI: 0.98;0.99). CONCLUSIONS: Among patients 65-74 years of age with multimorbidity and polypharmacy, lower functional support was related to nonadherence to treatment. The nonadherence decreased in those patients with higher functional support, lower urban vulnerability and higher perceived health status according to the visual analog scale of health-related quality of life.
OBJECTIVE: To estimate the prevalence of nonadherence to treatment and its relationship with social support and social context in patients with multimorbidity and polypharmacy followed-up in primary care. METHODS: This was an observational, descriptive, cross-sectional, multicenter study with an analytical approach. A total of 593 patients between 65-74 years of age with multimorbidity (≥3 diseases) and polypharmacy (≥5 drugs) during the last three months and agreed to participate in the MULTIPAP Study. The main variable was adherence (Morisky-Green). The predictors were social support (structural support and functional support (DUFSS)); sociodemographic variables; indicators of urban objective vulnerability; health-related quality of life (EQ-5D-5L-VAS & QALY); and clinical variables. Descriptive, bivariate and multivariate analyses with logistic regression models and robust estimators were performed. RESULTS: Four out of ten patients were nonadherent, 47% had not completed primary education, 28.7% had an income ≤1050 €/month, 35% reported four or more IUVs, and the average perceived health-related quality of life (HRQOL) EQ-5D-5L-VAS was 65.5. The items that measure functional support, with significantly different means between nonadherent and adherent patients were receiving love and affection (-0.23; 95%CI: -0.40;-0.06), help when ill (-0.25; 95%CI: -0.42;-0.08), useful advice (-0.20; 95%CI: -0.37;-0.02), social invitations (-0.22; 95%CI:-0.44;-0.01), and recognition (-0.29; 95%CI:-0.50;-0.08). Factors associated with nonadherence were belonging to the medium vs. low tertile of functional support (0.62; 95%CI: 0.42;0.94), reporting less than four IUVs (0.69; 95%CI: 0.46;1.02) and higher HRQOL perception (0.98; 95%CI: 0.98;0.99). CONCLUSIONS: Among patients 65-74 years of age with multimorbidity and polypharmacy, lower functional support was related to nonadherence to treatment. The nonadherence decreased in those patients with higher functional support, lower urban vulnerability and higher perceived health status according to the visual analog scale of health-related quality of life.
Authors: Cristina M Lozano-Hernández; Juan Antonio López-Rodríguez; Milagros Rico-Blázquez; Amaia Calderón-Larrañaga; Francisca Leiva-Fernández; Alexandra Prados-Torres; Isabel Del Cura-González Journal: PLoS One Date: 2022-07-27 Impact factor: 3.752