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Medication Adherence: Expanding the Conceptual Framework
Marie Krousel-Wood1,2, Leslie S Craig1, Erin Peacock1
1Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.
American Journal of Hypertension
|March 11, 2021
Summary
Traditional interventions show modest improvements in antihypertensive medication adherence among older adults. New factors like implicit attitudes, time preferences, and structural social determinants of health are needed to improve adherence and outcomes.
Area of Science:
- Gerontology and Geriatric Medicine
- Health Services Research
- Social and Behavioral Sciences
Background:
- Interventions for antihypertensive medication adherence have yielded modest adherence improvements.
- Translating these interventions to population-level adherence and clinical outcomes in older adults remains suboptimal.
- Traditional barriers explain limited variance in medication adherence among older adults with hypertension.
Purpose of the Study:
- To evaluate traditional barriers to antihypertensive medication adherence in older adults.
- To propose an expanded conceptual framework incorporating implicit attitudes, time preferences, and structural social determinants of health (SDOH) to explain adherence variation.
- To guide interventions for sustained improvement in medication adherence and clinical outcomes.
Main Methods:
- Analysis of data from the Cohort Study of Medication Adherence among Older adults (CoSMO).
- Evaluation of traditional barriers to antihypertensive medication adherence among 1,544 older adults with hypertension.
- Assessment of adherence using pharmacy refill data (proportion of days covered) and self-reported measures (Krousel-Wood Medication Adherence Scale).
Main Results:
- Traditional barriers explained only 6.4% of variance in pharmacy refill adherence and 14.8% in self-reported adherence.
- Persistent low adherence rates highlight the need to explore additional factors beyond traditional barriers.
- Implicit attitudes, time preferences, and structural SDOH are emerging determinants potentially explaining greater adherence variation.
Conclusions:
- Traditional barriers inadequately explain medication adherence in older adults with hypertension.
- An expanded conceptual framework including implicit attitudes, time preferences, and structural SDOH is proposed.
- This framework can inform the development of more effective interventions to improve medication adherence and clinical outcomes in this population.
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